Polypharmacy and Rational Prescribing: Changing the Culture of Medicine One Patient at a Time

Abstract

Polypharmacy and the associated concept of potentially inappropriate prescribing (PIP) have well-documented deleterious effects on older adults and other vulnerable groups commonly treated by physiatrists. Addressing the issues of polypharmacy and PIP presents an opportunity to improve health and rehabilitation outcomes. In this article, we review medications commonly initiated and managed by physiatrists such as anticoagulants, antidepressants, neuro-stimulants, and pain medications based on current evidence. We also offer strategies to minimize polypharmacy and PIP by exploring alternative and behavioral approaches to common clinical issues in rehabilitation according to the most recent guidelines. Polypharmacy is associated with a host of undesirable and potentially preventable outcomes including falls, hip fractures, delirium, incontinence, and cognitive impairments. As the number of medications increase, so does the risk of untoward effects. Physiatrists are well positioned to have a positive impact on rational prescribing and polypharmacy given our emphasis on function, familiarity with non-medication treatment modalities, and an embrace of a biopsychosocial orientation.