Reducing Polypharmacy: Evidence From a Simple Quality Improvement Initiative
2012; Elsevier BV; Volume: 14; Issue: 3 Linguagem: Inglês
10.1016/j.jamda.2012.11.007
ISSN1538-9375
Autores Tópico(s)Medication Adherence and Compliance
ResumoPolypharmacy and inappropriate medical use are common and difficult problems in the long term care setting. Polypharmacy is dangerous and expensive. Of geriatric patients admitted to the hospital, 5% to 28% of admissions were because of or involved an adverse drug reaction (ADR). 1 Planton J. Edlund B.J. Strategies for reducing polypharmacy in older adults. J Gerontol Nurs. 2010; 36: 8-12 Crossref PubMed Scopus (27) Google Scholar Population studies show an increase in mortality in individuals taking 6 or more medications, with the highest risk in those taking 10 or more. 2 Jyrkka J. Enlund H. Korhonen M.J. et al. Polypharmacy status as an indicator of mortality in an elderly population. Drugs Aging. 2009; 26: 1039-1048 Crossref PubMed Scopus (246) Google Scholar , 3 Beer C. Hyde Z. Almeida O.P. et al. Quality use of medicines and health outcomes among a cohort of community dwelling older men: An observational study. Br J Clin Pharmacol. 2011; 71: 592-599 Crossref PubMed Scopus (94) Google Scholar Moreover, as the number of medications increase, the more likely is a person to experience an ADR. It has been shown that up to 13% of patients on 2 medications and 82% on 6 or more medications develop an ADR. 4 Field T.S. Gurwitz J.H. Harrold L.R. et al. Risk factors for adverse drug events among older adults in the ambulatory setting. J Am Geriatr Soc. 2004; 52: 1349-1354 Crossref PubMed Scopus (245) Google Scholar Frail elderly with increasing comorbidities are more likely to experience polypharmacy than their healthier counterparts, 5 Bronskill S.E. Gill S.S. Paterson J.M. et al. Exploring variation in rates of polypharmacy across long term care homes. J Am Med Dir Assoc. 2012; 13: 309.e15-309.e21 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar but are less likely to benefit from the medications because of their multimorbidity. 6 Fitzgerald S.P. Bean N.G. An analysis of the interactions between individual comorbidities and their treatments—implications for guidelines and polypharmacy. J Am Med Dir Assoc. 2010; 11: 475-484 Abstract Full Text Full Text PDF PubMed Scopus (88) Google Scholar In nursing homes, a cost analysis found that for every $1 spent on medications, $1.33 was spent on treating ADRs. 7 Bootman J.L. Harrison D.L. Cox E. The health care cost of drug-related morbidity and mortality in nursing facilities. Arch Intern Med. 1997; 157: 2089-2096 Crossref PubMed Google Scholar The good news is that medications can be successfully reduced without detriment to the patient, as shown in a study of 2000 nursing home residents whose medications were safely reduced by 50%. 8 Thompson J.F. McGhan W.F. Ruffalo R.L. et al. Clinical pharmacists prescribing drug therapy in a geriatric setting: Outcome of a trial. J Am Geriatr Soc. 1984; 32: 154-159 Crossref PubMed Scopus (56) Google Scholar The benefit of an interprofessional medication review in long term care was shown in Australia through a large multisite randomized controlled clinical trial. 9 Roberts M.S. Stokes J.A. King M.A. et al. Outcomes of a randomized controlled trial of a clinical pharmacy intervention in 52 nursing homes. Br J Clin Pharmacol. 2001; 51: 257-265 Crossref PubMed Scopus (197) Google Scholar Interprofessional education and written drug reviews led to less medication use, decreased cost, and improved survival over control nursing homes.
Referência(s)