Clinical medication reviews in elderly patients with polypharmacy: a cross-sectional study on drug-related problems in the Netherlands

Abstract

Background Knowledge of drug-related problems (DRPs) identified in the medication of home-dwelling elderly patients with polypharmacy has been based predominantly on medication reviews conducted in research settings rather than in daily practice. Objective To evaluate the prevalence of DRPs identified by means of a clinical medication review (CMR) and the implementation rate of proposed interventions in a large group of older patients with polypharmacy in the daily practice of community pharmacies. Setting 318 Dutch community pharmacies. Method A cross-sectional study based on CMR-data of 3807 older patients (≥65 years) with polypharmacy (≥5 drugs) completed between January and August 2012. Data were extracted from community pharmacists’ databases and entailed: year of birth, gender, dispensing data, number and nature of identified DRPs, consultations performed, proposed and implemented interventions. Main outcome measure Prevalence of DRPs, drug classes involved in overtreatment and undertreatment, and proposed and implemented interventions. Results A median of two DRPs (interquartile range 1–4; mean 3.0) was identified per patient. The DRP-categories overtreatment (25.5 %) and undertreatment (15.9 %) were found most frequently. 46.2 % of the proposed interventions to solve DRPs were implemented as proposed, in 22.4 % of cases, the intervention differed from the proposal. In 31.3 % of cases no intervention was implemented. Conclusion By conducting a CMR community pharmacists identified a median of two DRPs in older patients with polypharmacy. Overtreatment and undertreatment accounted for 41.4 % of the DRPs identified. In dealing with DRPs, pharmacists proposed a variety of interventions of which the majority (69.9 %) was either implemented or led to alternative interventions. A set of explicit criteria should be applied during a CMR to solve and prevent DRPs.

Factors associated with polypharmacy in elderly home‐care patients

“…As noted in the Introduction, Japan's public health insurance system recently began rewarding physicians with the payment of a medical adjustment fee upon their eliminating two or more medications in patients prescribed six or more oral medications. Many past studies reported a high CCI as a factor of polypharmacy . In the present study, the OR for the CCI was significant at 1.201.…”

“…The current study investigated home‐care patients, who tend to be frail with multicomorbidity, and to have low cognitive status and low physical function status. These factors have reportedly been associated with an increased risk of polypharmacy . Therefore, the background characteristics of the participants in the current study tend to increase the risk of polypharmacy.…”

“…We carried out a cross‐sectional analysis of the participants’ data at the time of the registration to determine their exposure in conjunction with the outcome of polypharmacy. The use of medications was explored in relation to potential factors in accord with previous methods . The participants’ age, sex, number of drugs, PIM, care need level, Dysphagia Severity Scale, BI, MNA‐SF, CCI, chronic conditions, pollakisuria, insomnia and constipation were included in our analyses.…”

“…Factors associated with polypharmacy also differ depending on the patients’ cultural backgrounds, their ages, healthcare systems, the number of visits to multiple medical departments, the years in which the polypharmacy studies were carried out and more . Investigations of the polypharmacy situation in Japan have been carried out in hospitalization and outpatient clinic settings, but no studies have explored the prevalence and factors of polypharmacy among home‐care patients in Japan .…”

Geriatric falls and risk factors

“…Polypharmacy (PP) also increases the prevalence of drug-related problems, such as drug-drug interactions, adverse drug reactions, prescription errors and non-adherence [10,11]. Though there is no consensus about the exact cut-off value for polypharmacy, usually it is defined as the concomitant use of more than or equal to 4-8 chronic medications [6,12,13].…”