AANP: Polypharmacy Prevention Is Responsibility of All

INDIANAPOLIS, June 26 -- Polypharmacy represents a potential problem for patients of any age, but it can be managed safely through diligence on the part of caregivers and patients.

If it isn't monitored, said Thomas W. Barkley, Jr., D.S.N., APRN-RC, coordinator of the Acute Care Nurse Practitioner Program at California State University in Los Angeles, the result is likely to be overmedication, money wasted on drugs that may not be needed, drug interactions that can lead to over- or under-dosing, and even death.

Dr. Barkley told attendees at the American Academy of Nurse Practitioners meeting here that prevention of polypharmacy -- when a patient takes three or more drugs -- is the responsibility of all involved in healthcare, including the patient.

Polypharmacy sometimes appropriate, said Barkley, such as when a patient needs multi-drug treatment to handle comorbid conditions."

One contributing factor to polypharmacy is self-medication by the patient, said Dr. Barkley. Surveys show that 73% of Americans would rather treat themselves at home than see a doctor and 96% are confident about their ability to make their own healthcare decisions.

This decreases the ability of healthcare providers to properly monitor potentially dangerous interactions.

Patients' ability to start their own regimens without input from a healthcare provider is increasing as more medications make the switch to over-the-counter (OTC) status. There are more than 700 products available OTC today that were prescription-only less than 30 years ago, said Dr. Barkley.

Elderly patients are certainly at high risk for polypharmacy -- seniors consume 34% of all prescription drugs, 33% of all over the counter drugs and 6.5 million use 1 of 33 inappropriate prescription drugs. But, the possibility should not be discounted in other patients. Patients with co-morbidities, with multiple healthcare providers, and those who use fill prescriptions at more than one pharmacy are at increased risk.

"I spend 2 minutes at the end of every interaction going back over the patient's medications," said Barkley. "I ask about everything they have ever taken to include those medications they may take sporadically, those given by other providers, and OTC or herbal preparations. 'Ever' being the keyword here."

He suggests encouraging patients and their caregivers to:

• Closely monitor the patient for any physiological or psychological changes after a change in dosage or medication.
• Keep a list of all medications along with dosage, schedules, and dates of first use.
• Never add any herbs, supplements (including vitamins), or OTC medications without first asking their healthcare provider.
• Use only one pharmacy.
• Always know the reason why each medication is needed.
• Never use medications prescribed for others.

Responsibilities for those with prescriptive authority include such interventions as prompting the patient to report on what they are using, discontinuing unnecessary medications, closely monitoring the patient following changes is dose or medications, using single dose regimens and using one drug to treat multiple problems when possible, and avoiding the use of as-needed medications.

"Consider all new medications to be therapeutic trials," said Dr. Barkley. "Tell the patient that this isn't necessarily forever, and that you will evaluate together how well it is working in a few weeks."

"Overall polypharmacy is widespread and not limited to elderly patients," he said. "The risks can be substantially diminished by close monitoring and that is the collective responsibility of all involved."