Polypharmacy in older patients: identifying the need for support by a community pharmacist

Abstract

Background The community pharmacist is a key player in medication reviews of older outpatients. However, it is not always clear which individuals require a medication review. The objective of the present study was to identify high-priority older patients for intervention by a community pharmacist. Methods As part of their final-year placement in a community pharmacy, pharmacy students conducted 10 interviews each with older adults (aged 65 or over) taking at least five medications daily. The student interviewer also offered to examine the patient’s home medicine cabinet. An interview guide was developed by an expert group to assess the difficulties in managing and taking medications encountered by older patients. Results The 141 students interviewed a total of 1370 patients (mean age: 81.5; mean number of medications taken daily: 9.3). Of the 1370 interviews, 743 (54.2%) were performed in the patient’s home, and thus also included an examination of the home medicine cabinet. Adverse events were reported by 566 (42.0%) patients. A total of 378 patients (27.6%) reported difficulties in preparing, administering and/or swallowing medications. The inspections of medicine cabinets identified a variety of shortcomings: poorly located cabinets (in 15.0% of inspections), medication storage problems (21.7%), expired medications (40.7%), potentially inappropriate medications (15.0%), several different generic versions of the same drug (19.9%), and redundant medications (20.4%). Conclusions In a community pharmacy setting, high-priority older patients for intervention by a community pharmacist can be identified by asking simple questions about difficulties in managing, administering, taking or storing medications.

Analysis of clinical pharmacist interventions in the COVID-19 units of a French university hospital

“…Our comorbid patients were polymedicated at home: the number of home medications was 4.0 (1.0–7.3) and 6.0 (3.0–10.0) for COVID-19-positive and COVID-19-negative patients, respectively (p<0.0001), which is lower than that in the study by Beuscart et al 19 …”

<p>The Double Burden of the COVID-19 Pandemic and Polypharmacy on Geriatric Population – Public Health Implications</p>

“…The prevalence of polypharmacy is increasing, 4,6, mainly in patients above sixty-five years. [17][18][19][20][21] Multinational studies conducted showed that adults with advanced age are taking an average of 2-9 medications/day. 22 Aronson of the University of Oxford has reported that polypharmacy often advantageous and itself is not a noticeable problematic clinical issue.…”

A Descriptive Quantitative Analysis on the Extent of Polypharmacy in Recipients of Ontario Primary Care Team Pharmacist-Led Medication Reviews

“…In Canada, the province of Ontario has over 170 pharmacists integrated into primary care team settings including Family Health Teams (FHTs, or interdisciplinary group practices) and Community Health Centres (CHCs) [ 22 ]. Within these teams, pharmacists engage in many direct patient care activities including medication management, identifying adverse medication usage, and patient education, notably through the delivery of medication reviews [ 23 , 24 ]. When working in a primary care team setting, pharmacists are typically paid a salary and as such are not remunerated on a fee-for-service basis for each medication review or other professional service activities [ 25 , 26 ].…”

“…Pharmacist-led medication reviews in primary care have been shown to improve management of chronic disease and help to avoid adverse effects that result from polypharmacy [ 3 ]. Medication reviews are also known to decrease the number of drug therapy problems and inappropriate medications by altering drug dosage, formulation and regimen [ 24 ].…”