Tools to Reduce Polypharmacy

Gokula, Murthy; Holmes, Holly M.

doi:10.1016/j.cger.2012.01.011

Cited by 64 publications

(55 citation statements)

References 40 publications

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“…Similar suggestions and guidelines have been proposed by geriatric and supportive care associations 27,28,[32][33][34][35][36][37] . For those reasons, a concerted effort should be made to incorporate those recommendations into routine clinical practice for both css and elderly patients in general.…”

Section: Discussionmentioning

confidence: 99%

“…This type of practice setting has been demonstrated to improve the management of concomitant medications for patients [25][26][27] . Because of the severity of the toxicities that can result from many cancer treatments, cancer care providers might also be more vigilant in evaluating medication histories for css and thus more inclined to actively screen for pdis on a regular basis than during the management of non-cancer patients 28,29 .…”

Section: Discussionmentioning

confidence: 99%

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Potential drug interactions in patients with a history of cancer.

Chen¹,

Rai²,

Cheung³

2011

JCO

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Potential drug interactions in patients with a history of cancer.

Chen¹,

Rai²,

Cheung³

2011

JCO

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“…This work expands on analyses of individual drug prescription rates by examining co-prescription trends as a means to better understand the complexities of polypharmacy and the predicted frequency and impact of multi-drug interactions. Our co-prescription rate analyses shows that drug combinations are not simply the sum of prescribing rates for individual medications, and when combined with drug interaction data in a representative sample of the US population, can inform future prescribing, especially in lieu of recent efforts toward reducing polypharmacy as a best practice in treatment [23]. …”

Section: Discussionmentioning

confidence: 99%

Co-Prescription Trends in a Large Cohort of Subjects Predict Substantial Drug-Drug Interactions

et al. 2015

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Pharmaceutical prescribing and drug-drug interaction data underlie recommendations on drug combinations that should be avoided or closely monitored by prescribers. Because the number of patients taking multiple medications is increasing, a comprehensive view of prescribing patterns in patients is important to better assess real world pharmaceutical response and evaluate the potential for multi-drug interactions. We obtained self-reported prescription data from NHANES surveys between 1999 and 2010, and confirm the previously reported finding of increasing drug use in the elderly. We studied co-prescription drug trends by focusing on the 2009-2010 survey, which contains prescription data on 690 drugs used by 10,537 subjects. We found that medication profiles were unique for individuals aged 65 years or more, with ≥98 unique drug regimens encountered per 100 subjects taking 3 or more medications. When drugs were viewed by therapeutic class, it was found that the most commonly prescribed drugs were not the most commonly co-prescribed drugs for any of the 16 drug classes investigated. We cross-referenced these medication lists with drug interaction data from Drugs.com to evaluate the potential for drug interactions. The number of drug alerts rose proportionally with the number of co-prescribed medications, rising from 3.3 alerts for individuals prescribed 5 medications to 11.7 alerts for individuals prescribed 10 medications. We found 22% of elderly subjects taking both a substrate and inhibitor of a given cytochrome P450 enzyme, and 4% taking multiple inhibitors of the same enzyme simultaneously. By examining drug pairs prescribed in 0.1% of the population or more, we found low agreement between co-prescription rate and co-discussion in the literature. These data show that prescribing trends in treatment could drive a large extent of individual variability in drug response, and that current pairwise approaches to assessing drug-drug interactions may be inadequate for predicting real world outcomes.

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“…Multiple tools identify potentially inappropriate medications (Gokula, 2012). The Beers Criteria, developed by geriatric care experts (Beers, 1991), have been updated (Expert Panel, 2012; Fick, 2003) and validated in long-term care settings (Dedhiya, 2010; King, 2007; Ruggiero, 2010; Trygstad, 2005).…”

Section: Discussionmentioning

confidence: 99%

Combining Quality Improvement and Geriatrics Training: The Nursing Home Polypharmacy Outcomes Project

Kojima

Bell

Tamura

et al. 2014

Gerontology & Geriatrics Education

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To examine sustained effects of an educational intervention, we repeated a successful quality improvement (QI) project on medication safety and cost-effectiveness. In October 2007 and August 2008, facility leadership and geriatrics faculty identified all patients receiving ≥9 medications (polypharmacy cohort) in a 170-bed teaching nursing home and taught Geriatric Medicine fellows (n=12 in 2007, 11 in 2008) to: 1) systematically collect medication data; 2) generate medication recommendations (stop, taper, or continue) based on expert criteria (Beers Criteria) or drug-drug interaction programs; 3) discuss recommendations with patients’ attending physicians; and 4) implement approved recommendations. Over the two projects, the polypharmacy cohorts demonstrated decreased potentially inappropriate medications (odds ratio (OR) 0.78, 95% confidence interval (95%CI)0.69–0.88, p<0.001), contraindicated medications (OR=0.63, 95%CI=0.47–0.85, p=0.002) and medication costs (OR=0.97, 95%CI=0.96–0.99, p<0.001). Our findings suggest that programs planning educational QI projects for trainees may benefit from a multi-year approach to maximize both clinical and educational benefits.

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Tools to Reduce Polypharmacy

Cited by 64 publications

References 40 publications

Potential drug interactions in patients with a history of cancer.

Potential drug interactions in patients with a history of cancer.

Co-Prescription Trends in a Large Cohort of Subjects Predict Substantial Drug-Drug Interactions

Combining Quality Improvement and Geriatrics Training: The Nursing Home Polypharmacy Outcomes Project

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