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Polypharmacy

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1. Interventions to improve the appropriate use of polypharmacy for older people. (PubMed)

Interventions to improve the appropriate use of polypharmacy for older people. Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy is a priority, hence interest in appropriate polypharmacy, where many medicines may be used to achieve better clinical outcomes for patients, is growing. This is the second update of this Cochrane Review.To determine which interventions (...) , alone or in combination, are effective in improving the appropriate use of polypharmacy and reducing medication-related problems in older people.We searched CENTRAL, MEDLINE, Embase, CINAHL and two trials registers up until 7 February 2018, together with handsearching of reference lists to identify additional studies.We included randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series. Eligible studies described interventions affecting prescribing aimed

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2018 Cochrane

2. Psychotropic polypharmacy reconsidered: Between-class polypharmacy in the context of multimorbidity in the treatment of depressive disorders. (PubMed)

Psychotropic polypharmacy reconsidered: Between-class polypharmacy in the context of multimorbidity in the treatment of depressive disorders. Both psychiatric polypharmacy and multimorbidity are common in depressed adults. We examine recent patterns of psychotropic polypharmacy with attention to concurrent multimorbidity in the treatment of depressive disorders in outpatient psychiatric care.Data from the 2006-2015 National Ambulatory Medical Care Survey offer nationally representative samples (...) of office-based psychiatric care in adults with depressive disorders (ICD-9-CM codes 296.20-296.26, 296.30-296.36, 300.4, 311, and 301.10-301.13) (n = 6,685 unweighted). These data allowed estimation of the prevalence of polypharmacy (within-class, between-class, and both) involving four major psychotropic classes: antidepressants, antipsychotics, mood-stabilizers, and sedative-hypnotics. We further evaluated the proportion of within-class and between-class psychotropic prescription combinations

2019 Journal of Affective Disorders

3. How Can You Best Address Polypharmacy in the Elderly?

How Can You Best Address Polypharmacy in the Elderly? How Can You Best Address Polypharmacy in the Elderly? – Clinical Correlations Search How Can You Best Address Polypharmacy in the Elderly? December 21, 2017 5 min read By Michael Nguyen Peer Reviewed Polypharmacy has been defined as the use of multiple unnecessary medications, the use of more medications than is clinically warranted or indicated, .[1–3] Problematic polypharmacy should be differentiated from appropriate polypharmacy (...) , with increased .[8] In the geriatric population, polypharmacy is associated with increased falls and hip fracture frequency,[10] incontinence,[11] malnutrition, and drug-drug interactions. In addition to medical complications, the pill burden of polypharmacy causes poorer adherence to prescribed medications, which can already be particularly difficult in the geriatric population, in whom cognitive impairment and memory loss are more common. Many of these adverse drug events are preventable. In the ambulatory

2018 Clinical Correlations

4. Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. (PubMed)

Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. Polypharmacy is common in older people and associated with potential harms. The aim of this study was to analyse the characteristics of an older multimorbid population with polypharmacy and to identify factors contributing to excessive polypharmacy in these patients.This cross-sectional analysis is based on the PRIMA-eDS trial, a large randomised controlled (...) multicentre study of polypharmacy in primary care. Patients' baseline data were used for analysis. A number of socioeconomic and medical data as well as SF-12-scores were entered into a generalized linear mixed model to identify variables associated with excessive polypharmacy (taking ≥10 substances daily).Three thousand nine hundred four participants were recruited. Risk factors significantly associated with excessive polypharmacy were frailty (OR 1.45; 95% CI 1.22-1.71), > 8 diagnoses (OR 2.64; 95% CI

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2018 BMC Family Practice

5. Trends in multimorbidity and polypharmacy in the Flemish-Belgian population between 2000 and 2015. (PubMed)

Trends in multimorbidity and polypharmacy in the Flemish-Belgian population between 2000 and 2015. The aim of this paper was to describe the time trends in the prevalence of multimorbidity and polypharmacy in Flanders (Belgium) between 2000 and 2015, while controlling for age and sex.Data were available from Intego, a Flemish-Belgian general practice-based morbidity registration network. The practice population between 2000 and 2015 was used as the denominator, representing a mean of 159,946 (...) people per year. Age and gender-standardised prevalence rates were used for the trends of multimorbidity and polypharmacy in the total population and for subgroups. Joinpoint regression analyses were used to analyse the time trends and breaks in trends, for the entire population as well as for specific age and sex groups.Overall, in 2015, 22.7% of the population had multimorbidity, while the overall prevalence of polypharmacy was 20%. Throughout the study period the standardised prevalence rate

