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Polypharmacy and the brown bag

Discussion in 'General Issues and Discussion Forum' started by Cameron, Oct 24, 2005.

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  1. Cameron

    Cameron Well-Known Member


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    As we know the aging clientelle are prone to symtoms associated with polypharmacy. Whilst reading I was delighted to run acroos the brown bag method. An effective way to take a drug history is rather than relying on the patient's medical record, ask them to bring all of his medications with him to the next visit. A recent study found that this method produces a more accurate list of the drugs an elderly patient takes. Be sure to tell your patient to bring in all the medications, including prescription and OTC drugs, topical preparations, herbal products, vitamins, and other supplements. Also ask if he is using any medications he gets from family or friends.

    What say you?

    Cameron
     
  2. javier

    javier Senior Member

    I agree with you, but sometimes the old lady or the old sir you are asking for can have some logistic problems if he/she have to carry all drugs or preparations he/she is taking yo your office!

    Here, you can ask to his/her general practitioner for a complete list. They have only to push a button for printing a nice list. It is far more accurate since many older people can bring you the wrong medication also (they are unable to recognize what current medication they are taking now).

    Also, you can phone their pharmacy where they usually know what medication they are taking currently.

    Anyway, this is a common problem when you ask about medication to certain people. Here, it is typical the get the next reponse: "yes, I am taking the small white pills with the red line on the box, you know?"

    Regards,

    Javier
     
  3. George Brandy

    George Brandy Active Member

    Many of my patients would need a shopping trolly to bring all their medicines in or suffer a rupture carrying them. Brown paper bags tend to dissolve in the Northern climate

    I tend to opt for the repeat prescription form or a phonecall to the GP if I have any doubts at all.

    I thoroughly enjoy a good guessing game of tablets-shape, size colour, sounds like...

    GB
     
  4. Cameron

    Cameron Well-Known Member

    Javier & George

    From the research I was reading the benefits of the brown bag approach was more to do with the OTC and self medications as well as the prescribed course of pharmacy. To help obviate Polypharmcy or Hyperpharmacotherapy the authors recommend the following questions:


    1. Is each medication necessary?
    2. Is the drug contraindicated in the elderly?
    3. Are there duplicate medications?
    4. Is the patient taking the lowest effective dosage?
    5. Is the medication intended to treat the side effect of another medication?
    6. Can the drug regimen be simplified?
    7. Are there potential drug interactions?
    8. Is the patient adherent?
    9. Is the patient taking an OTC medication, an herbal product, or another person’s medication?

    Cameron
     
  5. javier

    javier Senior Member

    There are a lot of articles, studies and protocols for avoiding Polypharmcy or Hyperpharmacotherapy among elders. But, unfortunatly in a country with a socialized medicine like mine (where drugs are free for retired people) it is almost impossible to control people medication. They feel like a right to take as much pills as they want (for the enjoying of the pharmaceutical industry).

    Now, the government have engaged a national campaign for improving rational use of drugs. I dubt they will able to get results.

    Also, there is an obvious lack of time for each patient on the national health system (a common problem also on socialized medicine countries). Thus, although all the questions you propose are right, there is not enough time for asking them.

    Javier
     
  6. iain wilson

    iain wilson Welcome New Poster

    Hi Cameron
    Iain Wilson, Glasgow School 1979 - have greatly enjoyed your web articles re footwear and Australian radio programmes!
    Re Polypharmacy. Our method here is to request that all Pats. bring repeat prescription counterfoil. This generally works although we have our share of defaulters. We would absolutely insist on it if comtemplating Nail surgery, as part of the pre - op checklist, and on those occasions where there is doubt, we would contact Pat`s General Practitioner. Of more concern however is the increasing use of "Natural" products and any serious interaction with prescribed Medicines.
    Regards, Iain
     
  7. admin

    admin Administrator Staff Member

    Just stumbled on this:

    Polypharmacy

    Methylphenidat generics germany.jpg

    Polypharmacy is the concurrent use of multiple medications by a patient.[1][2][3][4] Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes.[5] About 21% of adults with intellectual disability are also exposed to polypharmacy.[6] Polypharmacy is not necessarily ill-advised, but in many instances can lead to negative outcomes or poor treatment effectiveness, often being more harmful than helpful or presenting too much risk for too little benefit. Therefore, health professionals consider it a situation that requires monitoring and review to validate whether all of the medications are still necessary. Concerns about polypharmacy include increased adverse drug reactions, drug interactions, prescribing cascade, and higher costs.[7] Polypharmacy is often associated with a decreased quality of life, including decreased mobility and cognition.[2]

    The definition of poly pharmacy is still debated. Definitions have ranged from two medications at a time to 18, or to more medications than clinically necessary. Five or more concurrent regular medications appears to be the most common definition. Despite the uncertainty around a definition, experts generally agree on the magnitude, potential for harm and potential for reduction in medication regimens for older people.[8]

    Whether or not the advantages of polypharmacy (over monotherapy) outweigh the disadvantages or risks depends upon the particular combination and diagnosis involved in any given case.[9] The use of multiple drugs, even in fairly straightforward illnesses, is not an indicator of poor treatment and is not necessarily overmedication. A perfectly legitimate treatment regimen could include, for example, the following: a statin, an ACE inhibitor, a beta-blocker, aspirin, paracetamol and an antidepressant in the first year after a myocardial infarction.[10] Moreover, it is well accepted in pharmacology that it is impossible to accurately predict the side effects or clinical effects of a combination of drugs without studying that particular combination of drugs in test subjects. Knowledge of the pharmacologic profiles of the individual drugs in question does not assure accurate prediction of the side effects of combinations of those drugs; and effects also vary among individuals because of genome-specific pharmacokinetics. Therefore, deciding whether and how to reduce a list of medications (deprescribe) is often not simple and requires the experience and judgment of a practicing physician. However, such thoughtful and wise review is an ideal that too often does not happen, owing to problems such as poorly handled care transitions (poor continuity of care, usually because of siloed information), overworked physicians, and interventionism.

