Rationalisation of polypharmacy in practice: a survey of physicians and pharmacists

Abstract

BackgroundIn the literature, polypharmacy is commonly defined as using five or more medicines. Little is known about how physicians and pharmacists define and assess polypharmacy in practice.AimThis study determined how expert physicians and pharmacists define and assess polypharmacy in practice.MethodsAn online survey was sent to 25 expert physicians and pharmacists who were chosen if they had done significant work in the area of polypharmacy through major research, clinical practice or both, to identify how experts define and assess polypharmacy in practice.ResultsTwenty‐two participants completed the survey (88% response rate). There was strong agreement between experts, including which factors are important when assessing polypharmacy (intraclass correlation coefficient = 0.94). Respondents used the number of medicines (n = 18 respondents; 56.3% of all definitions), such as five or more medicines, and brief descriptions (n = 4 respondents; 43.7% of all definitions), such as assessing appropriateness given comorbidities, to define polypharmacy. Respondents commonly indicated patient factors such as functional status (n = 11 respondents; 50%) and medicine‐related factors such as drug–drug interactions (n = 11; 50%) as important when assessing polypharmacy. Experts reported low use of externally validated polypharmacy tools during polypharmacy assessment, with 36.4% (n = 8) being unfamiliar with or never or rarely using these tools.ConclusionMedication‐ and patient‐related factors beyond a medicines count were deemed important in assessing polypharmacy. Given the low use of externally validated polypharmacy tools, strategies that include important medication‐ and patient‐related factors are required to facilitate polypharmacy rationalisation.

What Medication-Related Factors Are Important For Polypharmacy And Deprescribing Assessment By Physicians And Pharmacists Using A Novel Website To Rate Clinical Cases?

“…Our ndings provide guidance for the inclusion of other medication-related factors, including use of high risk medicines and inappropriate medication duplication when developing future polypharmacy tools and deprescribing guidelines. These results align with recent literature which has suggested to look beyond simply the number of medicines and incorporate the concept of the quality of prescribing by considering speci c types of medicines and inappropriate medication duplication to assess polypharmacy appropriateness [10,21,[28][29][30][31]. Additionally, these ndings provide guidance for identifying patients who may require a comprehensive review of their medicines such as a home medicines review (HMR) by a pharmacist [32].…”

“…Medicines which are less commonly associated with harm, namely paracetamol, vitamin D and multivitamins were also included as negative controls. These medications are usually considered to have relatively lower potential for harm and therefore, if the results indicate that these medications are not commonly associated with harm by clinicians, this would provide validation of our ndings [21]. The number of medicines within each individual medication class was identi ed using the Australian Medicines Handbook (AMH) [22].…”

“…For each case we determined a number of medication-related factors and performed univariate analysis to assess their relationship to clinician assessment of the three outcome variables. Medication-related factors were shortlisted from a systematic review of polypharmacy de nitions [10], polypharmacy assessment tools and criteria [20] and combined with ndings from a survey of clinical experts regarding medication-related factors which are important for polypharmacy rationalisation [21].…”

“…Previous studies have identi ed factors important for polypharmacy assessment through survey of the literature and surveying expert clinicians in geriatric medicine [21,33]. These factors include indications of different medicines, use of high risk medicines which have high potential for harm such as anticoagulants and insulin, drug-drug and drug-disease interactions [21,33]. These studies however did not assess how clinicians assess polypharmacy, using de-identi ed patient cases, to simulate clinical practice.…”

Predictors of unplanned hospitalisation in the older population: The role of polypharmacy and other medication and chronic disease‐related factors

“…Medication-related factors were shortlisted from a systematic review of polypharmacy definitions, tools and criteria 2,7 and combined with findings from a survey of clinical experts in medication management regarding important medication-related factors for polypharmacy rationalisation. 18 The total number of medicines used by a patient and the number of medicines within specific medicine classes which are associated with harm such as sedatives or anticholinergics were included as medication-related variables. Medicines that are less commonly associated with harm, namely paracetamol, vitamin D and multivitamins, were also included as negative controls.…”