Too many drugs: solutions to polypharmacy problems
As Americans take more prescription drugs and over-the-counter medications, physicians increasingly are having to cope with issues related to polypharmacy—arguably one of the most vexing prescribing issues they confront on a daily basis.
Polypharmacy, which is the practice of taking multiple medications--typically four or more—to manage a patient’s diseases and health conditions has become an increasingly alarming issue in medicine.
“Polypharmacy is driven by a combination of factors, including people living longer, the increasing prevalence of chronic diseases such as diabetes and the increasing availability of drugs to treat many of these diseases,” says internist Caleb Alexander, MD, codirector of the Johns Hopkins Center for Drug Safety and Effectiveness in Baltimore, Maryland.
Data from the National Center for Health Statistics (NCHS) show that older patients use the greatest number of prescription drugs. According to a 2015 NCHS report, from 2009 to 2012 3% of adults between the ages of 18 and 44 took five or more prescription drugs during the prior month, compared to 16% of those aged 45 to 64. Among people age 65 and over nearly 40% took five or more drugs.
Another area of concern is the use of pain relief medications. A 2013 NCHS report indicates that among people either taking pills to relieve pain or those that have developed a dependence on this class of drugs, use of prescription opioid analgesics increased 300% between 1999 and 2010. Death rates for poisonings involving opioid analgesics more than tripled between 2000 and 2010.
Physicians’ efforts to better manage polypharmacy are hampered by fragmentation of care, the lack of interoperability among electronic health record (EHR) systems, and challenges that arise as patients take supplements and other tablets that complicate their course of treatment.
The battle to cope with polypharmacy at many medical practices is overwhelming, doctors say. NCHS data back up these claims, indicating that 2.3 billion prescription and over-the-counter drugs were recorded in physician office visits in 2012.
Dealing with multiple medications
Managing polypharmacy, and ensuring that every medication a patient takes is appropriate and is not having harmful interactions with other drugs is part of a physician’s responsibility, says Nitin Damle, MD, FACP, president of the American College of Physicians. He adds that there are several steps doctors can take to keep track of their patient’s medications, including:
Making sure that practice staff follow up on any medication-relation issues. For example, when calling to remind patients of their next appointment, ask them to bring all their medications with them. This is especially important for patients on multiple medications who recently visited an emergency department, were hospitalized or spent time in a rehabilitation center.
Primary care physicians should ask patients to let them know if a specialist prescribes them any additional medication(s).
Continuously review medication regimens and confirm that there is an indication, no drug interaction and no side effects.
Trying to keep patients on the lowest dose possible and question them closely about new symptoms.
Ensuring that the patient is deriving therapeutic benefit from all drugs he or she is taking and that their benefits outweigh any side effects.
Ensuring any side effects the patient experiences are tolerable.