    Polypharmacy continues to grow in importance because of aging populations. Many countries are experiencing a fast growth of the older population, 65 years and older.[11][12] This growth is a result of the baby-boomer generation getting older and an increased life expectancy as a result of ongoing improvement in health care services worldwide.[13][14]

    1. ^ Munger MA (Nov 2010). "Polypharmacy and combination therapy in the management of hypertens". Drugs Aging. 27: 871–83. doi:10.2165/11538650-000000000-00000. PMID 20964461. 
    2. ^ a b "Polypharmacy in Elderly Patients" (PDF). Vumc.nl. Retrieved 16 January 2015. 
    3. ^ "polypharmacy". TheFreeDictionary.com. Retrieved 16 January 2015. 
    4. ^ Stawicki, S. P.; Gerlach, A. T. (2009). "Polypharmacy and medication errors: Stop, listen, look, and analyze..." OPUS 12 Scientist. 3 (1): 6–10. 
    5. ^ Haider, SI; Johnell, K; Thorslund, M; Fastbom, J (2007). "Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992 - 2002". International Journal of Clinical Pharmacology and Therapeutics. 45 (12): 643–653. doi:10.5414/cpp45643. PMID 18184532. 
    6. ^ Haider, SI; Ansari, Z; Vaughan, L; Matters, H; Emerson, E. (2014). "Prevalence and factors associated with polypharmacy in Victorian adults with intellectual disability". Research in Developmental Disabilities. 35 (11): 3070–3080. doi:10.1016/j.ridd.2014.07.060. 
    7. ^ Haider, SI; Johnell, K; Weitoft, GR; Thorslund, M; Fastbom, J (2009). "The influence of educational level on polypharmacy and inappropriate drug use: a register-based study of more than 600,000 older people". Journal of the American Geriatrics Society. 57 (1): 62–69. doi:10.1111/j.1532-5415.2008.02040.x. PMID 19054196. 
    8. ^ Ong, Gao-Jing; Page, Amy; Caughey, Gillian; Johns, Sally; Reeve, Emily; Shakib, Sepehr (2017-06-01). "Clinician agreement and influence of medication-related characteristics on assessment of polypharmacy". Pharmacology Research & Perspectives. 5 (3). doi:10.1002/prp2.321. 
    9. ^ "When Is Polypharmacy an Advantage?". Ajp.psychiatryonline.org. Retrieved 16 January 2015. 
    10. ^ Sergi, G; De Rui, M; Sarti, S; Manzato, E (2011). "Polypharmacy in the elderly: Can comprehensive geriatric assessment reduce inappropriate medication use?". Drugs Aging. 28 (7): 509–518. doi:10.2165/11592010-000000000-00000. 
    11. ^ da Cruz, Ligiane Paula; Miranda, Patrícia Monforte Miranda; Vedana, Kelly Graziani; Miasso, Adriana Inocenti (2011). "Medication therapy: Adherence, knowledge and difficulties of elderly people from bipolar disorder" (PDF). Revista Latino-Americana De Enfermagem (RLAE). 19 (4): 944–952. doi:10.1590/S0104-11692011000400013. PMID 21876947. 
    12. ^ Gellad, Walid F.; Grenard, Jerry L.; Marcum, Zachary A. (2011). "A systematic review of barriers to medication adherence in the elderly: Looking beyond cost and regimen complexity". American Journal of Geriatric Pharmacotherapy. 9 (1): 11–23. doi:10.1016/j.amjopharm.2011.02.004. PMC 3084587Freely accessible. PMID 21459305. 
    13. ^ Cline, C.M.J.; Björck-Linné, A.K.; Israelsson, B.Y.A.; Willenheimer, R.B.; Erhardt, L.R. (1999-06-01). "Non-compliance and knowledge of prescribed medication in elderly patients with heart failure". European Journal of Heart Failure. 1 (2): 145–149. doi:10.1016/S1388-9842(99)00014-8. ISSN 1879-0844. PMID 10937924. 
    14. ^ Yasein, Nada A.; Barghouti, Farihan F.; Irshaid, Yacoub M.; Suleiman, Ahmad A. (March 2013). "Discrepancies between elderly patient's self-reported and prescribed medications: a social investigation". Scandinavian Journal of Caring Sciences. 27 (1): 131–138. doi:10.1111/j.1471-6712.2012.01012.x. PMID 22616831. 
     
  8. Adrian Misseri

    Adrian Misseri Active Member

    G'day,

    Working in a small country town in central Victoria, Australia, the vast majority of my patients are elderly. With the DVA patients, it's usually not an issue as most of the local GPs just send out a new care plan every 12 months, even though they dont have to (neat eh?). Same for EPC patients. For the rest of them, it can be so hard to get a full pharmicotherapy picture of my patients. One trick I've found is encouraging the patients to carry a list of all their meds on a piece of paper in their wallets, just in case they have a fall in the street or a blackout or something, then it's safer all round. But I will give the brown paper bag idea a go for the obstinate ones.
    Cheers!
     
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