Many patients take medications to manage multiple chronic disease states. Clinical guidelines for these chronic diseases, such as hypertension, diabetes mellitus, chronic obstructive pulmonary disease, and heart failure, frequently include recommendations for multiple medications added in a stepwise approach. Therefore, adherence to these guidelines can quickly lead to polypharmacy. An example of this may be seen in a patient being treated for type 2 diabetes, hypertension, and dyslipidemia, which are three common comorbid disease states. If this patient is prescribed three antihypertensives, two antidiabetics, and one lipid-lowering medication, as is often seen in management of these diseases, he or she may already have achieved polypharmacy.
Can I get an amen for medication coordination?........
https://goo.gl/2T2nsBPolypharmacy, the simultaneous use of multiple medications by a single patient for one or more conditions, has become a staggering problem in the United States. From 2000 to 2008, the percentage of Americans using at least one, two, or five prescription medications in the past month increased from 44% to 48%, 25% to 31%, and 6% to 11%, respectively. Prescription-related medication problems result in an estimated 119,000 deaths annually. Polypharmacy is especially problematic for the elderly. Eight or more prescription medications are used by 30% of this population daily, with an average of 18 prescription medications taken per year. In any given year, >175,000 elderly patients will visit the emergency room because of an adverse reaction to a commonly prescribed medication.
Use of multiple healthcare providers is common for the management of chronic diseases, including a primary care physician and various specialists. While each provider is responsible for completing a thorough assessment of the whole patient, a “silo effect” may occur in prescribing (i.e., concentrating only on one disease state). Additionally, patients may fill medications at multiple community pharmacies or through a mail-order pharmacy. This may cause pharmacists to fill prescriptions without knowing the patient’s entire medication regimen. Use of multiple providers and pharmacies to manage a patient without proper interprofessional communication can lead to therapeutic duplication or prescribing of medications with significant drug-drug interactions. If patients do not have at least one single provider who knows their complete medication regimen, the risk of polypharmacy increases greatly.
Therapeutic duplication can result from prescribing by multiple providers. Duplication of medications in the same pharmacologic class or use of medications in different pharmacologic classes with similar side effects can also occur. This situation can lead to cumulative effects, as well as increased risk of adverse effect severity. If patients experience adverse effects that are unrecognized or misinterpreted by the healthcare provider, a prescribing cascade can result. For example, another drug could be inappropriately prescribed to treat a side effect that would have been alleviated by discontinuing the causative medication.