Managing Multiple Medications: What is polypharmacy?
Dave Wegman, RPh, MS
Manager, Green Tree
Pharmacy
This article was submitted by Dave Wegman to Pantagraph Health.
For additional information, please visit www.pantagraph.com
What is polypharmacy?
Polypharmacy simply
means "many drugs." It generally refers to problems that can occur when patients
take a large number of medications. It is of particular concern for the elderly,
since they make up about 13 percent of the population but account for using
around 30 percent of all prescription drugs. The elderly often experience
multiple disease states which require multiple medications, increasing the
chances for adverse reactions, drug interactions and self-medication errors.
Additionally, more medication side effects can result in even more polypharmacy,
since many medications are given to mitigate the side effects of other
medications. If you, a parent, or another loved one is taking multiple
medications, it is important to be aware of polypharmacy issues.
Polypharmacy is becoming responsible for a greater proportion of
health care problems and expenses. With an increasing population of older people
experiencing more health problems and consuming more and more prescription and
non-prescription drugs, the potential exists for the cure to be worse than the
cause. Adverse drug effects are currently the fourth leading cause of death in
the United States. The costs associated with drug-related problems are
staggering. A study done in 2001 found that costs associated with drug-related
problems in the U.S. exceed $177 billion -- more than the cost of the drugs
themselves. Another study found that for people over 65 in the United States,
more than 25 percent of hospitalizations are medication-related, and 60 percent
of those are due to adverse drug reactions or unsafe combinations of drugs.
While polypharmacy problems are usually associated with taking
too many drugs, other problems are a result of not taking medications as
prescribed or not taking them at all. Forty percent of medication-related
problems result from compliance issues, according to some estimates. The
overwhelming task of taking multiple medications several times each day often
reduces compliance with prescribed drug regimens. Needing to take more
medications and more daily doses may reinforce an individual's self-perception
of not being well and can result in a decreased desire to take medications.
The high cost of medications often results in decreased
compliance. Some patients decide to lower their drug expenditures by taking
medications less frequently. This may lead to a worsening of their condition and
higher overall medical expenses. The perceived severity of the condition may
also result in problems with compliance. People who wake up with pain or stiff
hands have obvious reasons to take their arthritis medications, whereas patients
with mild hypertension or diabetes may not feel any symptoms so they may be
inclined to skip doses.
What leads to polypharmacy?
Both patients and their
physicians can contribute to polypharmacy. Patients often imply to their
physicians that a prescription is expected when they are seen for any condition.
They also frequently do not tell the physician all the medications they are
currently taking, resulting in duplicate prescriptions or treating the effects
of one drug by prescribing another. Visiting multiple physicians and multiple
pharmacies also increases the chances for polypharmacy by reducing the ability
to track other medications.
What can be done to prevent polypharmacy?
Fortunately,
several simple steps can be taken to reduce the chances of having problems from
polypharmacy. Effective communication with your pharmacist and physician is the
first step. Learn as much as you can about each medication you take, both
over-the-counter as well as prescription drugs. Know what they are prescribed
for and what possible side effects you may experience. In general, avoid
combination products by asking your pharmacist to help you find a product just
for the symptoms you are experiencing, not for every possible symptom. Make a
list of all the medications you take and update the list after each physician
visit. Be sure your physicians and pharmacist know all the medications you take,
and periodically discuss with your physician whether each medication you are
taking is still needed. Use only one pharmacy. If you use more than one
physician, make sure each one knows what the others have prescribed. Read all
the information on the labels. Have a system to remind you which medications are
to be taken at different times throughout each day. Following a few simple steps
like these can significantly reduce the chances of experiencing problems with
polypharmacy.
Heritage Enterprises Inc.
115 W. Jefferson St., Suite 401
P.O. Box 3188 Bloomington IL 61702-3188
PH: (309) 828-4361 FAX: (309)
829-5477
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