Epidemiology of Polypharmacy Among Family Medicine Patients at Hospital Discharge

Rohrer, James E.; Garrison, Gregory M.; Oberhelman, Sara A.; Meunier, Matthew R.

doi:10.1177/2150131912472905

Cited by 16 publications

(10 citation statements)

References 23 publications

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“…Although polypharmacy has been studied in numerous observational and interventional primary studies in the past two decades, 22 26 27 30 this important health problem still lacks a unique and precise deﬁnition. 1 7 As a consequence, all reviews performed on this subject are at risk of different types of heterogeneity due to various populations, research designs and study settings, as well as of unavoidable bias due to non-homogeneous definitions.…”

Section: Discussionmentioning

confidence: 99%

Defining polypharmacy in the elderly: a systematic review protocol

et al. 2016

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IntroductionAgeing—along with its associated physiological and pathological changes—places individuals at a higher risk of multimorbidity and treatment-related complications. Today, polypharmacy, a common and important problem related to drug use, occurs subsequent to this multimorbidity in the elderly in all populations. In recent decades, several scientific investigations have studied polypharmacy and its correlates, using different approaches and definitions, and their results have been inconclusive. Differences in definitions and approaches in these studies form a barrier against reaching a conclusion regarding the risk factors and consequences of polypharmacy. It is therefore imperative to establish an appropriate definition of polypharmacy.Methods and analysisA systematic review will be conducted using PubMed, Scopus, Web of Science, EMBASE, PsycINFO and AgeLine bibliographic databases, as well as the grey literature on polypharmacy in older adults to answer these two questions: What definitions in the literature are being used for polypharmacy in older people?, and Which definitions are more comprehensive and applicable? 2 independent reviewers will conduct the primary screening of the articles and data extraction, and eligible sources will be selected after discussing non-conformities. All extracted data from selected articles will be categorised based on the type of study participants, study design and setting, the methodological quality of primary studies and any other potential source of heterogeneity, and results will be summarised in a table, which will contain the levels of evidence and methodological quality of the included studies. The most comprehensive definition of polypharmacy will be selected from the final list of definitions through an international expert webinar.Ethics and DisseminationThis research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal.

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Section: Discussionmentioning

confidence: 99%

Defining polypharmacy in the elderly: a systematic review protocol

et al. 2016

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“…Complexity arises from age‐related changes in body composition and function, together with multiple comorbid conditions, including sensory and cognitive impairment, as well as polypharmacy . The prevalence of polypharmacy in the older population is high in all healthcare settings . A large European study showed that 51% of home care patients are taking ≥6 medications per day.…”

Section: Introductionmentioning

confidence: 99%

Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta‐analysis

Johansson

Abuzahra

Keller

et al. 2016

Brit J Clinical Pharma

185

188

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AIMThe aim of the present study was to explore the impact of strategies to reduce polypharmacy on mortality, hospitalization and change in number of drugs. METHODSSystematic review and meta-analysis: a systematic literature search targeting patients ≥65 years with polypharmacy (≥4 drugs), focusing on patient-relevant outcome measures, was conducted. We included controlled studies aiming to reduce polypharmacy. Two reviewers independently assessed studies for eligibility, extracted data and evaluated study quality. RESULTSTwenty-five studies, including 10 980 participants, were included, comprising 21 randomized controlled trials and four nonrandomized controlled trials. The majority of the included studies aimed at improving quality or the appropriateness of prescribing by eliminating inappropriate and non-evidence-based drugs. These strategies to reduce polypharmacy had no effect on all-cause mortality (odds ratio 1.02; 95% confidence interval 0.84, 1.23). Only single studies found improvements, in terms of reducing the number of hospital admissions, in favour of the intervention group. At baseline, patients were taking, on average, 7.4 drugs in both the intervention and the control groups. At follow-up, the weighted mean number of drugs was reduced (À0.2) in the intervention group but increased (+0.2) in controls. CONCLUSIONSThere is no convincing evidence that the strategies assessed in the present review are effective in reducing polypharmacy or have an impact on clinically relevant endpoints. Interventions are complex; it is still unclear how best to organize and implement them to achieve a reduction in inappropriate polypharmacy. There is therefore a need to develop more effective strategies to reduce inappropriate polypharmacy and to test them in large, pragmatic randomized controlled trials on effectiveness and feasibility. British Journal of Clinical PharmacologyBr J Clin Pharmacol (2016) 82 532-548 532

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“…Studies have proposed definitions that ranged from 5 to 16 medications. 20,21 We selected a definition of greater than 9 medications as internal quality data suggested this was a key driver for readmission in patients discharged from our institution. Therefore, our definition may not be generalized to other institutions.…”

Section: Discussionmentioning

confidence: 99%

Incorporating a Pharmacist into the Discharge Process: A Unit-Based Transitions of Care Pilot

Guffey

Honeycutt

et al. 2016

Hosp Pharm

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To evaluate the impact of a multifaceted, pharmacy-driven, unit-based transitions of care (TOC) program on all-cause 30-day readmission rates and to assess readmission rates in predefined subgroup patient populations. This prospective study included adult patients who were discharged from the pilot unit from January 5 to January 30, 2015. Patients who expired during hospitalization, left the hospital against medical advice, or transferred to another unit or nonaffiliated hospital were excluded. Possible pharmacist interventions included daily medication profile review, delivery of discharge medications to the bedside, counseling, and communication of a discharge medication list to follow-up providers. Patients had a 30-day follow-up period from the date of discharge to assess for readmission. A total of 131 patients were screened and 94 patients were included. The primary outcome evaluating 30-day readmission rates occurred in 12.8% of patients in the pilot group versus 18.8% of patients in the historical control group ( = .26). None of the patients who received all possible pharmacist interventions were readmitted. Secondary outcomes assessing readmission rates in predefined subgroup populations as well as length of stay were comparable between the 2 groups. All identified medication discrepancies were resolved prior to discharge. Readmission rates during the pilot were numerically lower but not statistically significant when compared with historical data. Enhancement of the pharmacy-driven TOC services through allocation of additional resources is in progress. Further investigation is warranted to determine the impact of a TOC pharmacist after the service is sustained.

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Epidemiology of Polypharmacy Among Family Medicine Patients at Hospital Discharge

Abstract: Drug reviews intended to reduce the rate of polypharmacy among discharged persons aged ≥65 years can be targeted at patients who have 2 or more high-risk diagnoses and at those discharged to receive personal health services either at home or in a convalescence facility.

Cited by 16 publications

References 23 publications

Defining polypharmacy in the elderly: a systematic review protocol

Defining polypharmacy in the elderly: a systematic review protocol

Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta‐analysis

Incorporating a Pharmacist into the Discharge Process: A Unit-Based Transitions of Care Pilot

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