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2019 PLoS ONE

6. Polypharmacy in outpatients with relapsing-remitting multiple sclerosis: A single-center study. (PubMed)

Polypharmacy in outpatients with relapsing-remitting multiple sclerosis: A single-center study. Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. Given the chronic and heterogenous nature of the disease, treatment with various therapies is a frequent scenario in clinical practice. In persons with chronic morbidity such as MS patients, polypharmacy can give rise to considerable health problems.The aim of the present study was to examine the frequency (...) of polypharmacy among relapsing-remitting (RR) MS patients as well as to analyse sociodemographic and clinical factors, which might be associated with polypharmacy (use of five or more medications). Differences in medication between MS patients with and without secondary illnesses (PwSI and Pw/oSI), between men and women and between patients with and without polypharmacy (PwP and Pw/oP) were examined.For 145 RRMS outpatients, we prospectively collected data by means of anamnesis, patient records, clinical

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2019 PLoS ONE

7. Polypharmacy for major depression: is practice evidence-based?

Polypharmacy for major depression: is practice evidence-based? Polypharmacy for major depression: is practice evidence-based? Search National Elf Service Search National Elf Service » » » » Polypharmacy for major depression: is practice evidence-based? May 22 2018 Posted by Prescriptions of are at an all-time high in England, with of antidepressants prescribed in 2016. Despite their popularity, antidepressants don’t work for everyone with major depressive disorder (MDD) and, for those who do

2018 The Mental Elf

8. Medication-related quality of life among Ethiopian elderly patients with polypharmacy: A cross-sectional study in an Ethiopia university hospital. (PubMed)

Medication-related quality of life among Ethiopian elderly patients with polypharmacy: A cross-sectional study in an Ethiopia university hospital. Polypharmacy among older patients has been associated with a decline in their quality of life. We aimed to assess the medication-related quality of life (MRQOL) among older patients with polypharmacy at Gondar University Hospital, Gondar, Ethiopia. A prospective cross-sectional study was carried out among 150 elder patients who had visited (...) the internal medicine ward and ambulatory ward of Gondar referral hospital from March 25 to May 15, 2017, using a validated scale, Medication-Related Quality of Life Scale version 1.0 (MRQoLS-v1.0). A total of 150 older patients with polypharmacy participated in the study with a mean age of 70.06±5.12, andtwo-thirds of the participants (67.3%) were female. The overall prevalence of poor quality of life due to polypharmacy in the current study was found to be three fourth (75.3%) of the participants

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2019 PLoS ONE

9. Multimorbidity and polypharmacy

Multimorbidity and polypharmacy Multimorbidity and polypharmacy Multimorbidity and polypharmacy Key therapeutic topic Published: 16 January 2017 nice.org.uk/guidance/ktt18 pathways K Ke ey points y points Multimorbidity is associated with reduced quality of life, higher mortality, polypharmacy and high treatment burden, higher rates of adverse drug events, and much greater health services use (including unplanned or emergency care). Polypharmacy in people with multimorbidity is often driven (...) implementation: Develop and agree an action plan for multimorbidity and polypharmacy to inform local medicines optimisation strategic and operational plans. Shared learning case studies are available showing how NICE guidance and standards have been put into practice by a range of NHS organisations. Encourage and support a shared decision-making approach to care: see the related NICE key therapeutic topic on shared decision making that discusses this in more detail. Develop an individualised, person-centred

2017 National Institute for Health and Clinical Excellence - Advice

10. Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities (PubMed)

Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities Research into which medications contribute to polypharmacy and the variability in these medications across long-term care facilities (LTCFs) has been minimal.Our objective was to investigate which medications were more prevalent among residents with polypharmacy and to determine the variability in prescribing of these medications across LTCFs.This was a cross-sectional study of 27 LTCFs (...) in regional and rural Victoria, Australia. An audit of the medication charts and medical records of 754 residents was performed in May 2015. Polypharmacy was defined as nine or more regular medications. Logistic regression was performed to determine the association between medications and resident characteristics with polypharmacy. Analyses were adjusted for age, sex and Charlson's comorbidity index. Variability in the use of the ten most prevalent medication classes was explored using funnel plots

