A Call for a Rational Polypharmacy Policy: International Insights From Psychiatrists

Abstract

Objective Recently, rational polypharmacy approaches have been proposed, regardless of the lower risk and cost of monotherapy. Considering monotherapy as first-line treatment and polypharmacy as rational treatment, a balanced attitude toward polypharmacy is recommended. However, the high prevalence of polypharmacy led the Japanese government to establish a polypharmacy reduction policy. Based on this, the association between the policy and psychiatrists’ attitude toward polypharmacy has been under debate.Methods We developed an original questionnaire about Psychiatrists’ attitudes toward polypharmacy (PAP). We compared the PAP scores with the treatment decision-making in clinical case vignettes. Multiple regression analyses were performed to quantify associations of explanatory variables including policy factors and PAP scores. The anonymous questionnaires were administered to psychiatrists worldwide.Results The study included 347 psychiatrists from 34 countries. Decision-making toward polypharmacy was associated with high PAP scores. Multiple regression analysis revealed that low PAP scores were associated with the policy factor (β=-0.20, p=0.004). The culture in Korea was associated with high PAP scores (β=0.34, p<0.001), whereas the culture in India and Nepal were associated with low scores (β=-0.15, p=0.01, and β=-0.17, p=0.006, respectively).Conclusion Policy on polypharmacy may influence psychiatrists’ decision-making. Thus, policies considering rational polypharmacy should be established.

A Survey Study on Clinicians’ Rationale and Attitude Towards the Prescription of Antipsychotic Polypharmacy in the East Perth Metropolitan Area in Western Australia

“…Antipsychotic medication remains the main pharmacological agent in treating psychiatric illnesses, especially schizophrenia [ 1 , 2 ], which is considered a chronically disabling condition. Its management requires immense input from clinicians and family members, not to mention the financial burden it places on the health system.…”

“…Another study was a Japanese survey conducted in Japan in 2013, highlighting prescribers’ attitudes towards APP; however, no significant outcome data were reported to support clinicians' prescribing habits [ 11 ]. Similarly, potential advocates for APP posit that the so-called "rational polypharmacy", somewhat justifies the use of APP in certain situations where a "crossover" approach is inevitable as patients switch from one medication to another and require an overlapping medication regimen [ 1 , 12 ].…”