We Need to Talk: Polypharmacy
All roads lead to Pharmacy
Polypharmacy increases healthcare costs, hospitalizations, drug-drug interaction, and in some cases can even lead to death.
What is Polypharmacy?
Merriam-Webster defines polypharmacy as “the practice of administering many different medicines especially concurrently for the treatment of a single disease.”
Now that I have lived out my High School dreams let’s get into it
Polypharmacy is simply the use of multiple medications to treat one disease or using medication to counteract the side effects of another medication.
Some people also define polypharmacy as someone taking 5 medications or more.
Or is it based on the number of medications over a certain amount of time?
Has Merriam-Webster lied to us?!?! Can I trust anything anymore?!?!
As you can see, solving a problem with so many different definitions is hard. There is a great article that goes into defining what polypharmacy is. Their conclusion was…you know what I will let them tell you:
While the most commonly used definition of polypharmacy is being on five or more medicines, definitions are variable, which can cause confusion for researchers as well as clinicians in practice. Numerical definitions of polypharmacy do not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting. There is a need for an internationally agreed definition of polypharmacy. The results indicate the need for a shift towards the term ‘appropriate polypharmacy’ using a holistic approach of assessing medication use in context of comorbidities present, according to best available evidence in order to optimise health outcomes.
You’re probably thinking…”ummmmmm…great we are right where we started.
And to that, I say you are right! But, also to fix the problem you need to know what the problem is. These authors looked at 1161 articles and distilled them down to 110 to include in their paper. That is a lot of reading.
I also agree with them on shifting towards a definition that includes “appropriate polypharmacy.”
Do read the article if you are interested in this topic. It is pretty fascinating.
There are many diseases that once you get diagnosed you are started on multiple medications. For example heart failure. And if that heart failure patient has other chronic diseases, which they more than likely will, they will be above that 5 medication threshold quickly!
To me, polypharmacy is prescribing someone a calcium channel blocker (commonly used to treat high blood pressure) and then prescribing them a diuretic (water pill) to combat its side effects. I have seen it being done.
Polypharmacy is not maximizing the dose of the medication they are on and just starting them on another one.
Sometimes, it can’t be avoided. For example, in the treatment of cancer. We give our patients medications that cause nausea/vomiting, diarrhea, nerve pain, and the list goes on and on. We have no other option than to prescribe medications to combat those side effects.
As you can see as it seems like everything in healthcare the problem is very complex.
Medication Therapy Management (MTM)
This is where Medication Therapy Management (MTM) programs are so valuable. You have an expert Pharmacist (I might be a little biased) that can look at a medication list and interview the patient and then give recommendations to the patient and the physician. This is literally what we went to school for. We didn’t have any classes on how to call an insurance company, but we did have many classes on evaluating drug therapy, their side effects, and disease state management.
Most pharmacists you will meet will tell you the same thing. Patients are on WAY too many medications these days. We want to get people off their medications because that is what we are taught to do. Contrary to popular belief.
It is great to see MTM taking hold but it needs to become the standard of care. I think every clinic should have a relationship with an MTM service or employ a pharmacist that sits in their clinics. Send us your complicated hard-to-manage patients. We can decipher if they are taking their medications properly or at all. We can see if some medications can be taken off or maybe we can change to another medication. We can optimize their therapy!
But, we do need to talk about that accountant in the room. Like anything related to pharmacy, outside of the sale of medications, we do not bring in revenue. We are the blackhole that finance is trying to figure out how to cut. As a pharmacist our value to the system is prevention. How many dollars have we saved. That is how we justify our existence. And is a very stressful existence.
Insurers are starting to pay for these services now and even offering them as add-on services, but it is still not standard.
Anyone who has worked with a pharmacist can tell you how valuable we are. But that is the problem. Our value is only seen when you work with us.
We as pharmacists need to get out of the basements and from behind the counters and do what we were trained to do, and digital health is the path to that. We need to stop relying on others and go out and show what we can do!
Next time someone comes up and says “Oh, I thought you only sell drugs”
You respond with: You bring the Doctor of Pharmacy degrees of fallen pharmacists to my city steps! You insult my profession and threaten me with arbitrary metrics and flawed financial statements! Oh, I’ve chosen my words carefully, Sir/Madam. Perhaps you should have done the same.
THIS IS PHARMACY!
Ok, that might be a little overkill but you get the message!
If you have a difficult-to-manage patient or just a question about disease management reach out to an MTM service or why not just have us as part of your clinic? We are pretty swell people.
Thank you so much for your support! Please do not hesitate to reach out if you have any questions.
I hope you have a great day!