Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug‐related problems

Abstract

What is already known about this subject • Polypharmacy has been linked to heightened risk of occurrence of drug‐related problems (DRPs) and a detrimental health outcome. • Polypharmacy has been variously defined; in research studies a commonly applied definition has been the concomitant use of five or more drugs. • The value of using a definite number of drugs as a cut‐off to describe polypharmacy as a risk factor for the occurrence of DRPs has not been validated. What this study adds • Nearly half of the patients admitted to general hospitals used five or more drugs; during the hospital stay these patients were prescribed as many new drugs as those admitted with fewer drugs. • The presence of DRPs increased approximately linearly with the number of drugs used, for the range of one to >11 drugs. • To set a strict cut‐off to identify polypharmacy and declare that using more than this number of drugs represents a potential risk for occurrence of DRPs, is of limited value in clinical practice. Aim To investigate whether polypharmacy defined as a definite number of drugs is a suitable indicator for describing the risk of occurrence of drug‐related problems (DRPs) in a hospital setting. Methods Patients admitted to six internal medicine and two rheumatology departments in five hospitals were consecutively included and followed during the hospital stay, with particular attention to medication and DRPs. Comparisons were made between patients admitted with five or more drugs and with less than five drugs. Clinical pharmacists assessed DRPs by reviewing medical records and by participating in multidisciplinary team discussions. Results Of a total of 827 patients, 391 (47%) used five or more drugs on admission. Patients admitted with five or more and less than five drugs were prescribed the same number of drugs after admission: 4.1 vs. 3.9 drugs [P = 0.4, 95% confidence interval (CI) − 0.57, 0.23], respectively. The proportion of drugs used on admission which was associated with DRPs was similar in the patient group admitted with five or more drugs and in those admitted with less than five drugs. The number of DRPs per patient increased approximately linearly with the increase in number of drugs used; one unit increase in number of drugs yielded a 8.6% increase in the number of DRPs (95% CI 1.07, 1.10). Conclusion The number of DRPs per patient was linearly related to the number of drugs used on admission. To set a strict cut‐off to identify polypharmacy and declare that using more than this number of drugs represents a potential risk for occurrence of DRPs, is of limited value when assessing DRPs in a clinical setting.

Analysis of Potential Drugs Interaction on Antihypertension Drugs Prescription in Community Health Center of Sukmajaya District in Period of June-November 2015

“…In addition, hypertension is a disease susceptible to drug interactions because they have to take their medication for lifetime and if they have other disease among their medication then the drug interaction may occur from other drug prescription [2]. These results concur with a study by Viktil et al, which concluded that a higher number of drugs taken can lead to more drug therapy problems, including drug interactions [13].…”

“…This result is coherent with Sivva et al's (2015) study in which moderate interaction cases (84.90%) were much more common than major and minor interactions. Moderate interactions may lead to changes in patient clinical status, the need for additional treatment, or the prolongation of hospital stays [13].…”

Determinants of change in polypharmacy status in Switzerland: the population-based CoLaus study

“…fixed dose combinations). [12] Changing of polypharmacy status was defined as never (no polypharmacy at baseline and follow-up); initiation (no polypharmacy at baseline but at follow-up); quitting (polypharmacy at baseline but not at follow-up) and maintaining (polypharmacy at baseline and follow-up). smoking categories (never, former, current); being physically active (yes vs. no); hypertension (never, previous and newly diagnosed); dyslipidemia (never, previous and newly diagnosed) and diabetes (never, previous and newly diagnosed).…”

Effects of Polypharmacy on Adverse Drug Reactions among Geriatric outpatients at a Tertiary Care Hospital in Karachi, A prospective cohort study.

“…Trained interviewers screened and enrolled participants on the basis of standard definition of Polypharmacy which is defined by WHO as the, ''concurrent use of five or more different prescription medications [13].'' Multiple sources like computerized medical records, patient's medical files and pharmacy prescriptions were used for data extraction to avoid any miss outs.…”