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2017 Drugs - real world outcomes

11. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. (PubMed)

Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. (1) To evaluate the prevalence of polypharmacy (5-9 medicines) and excessive polypharmacy (10+ medicines) and (2) to determine associated demographic and clinical characteristics in an ageing population with intellectual disabilities (IDs).Observational cross-sectional study.Wave One (2009/2010 (...) ) of the Intellectual Disability Supplement to the Irish Longitudinal Study on Ageing (IDS-TILDA).A nationally representative sample of 753 persons with ID, aged between 41 and 90 years. Participants/proxy reported medicines (prescription and over the counter) taken on a regular basis; medication data was available for 736 participants (98%).Participants were divided into those with no polypharmacy (0-4 medicines), polypharmacy (5-9 medicines) and excessive polypharmacy (10+ medicines). Medication use patterns were

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2016 BMJ open

12. Evaluation of a collaborative care approach between general practitioners and clinical pharmacists in primary care community settings in elderly patients on polypharmacy in Slovenia: a cohort retrospective study reveals positive evidence for implementatio (PubMed)

Evaluation of a collaborative care approach between general practitioners and clinical pharmacists in primary care community settings in elderly patients on polypharmacy in Slovenia: a cohort retrospective study reveals positive evidence for implementatio The population of developed countries is aging, leading to an increase in the use of medication in daily practice, which can lead to serious treatment costs and irrational polypharmacy. A collaborative care approach, such as providing (...) medication review service provided by a clinical pharmacist (CP), is a possible way to reduce drug-related problems and irrational polypharmacy. The aim of this study was to determinate whether a CP's medication review service can improve the quality of drug prescribing in elderly patients treated with polypharmacy in primary care.In a retrospective observational medical chart review study, patients aged 65 years or more in the period 2012-2014 who received 10 or more medications concomitantly and who

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2019 BMC health services research

13. Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness. (PubMed)

Associations Between Polypharmacy, Symptom Burden, and Quality of Life in Patients with Advanced, Life-Limiting Illness. Polypharmacy may be particularly burdensome near the end of life, as patients "accumulate" medications to treat and prevent multiple diseases.To evaluate associations between polypharmacy, symptom burden, and quality of life (QOL) in patients with advanced, life-limiting illness (clinician-estimated, 1 month-1 year).Secondary analysis of baseline data from a trial of statin (...) discontinuation.Adults with advanced, life-limiting illness.Polypharmacy was assessed by summing the number of non-statin medications taken regularly or as needed. Symptom burden was assessed using the Edmonton Symptom Assessment Scale (range 0-90; higher scores indicating greater symptom burden) and QOL was assessed using the McGill QOL Questionnaire (range 0-10; higher scores indicating better QOL). Linear regression models assessed associations between polypharmacy, symptom burden, and QOL.Among 372 participants

2019 Journal of General Internal Medicine

14. Medication Appropriateness in Vulnerable Older Adults: Healthy Skepticism of Appropriate Polypharmacy. (PubMed)

Medication Appropriateness in Vulnerable Older Adults: Healthy Skepticism of Appropriate Polypharmacy. Older adults are prescribed a growing number of medications. Polypharmacy, commonly considered the receipt of five or more medications, is associated with a range of adverse outcomes. There is a debate about the reason(s) why. On one side is the assertion that older persons are being prescribed too many medications, with the number of medications increasing the risk of adverse events (...) . On the other side is the observation that polypharmacy is associated both with overprescribing of inappropriate medications and underprescribing of appropriate medications. This leads to the concept of "inappropriate" vs "appropriate" polypharmacy, with the latter resulting from the prescription of many correct medications to persons with multiple chronic conditions. Few studies have examined the health outcomes associated with adding and/or removing medications to address this debate directly

2019 Journal of the American Geriatrics Society

15. Polypharmacy, Gait Performance, and Falls in Community-Dwelling Older Adults. Results from the Gait and Brain Study. (PubMed)

