Aside from the clinically significant risks associated with polypharmacy, an increased pill burden can be unaffordable and difficult to manage.
Polypharmacy is commonly seen in adults 65 years of age and older, as the development or progression of disease states increases with age. A multitude of disease states comes with a variety of specialty providers who manage a specific condition and prescribe medications for these individual disease states.
A lack of continuity among different providers can lead to safety concerns for a patient, including but not limited to: duplicate medications, drug-drug interactions, drug-disease state interactions, and increased risk of adverse effects.1 According to the Centers for Disease Control and Prevention, between 2015 and 2018, 41.9% of adults 65 years of age and older filled prescriptions for 5 or more medications over a 30-day period.2 Aside from the clinically significant risks associated with polypharmacy, an increased pill burden can be unaffordable and difficult to manage.
The purpose of this article is to highlight the incidences of polypharmacy in the elderly and provide insight on the impact that a pharmacist had in improving patient care within an ambulatory care setting.
As an ambulatory care pharmacist in the outpatient setting, I work in a variety of different clinics, such as anticoagulation management, transitions of care, population health, senior care, and diabetes management. Polypharmacy is a common theme in all of these clinics, especially the senior care clinic, which focuses on the management of chronic disease states in patients 65 years of age and older.
In this service line, our pharmacists provide medication management and optimization through collaborative practice agreements with the patient’s primary care physician. The roles of a pharmacist include a comprehensive medication reconciliation, identifying discrepancies and providing solutions using evidence-based medicine, and implementing changes or making recommendations to best optimize care. From August 2022 through January 2023, I had the opportunity to complete 106 patient visits in the senior care clinic. I reviewed each visit to analyze the data points shown in Table 1.
Based on a review of current data, polypharmacy is identified as a patient taking 5 or more medications.3 When using this definition, 104 patients (98%) were taking 5 or more medications, with an average of 13 medications per patient. A total of 423 changes were made to the patients’ medication lists, to accurately reflect their active medications. Discrepancies such as duplicate therapy, incorrect dosing, or missing medications were identified in 80 scenarios.
Optimizing therapy during these visits is done using collaborative practice agreements or through recommendations to a patient’s provider. Table 2 provides details of the interventions that were made during these visits.
There were a total of 245 scenarios in which I recommended either initiating, discontinuing, dose adjusting, or switching therapies. It is important to highlight that there were 107 opportunities to discontinue inappropriate or unnecessary medications, which highlights the commonality of polypharmacy in this patient population.
Another common theme I have identified throughout these patient visits is the perception that OTC vitamins and supplements are not medications. As pharmacists, we know these have a strong impact on clinical outcomes by introducing potential drug-drug or drug-disease state interactions. Streamlining OTC medications is a great way to reduce pill burden in the elderly.
In summary, the impact that a pharmacist can have on decreasing the risks associated with polypharmacy is evident. Assessing medication regimens, providing extensive education, and ensuring continuity between phases of care are all services that pharmacists can provide to optimize patient care. With pharmacist intervention, we can improve patient safety while offering effective solutions to reduce polypharmacy.