Concept Of Polypharmacy Research Articles

The effect of polypharmacy on rheumatoid and psoriatic arthritis treatment: retrospective study.

Rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are chronic, progressive inflammatory diseases that can be accompanied by other diseases. In recent years, with the increase in the lifespan of individuals, the concept of polypharmacy has become more prominent. We aimed to show the prevalence of polypharmacy and the effects of polypharmacy on disease activity in RA and PsA. This study included PsA patients who had peripheral joint involvement and, RA patients. Since PsA has a heterogeneous clinical picture, only patients with peripheral joint involvement were included in the study and patients with inflammatory low back pain or radiological sacroiliitis or spondylitis, dactylitis or enthesitis were not included in the study due to homogeneity concerns. The numbers of medications used by the patients at the onset of their treatment and at sixth months into their treatment were recorded. Polypharmacy was accepted as the simultaneous use of at least five medications by the person. The Disease Activity Score 28 joints C-Reactive Protein (DAS-28 CRP) was used to assess disease activity for both disease. The modified Charlson Comorbidity Index (CCI) scores of the patients were calculated based on their chronic diseases. The sample of the study included 232 RA and 73 PsA patients. Polypharmacy was present at the treatment onset in 115 (49.6%) of the RA patients and 28 (38.4%) of the PsA patients. At the sixth month of treatment, polypharmacy was present in the sixth month of the treatment in 217 (93.5%) RA and 61 (83.6%) PsA patients. The mean ages of the RA and PsA patients who were receiving polypharmacy treatment at the beginning were significantly older than the mean ages of those who were not receiving polypharmacy treatment. In both the RA and PSA groups, the patients with polypharmacy at the beginning had statistically significantly higher DAS-28 CRP scores at six months of treatment than those without polypharmacy at the beginning (p<0.001). Polypharmacy was present both at the time of diagnosis and in the treatment process in the RA and PsA patients, and the presence of polypharmacy at the beginning of the treatment was among the factors that affected the treatment of these patients by significantly affecting their 6th-month DAS-28 CRP values.

Polypharmacy- Purpose, Benefits and Limitations.

With what has become increasingly common among nearly all medical specialties, the number of patients who have various comorbid diseases both psychiatrically and mentally challenges the field of psychiatry. As a result, it is not uncommon for physicians to be imposed with treatment decisions regarding polypharmacy, the use of multiple medications to treat different diseases, or even the same illness several times. In recent years, the concept of polypharmacy has been known to have a negative undertone, implying that its use is inappropriate or causes more harm than the potential benefit. Although the use of any medication should involve risk versus benefit discussion, when used with good clinical judgment and pharmacologically sound knowledge, this practice can be potentially life-altering for patients.

Combine and Conquer: With Type 2 Diabetes Polypharmacy Is Essential Not Only to Achieve Glycemic Control but Also to Treat the Comorbidities and Stabilize or Slow the Advancement of Diabetic Nephropathy.

The concept of polypharmacy in the type 2 diabetic patient is both historic and redundant. A combination of three or more medications usually at doses which are less than those utilized for monotherapy is efficacious not only in the therapy of hyperglycemia but also in the therapy of the comorbidities of hypertension and hyperlipidemia. In addition, multiple medications are now accepted as being necessary to reduce albuminuria and decelerate the decline in renal function in the patient with diabetic nephropathy.

Polypharmacy: volume or value, quantity or quality? The high quantity originates low quality. There is no adequate and valuable polypharmacy

All patients, especially elderly patients, those with certain pathologies, those with multimorbidity, or those who live in institutions, are exposed to polypharmacy. The prevalence of polypharmacy is high (18-30%) and the prevalence of excessive polypharmacy (10+ drugs) is 12%. Polypharmacy affects between 40% and 50% of all older adults. The incidence rate of polypharmacy is 20% person-years, ranging from 17% in individuals aged 65–74 years to 33% in those aged ≥95 years. From this point of view, polypharmacy seems to be a concept of quantity or volume of prescriptions. It can lead to serious adverse events related to a wide variety of drug-drug interactions (DDIs) and adverse drug reactions (ADRs): the frequency of ADR is 6% when a patient takes two medications, 50% when he takes five and almost 100% when he takes eight or more medications. Of every 100 courses of drug treatment, there are 20 adverse drug ADRs, between 5 and 25 of clinically observable DDIs and between 15 and 50 potential DDIs, which arrive to 100 in geriatric patients. But on the other hand, low-quality pharmacological care reports are not uncommon. About 60% of patients may be exposed to at least one potentially inappropriate medication: benzodiazepines, psychotropics, proton pump inhibitors, analgesics (including opiates), laxatives, NSAIDs, antacids, etc. Adverse health outcomes related to inappropriate medications for the population, and especially the elderly, include falls, strokes, delirium and death. The quantity of drugs as a defining concept of polypharmacy implies poor quality. The more drugs that are prescribed to a patient, not only there are more possibilities of inappropriate prescriptions or of little value, but even suitable prescriptions tend to lose their indication, and from a certain level of quantity or volume of prescriptions, the increase IDDs and ADRs makes their value decrease in such prescriptions, and they begin to be inappropriate and give rise to poor quality. In other words, there is no adequate and valuable polypharmacy; the high quantity originates low quality.

