Abstract
BackgroundPolypharmacy is the administration of an excessive number of medicines and a significant irrational medicine use practice. Little is known about this practice in South Africa. This study aimed to determine the level of polypharmacy and potential drug–drug interactions amongst the geriatric patient population in a facility in South Africa.MethodA cross-sectional retrospective prescription chart review for 250 geriatric patients was conducted at the outpatient pharmacy department of a regional hospital. Variables extracted included demographic information, diagnosis, type of prescriber contact, and polypharmacy. Potential drug–drug interactions were determined with web-based multi-drug interaction checkers.ResultsThe average (SD) number of diagnosed clinical problems was 3.54 ± 1.26, with hypertension, diabetes mellitus, and heart disease occurring most frequently. The level of polypharmacy was high with patients receiving an average (SD) of 12.13 ± 4.25 prescribed medicines from 3032 prescribed medicines. The level of polypharmacy was highest within the age categories, 60–64, and 70–74 years of age, respectively. The level of potential drug–drug interactions was also high with an average (SD) of 10.30 ± 7.48 from 2570 potential drug interactions. The majority of these interactions were moderate (72.5%) and pharmacodynamic (73.2%) by nature of the clinical severity of action and mechanism of action, respectively. Polypharmacy and type of prescriber contact were statistically significant contributors to the occurrence of potential drug–drug interactions, (F (2, 249) = 68.057, p < 0.05). However, in a multivariate analysis of variables to determine the strength of the association, polypharmacy was determined to be the strongest contributor to the occurrence of potential drug–drug interactions (p < 0.05) when compared with the type of prescriber contact (p value = 0.467). Therefore, irrespective of the type of prescriber contact, polypharmacy increases the potential for drug interactions among the sampled patient population.ConclusionA comprehensive consideration of disease management guidelines, patient factors, and rational medicine review could be measurable strategies towards improving medicine use. This would also limit the occurrence of significant drug interactions among the geriatric patient population. A national study is required to determine if differences occur across hospitals and regions.
Highlights
Polypharmacy is the administration of an excessive number of medicines and a significant irrational medicine use practice
In a multivariate analysis of variables to determine the strength of the association, polypharmacy was determined to be the strongest contributor to the occurrence of potential drug–drug interactions (p < 0.05) when compared with the type of pre‐ scriber contact (p value = 0.467)
While polypharmacy can be considered beneficial in specific conditions and patient populations, among the older patient population with complex agerelated deterioration in renal and hepatic physiological functions, decreased body volume, and reduced body mass, inappropriate polypharmacy increases the risk of negative outcomes, such as adverse drug reactions (ADRs) and drug–drug interactions (DDIs) [4]
Summary
Polypharmacy is the administration of an excessive number of medicines and a significant irrational medicine use practice. While polypharmacy can be considered beneficial in specific conditions and patient populations, among the older patient population with complex agerelated deterioration in renal and hepatic physiological functions, decreased body volume, and reduced body mass, inappropriate polypharmacy increases the risk of negative outcomes, such as adverse drug reactions (ADRs) and drug–drug interactions (DDIs) [4] These outcomes are influenced by patient factors (e.g., age, gender, and patient’s physiology) and medicine use properties, such as duration of combined therapy, and can produce insignificant to potentially harmful effects which can be deleterious to a patient’s overall health and wellbeing with negative consequences, such as medicationrelated hospitalisations as well as increased morbidity and mortality [5,6,7]. With polypharmacy appearing empirically unavoidable among the geriatric patient population [14], an improved understanding of medicine use practices among geriatrics is crucial in developing countries towards reducing medicine-related harm and associated adverse health outcomes
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