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Polypharmacy

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1. Interventions to improve the appropriate use of polypharmacy for older people. Full Text available with Trip Pro

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

2018 Cochrane

2. 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

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

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

5. Polypharmacy in older patients with chronic diseases: a cross-sectional analysis of factors associated with excessive polypharmacy. Full Text available with Trip Pro

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

2018 BMC Family Practice

6. Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: A randomised controlled trial (DREAMeR-study) Full Text available with Trip Pro

Effects of a clinical medication review focused on personal goals, quality of life, and health problems in older persons with polypharmacy: A randomised controlled trial (DREAMeR-study) Clinical medication reviews (CMRs) are increasingly performed in older persons with multimorbidity and polypharmacy to reduce drug-related problems (DRPs). However, there is limited evidence that a CMR can improve clinical outcomes. Little attention has been paid to patients' preferences and needs. The aim (...) of this study was to investigate the effect of a patient-centred CMR, focused on personal goals, on health-related quality of life (HR-QoL), and on number of health problems.This study was a randomised controlled trial (RCT) performed in 35 community pharmacies and cooperating general practices in the Netherlands. Community-dwelling older persons (≥70 years) with polypharmacy (≥7 long-term medications) were randomly assigned to usual care or to receive a CMR. Randomisation was performed at the patient level

2019 EvidenceUpdates

7. Effect of Clinical Geriatric Assessments and Collaborative Medication Reviews by Geriatrician and Family Physician for Improving Health-Related Quality of Life in Home-Dwelling Older Patients Receiving Polypharmacy: A Cluster Randomized Clinical Trial (Abstract)

Effect of Clinical Geriatric Assessments and Collaborative Medication Reviews by Geriatrician and Family Physician for Improving Health-Related Quality of Life in Home-Dwelling Older Patients Receiving Polypharmacy: A Cluster Randomized Clinical Trial Polypharmacy and inappropriate drug regimens are major health concerns among older adults. Various interventions focused on medication optimization strategies have been carried out, but the effect on patient-relevant outcomes remains uncertain.To (...) , reduced dosages, and new drug regimens started in the intervention group.This study's findings indicate that, among older patients exposed to polypharmacy, clinical geriatric assessments and collaborative medication reviews carried out by a geriatrician in cooperation with the patient's FP can result in positive effects on health-related quality of life.ClinicalTrials.gov identifier: NCT02379455.

2019 EvidenceUpdates

8. Medication-related quality of life among Ethiopian elderly patients with polypharmacy: A cross-sectional study in an Ethiopia university hospital. Full Text available with Trip Pro

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

2019 PLoS ONE

9. Trends in polypharmacy and dispensed drugs among adults in the Netherlands as compared to the United States. Full Text available with Trip Pro

Trends in polypharmacy and dispensed drugs among adults in the Netherlands as compared to the United States. Polypharmacy is becoming increasingly common owing to the ageing population, which can pose problems for patients and society. We investigated the trends in polypharmacy and underlying drug groups among adults in the Netherlands from 1999 to 2014 stratified by age, and compared these with findings from the United States (US).We conducted a repeated cross-sectional study using the Dutch (...) IADB.nl prescription database. All patients aged 20 years and older in the period 1999 to 2014 were included. Polypharmacy was defined as the dispensing of five or more chronic drugs at the pharmacological subgroup level. Chi-square tests were applied to calculate the p-value for trends. Changes in prevalences were compared between the Netherlands and the US.The prevalence of polypharmacy increased from 3.1% to 8.0% (p-value for trend <0.001) over 15 years, and increased in all age groups. The highest

2019 PLoS ONE

10. Patterns of multimorbidity and polypharmacy in young and adult population: Systematic associations among chronic diseases and drugs using factor analysis. Full Text available with Trip Pro

Patterns of multimorbidity and polypharmacy in young and adult population: Systematic associations among chronic diseases and drugs using factor analysis. The objective was to identify the systematic associations among chronic diseases and drugs in the form of patterns and to describe and clinically interpret the constituted patterns with a focus on exploring the existence of potential drug-drug and drug-disease interactions and prescribing cascades.This observational, cross-sectional study (...) potential interactions among diseases and drugs, the associations found in each pattern were independently reviewed by two pharmacists and two doctors and tested against the literature and the information reported in the technical medicinal forms.Six multimorbidity-polypharmacy patterns were found in this large-scale population study, named as respiratory, mental health, cardiometabolic, endocrinological, osteometabolic, and mechanical-pain. The nature of the patterns in terms of diseases and drugs

2019 PLoS ONE

11. Trends in multimorbidity and polypharmacy in the Flemish-Belgian population between 2000 and 2015. Full Text available with Trip Pro

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

2019 PLoS ONE

12. Polypharmacy in outpatients with relapsing-remitting multiple sclerosis: A single-center study. Full Text available with Trip Pro

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

2019 PLoS ONE

13. Influence of polypharmacy on heart rate variability in older adults at the Hiroshima Atomic Bomb Survivors Recuperation Research Center, Japan. Full Text available with Trip Pro

