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Polypharmacy

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1. 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

2. Interventions to improve the appropriate use of polypharmacy for older people. (Full text)

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

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. (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

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

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

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

7. Trends in polypharmacy and dispensed drugs among adults in the Netherlands as compared to the United States. (PubMed)

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

8. Patterns of multimorbidity and polypharmacy in young and adult population: Systematic associations among chronic diseases and drugs using factor analysis. (PubMed)

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

9. 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)

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

10. 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

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

11. Defining pediatric polypharmacy: A scoping review. (Full text)

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

12. Trends in polypharmacy over 12 years and changes in its social gradients in South Korea. (Full text)

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

13. Polypharmacy in outpatients with relapsing-remitting multiple sclerosis: A single-center study. (Full text)

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

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

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

15. A systematic review of practice-based pharmacists' services to optimize medicine management in older people with multimorbidity and polypharmacy: protocol

A systematic review of practice-based pharmacists' services to optimize medicine management in older people with multimorbidity and polypharmacy: protocol Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr Smith

2019 PROSPERO

16. Effect of pharmacists' interventions on medication therapy management in older patients with polypharmacy during hospitalization: a systematic review and meta-analysis

Effect of pharmacists' interventions on medication therapy management in older patients with polypharmacy during hospitalization: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability

2019 PROSPERO

17. Polypharmacy and potentially inappropriate medication in older cancer patients: a systematic review and meta-analysis

Polypharmacy and potentially inappropriate medication in older cancer patients: a systematic review and meta-analysis Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any associated

2019 PROSPERO

18. Evidence for the impact of interventions for, and medicines reconciliation in, problematic polypharmacy: a rapid review of systematic reviews

Evidence for the impact of interventions for, and medicines reconciliation in, problematic polypharmacy: a rapid review of systematic reviews Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content

2019 PROSPERO

19. Are there evidence based strategies to guide deprescribing in children and young people with problematic polypharmacy?

Are there evidence based strategies to guide deprescribing in children and young people with problematic polypharmacy? Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submission is accurate and complete. CRD bears no responsibility or liability for the content of this registration record, any

2019 PROSPERO

20. Prevalence and Variability in Medications Contributing to Polypharmacy in Long-Term Care Facilities (Full text)

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

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