Polypharmacy and Adherence: Key Components of Integrated Care Findings from the SIMPATHY Project

Context, aims and objectives : As many as half of all patients with chronic conditions are using their medicines in a way that is not fully effective, resulting in sub-optimal treatment and subsequent increases in hospitalisations and emergency department visits. High levels of inappropriate prescribing further compound this problem. These issues are especially germane to older patients. Safe and effective pharmacotherapy remains one of the greatest challenges in this population, where models of healthcare delivery lag behind the enormous growth in single disease focused pharmacotherapy. The implications for safe, efficient, effective and sustainable deployment of healthcare resources are significant from both a healthcare systems and societal perspective. Integrated care models have the potential to mitigate inappropriate polypharmacy, while simultaneously diminishing problems related to poor adherence. Project SIMPATHY addresses both of these issues by aiming to stimulate and support innovation throughout the European Union regarding the management of polypharmacy and adherence in the older patient. The SIMPATHY Consortium has completed case studies in eight EU countries, providing useful insights into how different health care systems address this challenge. This workshop will present these findings, using them as a basis for discussion on the practicalities of integrating new practices into existing workflow, highlighting the opportunities that an integrated care model can provide. Target participants : Policymakers, health system administrators, managers, clinicians Proposed structure and timing : What do we mean when we say polypharmacy? How does it apply to me? Alpana Mair; Deputy Chief Pharmaceutical Officer for Scotland, Healthcare Quality and Strategy Directorate, Scottish Government Health Department Medicines management should be a key component of integrated care, affecting nearly all providers in all settings, and is paramount in the older population. However, health care providers are often faced with problems related to inappropriate management of polypharmacy and poor adherence by patients. This presentation will introduce the audience to the concept of polypharmacy and adherence, its importance, and what tools and evidence already exist to create solutions. Looking at Europe: A diverse and emerging picture of polypharmacy Jennifer McIntosh; Research Scientist at Hospital Clinic Barcelona / FCRB Building on original research undertaken by the SIMPATHY Consortium, a picture of current policies around polypharmacy in Europe has emerged. The picture is complex, with multiple economic, social, and cultural factors explaining the development of these programmes. The details of this picture provide a strong foundation for the development of future policies for appropriate management of polypharmacy. This presentation will detail the findings of 8 European case studies, showcasing current approaches polypharmacy management. _(Important: The details of each case study will be presented in a set of 8 posters that will be submitted to the conference by each institution carying out the work)_ Scaling up polypharmacy management: The Scottish success story Alpana Mair; Deputy Chief Pharmaceutical Officer for Scotland, Healthcare Quality and Strategy Directorate, Scottish Government Health Department Implementing a new programme into existing practice is one of the most challenging aspects of creating integrated health care systems. The Scottish National Health Service has achieved this by successfully developing and implementing a comprehensive polypharmacy management policy throughout their healthcare system. This programme has become a model on an international level, and is currently a reference point for the development of European wide policies to address polypharmacy in the elderly. This presentation will describe the rationale that prompted the development of the Scottish programme, unique features of the programme including leveraging national level patient data to identify patients at risk for inappropriate polypharmacy, and management strategies that facilitated the integration of the programme into daily practice on a wide scale. Polypharmacy and teamwork: The Catalan multidisciplinary experience Carles Codina; Head of Pharmacy Department at Hospital Clinic Barcelona - Consorci Hospitalari de Vic Nuria Molist; physician at the Acute Geriatrician Unit Consorci Hospitalari de Vic - Hospital Santa Creu de Vic Introducing new practices requires champions, especially in complex institutions. Although multidisciplinary teams are becoming the functional decision making unit, their implementation requires support from multiple stakeholders. Pharmacists in particular have a central role to play on these teams in developing a new understanding about the importance of appropriate polypharmacy management. This presentation will describe the development and implementation of a patient centred multidisciplinary care team, highlighting the role both the pharmacy and geriatric medicine departments played in creating a successful and sustainable programme. Facilitated discussion Albert Alonso (moderator); Innovation Directorate at Hospital Clinic Barcelona This work has been supported by the SIMPATHY project, grant agreement number 663082, co-funded by the European Commission CHAFEA Health Program

FC13-08 - Not polypharmacy, just symptomatic treatment

The concept of polypharmacy has generated much argument and this is has now come to a head with specific symposia and now a CINP thematic meeting. Briefly, those in academia, pharmacy and general adult practice tend to frown on this whereas the forensic members rely on it. Steven Stahl has even famously called it “the dirty little secret”.More recently the concept of rational polypharmacy has arisen where the clicinician can justify his prescriptions. All of this depends on treating a named condition eg schizophrenia. Indeed affective disorders are often treated with polypharmacy and many physical conditions are routinely given polypharmacy.If we assume that Kraepelin was wrong about his original assertion that there is a schism and whether other conditions are also not proven like personality disorders, then patients can simply be treated by their symptoms without a diagnosis. There are many advantages to this like the abolition of stigma but more importantly this allows the use of traditional drugs used for other conditions like lithium or anti manic agents to be used as required according to response rather than for specific diagnoses. There are other advantages eg in research and especially genetics.The presentation examines this in detail with some real life examples.

336 – Combination of new antipsychotics in the treatment-resistant schizophrenic. Approaches to the concept of polypharmacy

336 – Combination of new antipsychotics in the treatment-resistant schizophrenic. Approaches to the concept of polypharmacy