Influence of polypharmacy on heart rate variability in older adults at the Hiroshima Atomic Bomb Survivors Recuperation Research Center, Japan. Many studies have identified the risk of polypharmacy, but physiological evidence and methods of evaluation in these studies were poor. The relationship between polypharmacy and heart rate variability in older adults remains unclear. We investigated the relationship between polypharmacy in older adults, including atomic bomb survivors, and heart rate (...) variability indices in older adults. The differences in heart rate variability indices were analyzed using six medications as a cut-off point.Participants included 36 atomic bomb survivors and 20 non-atomic bomb survivors. The mean number of medication types was 3.6±3.4 (mean±standard deviation). SDNN, TP, and VLF decreased with an increased number of medications in all participants (P<0.01). When the standard of polypharmacy was set to more than six types of medications, SDNN, TP, and VLF were

2018 PLoS ONE

14. Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016. Full Text available with Trip Pro

Prevalence and trends of polypharmacy among HIV-positive and -negative men in the Multicenter AIDS Cohort Study from 2004 to 2016. Rates of aging-related comorbidities, which require targeted medications to treat, have been shown to be increased among persons living with HIV compared with uninfected counterparts. Polypharmacy is generally defined as the concurrent use of 5 or more medications. We investigated polypharmacy prevalence for non-HIV medications over a 12-year period among HIV (...) -positive and -negative participants in the Multicenter AIDS Cohort Study. Information regarding non-HIV medication use, HIV status, age, race/ethnicity, enrollment period, and medication insurance was obtained on 3,160 participants from semiannual visits between 2004 and 2016. Polypharmacy was defined as taking 5 or more non-HIV medications since the last health care visit. Generalized estimating equation models with repeated measures were produced overall and by HIV status to examine polypharmacy

2018 PLoS ONE

15. Trends in polypharmacy over 12 years and changes in its social gradients in South Korea. Full Text available with Trip Pro

Trends in polypharmacy over 12 years and changes in its social gradients in South Korea. Polypharmacy is associated with adverse drug reactions and represents an economic burden on the health insurance system. The objective of our study was to assess the trends in polypharmacy and its associated factors in South Korea. This cross-sectional study used a nationwide sampled database between 2002 and 2013, including outpatients of all ages who received at least 1 prescription in the same period (...) . Polypharmacy was defined as the concomitant prescription of ≥6 distinct medications on a single prescription at least once without a given duration. The yearly prescribing trends were calculated and plotted. We conducted comparative analyses to identify the changes in social gradients of polypharmacy between the first 2 years, 2002‒2003, and the final 2 years, 2012‒2013. We repeated logistic regressions for pediatrics <20 years of age and adults ≥20 years of age to estimate the adjusted odds ratios (aOR

2018 PLoS ONE

16. A case study of polypharmacy management in nine European countries: Implications for change management and implementation. Full Text available with Trip Pro

A case study of polypharmacy management in nine European countries: Implications for change management and implementation. Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained.Change (...) management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation

2018 PLoS ONE

17. Defining pediatric polypharmacy: A scoping review. Full Text available with Trip Pro

Defining pediatric polypharmacy: A scoping review. Lack of consensus regarding the semantics and definitions of pediatric polypharmacy challenges researchers and clinicians alike. We conducted a scoping review to describe definitions and terminology of pediatric polypharmacy.Medline, PubMed, EMBASE, CINAHL, PsycINFO, Cochrane CENTRAL, and the Web of Science Core Collection databases were searched for English language articles with the concepts of "polypharmacy" and "children". Data were (...) extracted about study characteristics, polypharmacy terms and definitions from qualifying studies, and were synthesized by disease conditions.Out of 4,398 titles, we included 363 studies: 324 (89%) provided numeric definitions, 131 (36%) specified duration of polypharmacy, and 162 (45%) explicitly defined it. Over 81% (n = 295) of the studies defined polypharmacy as two or more medications or therapeutic classes. The most common comprehensive definitions of pediatric polypharmacy included: two or more

2018 PLoS ONE

18. Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities Full Text available with Trip Pro

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

2017 Drugs - real world outcomes

19. The composition of polypharmacy: A register-based study of Swedes aged 75 years and older. Full Text available with Trip Pro

The composition of polypharmacy: A register-based study of Swedes aged 75 years and older. Polypharmacy is common among older adults. However, little is known about the composition of polypharmacy: which are the most frequently used drugs, and how much do these drugs contribute to the overall prevalence of polypharmacy.A total of 822,619 Swedes aged ≥75 years was identified from the Total Population Register. Through record-linkage with the Swedish Prescribed Drug Register and the Social (...) Services Register we could analyze concurrent drug use in the entire population (both individuals living in the community and institution) on the 31 December 2013.The prevalence of polypharmacy (≥5 drugs) was 45%. The most frequently used drugs were cardiovascular drugs, analgesics, and psychotropics. By excluding the ten most frequently used drug classes or compounds, the prevalence of polypharmacy was reduced by 69% and 51% respectively. The majority of the users of either one of the 10 most

2018 PLoS ONE

20. Comorbidity and polypharmacy among women living with HIV in British Columbia. (Abstract)

Comorbidity and polypharmacy among women living with HIV in British Columbia. To characterize comorbid disease and medication burden among women living with HIV (WLWH) in British Columbia (BC), Canada.We examined baseline data from 267 WLWH and 276 HIV-negative females, ≥19 years, enrolled in the Children and Women: Antiretrovirals and Markers of Aging (CARMA) cohort.Self-reported demographic, medical condition, medication, vitamin, and substance exposure data were collected at baseline CARMA

2019 AIDS

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