Polypharmacy, Gait Performance, and Falls in Community-Dwelling Older Adults. Results from the Gait and Brain Study. Polypharmacy, defined as the use of five or more medications, has been repeatedly linked to fall incidence, and recently it was cross-sectionally associated with gait disturbances. Our objectives were to evaluate cross-sectional and longitudinal associations between polypharmacy and gait performance in a well-established clinic-based cohort study. We also assessed whether gait

2019 Journal of the American Geriatrics Society

16. Risk Factors for Polypharmacy in Elderly Patients With Cancer Pain. (PubMed)

Risk Factors for Polypharmacy in Elderly Patients With Cancer Pain. Polypharmacy (PP) is a burden in elderly patients with cancer pain; however, risk factors for PP remain unclear. The purpose of this study was to investigate the risk factors for PP in this patient population.We retrospectively reviewed the medical charts of patients aged ≥65 years with cancer pain who were treated at Osaka University Hospital between February 2014 and June 2016 according to the World Health Organization 3-step

2019 American Journal of Hospice and Palliative Medicine

17. Non-dispensing pharmacists' actions and solutions of drug therapy problems among elderly polypharmacy patients in primary care. (PubMed)

Non-dispensing pharmacists' actions and solutions of drug therapy problems among elderly polypharmacy patients in primary care. To evaluate the process of clinical medication review for elderly patients with polypharmacy performed by non-dispensing pharmacists embedded in general practice. The aim was to identify the number and type of drug therapy problems and to assess how and to what extent drug therapy problems were actually solved.An observational cross-sectional study, conducted in nine

2019 Family Practice

18. Clinical Utility of Pharmacogenetic Testing and a Clinical Decision Support Tool to Enhance the Identification of Drug Therapy Problems Through Medication Therapy Management in Polypharmacy Patients. (PubMed)

Clinical Utility of Pharmacogenetic Testing and a Clinical Decision Support Tool to Enhance the Identification of Drug Therapy Problems Through Medication Therapy Management in Polypharmacy Patients. In polypharmacy patients, medication therapy management (MTM) services provide a comprehensive review of current medications and future treatment goals. Pharmacogenetics (PGx) may further optimize the identification of potential drug therapy problems (DTPs); however, the clinical utility of PGx (...) information with a clinical decision support tool (CDST) in an MTM setting in identifying DTPs has not been systematically assessed.To assess the clinical utility of an MTM service enhanced by pharmacogenetic test results and a clinical decision support tool.This study was a post hoc analysis of the data obtained from an open-label, randomized, observational trial. Polypharmacy patients eligible for MTM service were randomly assigned to 3 intervention arms: standard MTM (SMTM), MTM incorporating CDST

2019 Journal of managed care & specialty pharmacy

19. GPs' management of polypharmacy and therapeutic dilemma in patients with multimorbidity: a cross-sectional survey of GPs in France. (PubMed)

GPs' management of polypharmacy and therapeutic dilemma in patients with multimorbidity: a cross-sectional survey of GPs in France. GPs are confronted with therapeutic dilemmas in treating patients with multimorbidity and/or polypharmacy when unfavourable medication risk-benefit ratios (RBRs) conflict with patients' demands.To understand GPs' attitudes about prescribing and/or deprescribing medicines for patients with multimorbidity and/or polypharmacy, and factors associated

2019 British Journal of General Practice

20. Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification. (PubMed)

Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification. Polypharmacy increases the risk of pharmacological interactions, prevalence of secondary effects and with this the lack of adherence to treatment. It is estimated that between 10 and 40% of patients hospitalized in psychiatric institutions are prescribed more than one antipsychotic. The objective of the present study was to identify the prevalence of polypharmacy, evaluate adverse effects (...) extrapyramidal symptoms. 81.4% of patients were prescribed 6 or more drugs (polypharmacy) and were 5 times more likely to suffer a secondary effects (OR 6.24). 14.2% had polypharmacy while receiving antipsychotics and had more than twice the risk of presenting extrapyramidal symptoms (OR 3.05). For each added psych drug, hospital stay increased by 6.56 days.Despite international guideline recommendations where reasoned and conciliatory prescription of psych drugs is advised, there is still a high prevalence

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2019 BMC Psychiatry

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