Reducing Cost by Reducing Polypharmacy: The Polypharmacy Outcomes Project

Special Considerations for Older Adults With Diabetes Residing in Skilled Nursing Facilities

“…Polypharmacy has been defined in various ways ranging from situations in which a patient takes at least five medications 29 to situations in which a patient takes at least nine medications. 30 Regardless of the exact definition used, polypharmacy is common in residents of SNFs and other long-term care settings, particularly those with diabetes, who may be taking not only glucose-lowering medications, but also agents for the treatment of hypertension, dyslipidemia, and a multitude of other possible comorbidities.…”

“…Appropriately reducing polypharmacy when possible can help to reduce such errors and lower facilities' medication costs. 29 The key word in the previous sentence is "appropriately," because taking more than five (or nine) medications is not inherently inappropriate for particular patients who may need them. That said, streamlining residents' medication regimens to include the fewest number of medications possible can benefit both residents and the facilities in which they reside.…”

“…33,39 Hyperglycemia risks Although hypoglycemia is a major safety concern for residents with diabetes, hyperglycemia can also contribute to significant morbidity in this population. The ADA consensus report 29 recommends an A1C target of < 8.5% for many residents in long-term care facilities, including those with end-stage chronic illness, moderate to severe cognitive impairment, or two or more dependencies with regard to activities of daily living. It is important to avoid preprandial blood glucose levels > 200 mg/dl to reduce residents' risks for dehydration, electrolyte disturbances, urinary incontinence, nocturia, blurred vision, and falls that can occur secondary to excessive glycosuria.…”

“…One study of the cost of polypharmacy in a long-term care facility found that many medications could be reduced, not only saving money, but also significantly reducing polypharmacy, particularly of diabetes, central nervous system-active, and analgesic medications. 29 Although this study focused on costs, it showed that many medications, particularly those that increase fall risk, could be safely tapered, decreased, or discontinued.…”

Frailty and polypharmacy

“…Persons with cognitive decline have decreased self-management skills and this creates increased risks when they are on multiple medications (68). Reduction in polypharmacy leads to reduction in costs without creating any increase in harms (1,(69)(70)(71). We recommend that all frail older persons have their medications reviewed by a pharmacist with the ideal of reducing medications to 6 or less (72).…”