Healthcare Consideration: Why are drug-drug interactions a challenge in disease treatment?
Insight and Rationale : Using multiple medications at the same time increases risk for adverse events. One of the potential risks can be based on how drugs interact with each other. Always recommend medication management and analysis for patients using multiple medications. For older adults, the Beers Criteria can provide the most current information detailing medications and medication combinations that should be avoided by that population. Prescription cascade
each provider to evaluate potential risks and review all pharmaceuticals including: ● Prescription drugs ● Over-the-counter (OTC) medications ● Vitamins and supplements ● Diet and nutritional needs (consider food as medicine) Reviewing all pharmaceuticals must be done with trust, knowledge, and understanding of the priorities and needs of each respective patient. Identifying the exact priorities for each patient is imperative. These priorities could be long- term quality of life, maintenance of functional mobility and independence, and ability to be autonomous. These factors should be communicated when determining medication management. Evidence-based practice! Chen et al. (2022) researched impact of prescription cascade reporting that older adults taking prescription medication that correlate to cascades, are more likely to take inappropriate and unnecessary medications, as identify in the Beers criteria. Their desire to identify specific drugs that can lead to this series of unfortunate clinical events is driven by the need to improve care for older adults, reverse adverse events, and improve quality of life for people living with multiple chronic conditions. Their extensive research was designed to create an algorithm that could validate prescribing cascades with the evaluation of a large cohort of older adults treated for complex disease with extensive pharmacological treatment. ● Beliefs guide behavior, personal choice, and self- determination in regard to managing health and chronic conditions. ● Beliefs are often distinguishable from knowledge, and they can impact a patient’s ability to be objective relative to truth about their health status and disease management. ● Beliefs can form the basis of truthful reality and may fervently guide the framework within which one makes determinations and takes action for their health-related choices and decisions. ● Beliefs regarding a medication can impact perception of medication effects and can cause nocebo effects in which thoughts shape outcomes and impact response to interpreted health-related results or feelings. ● The result of addressing misguided beliefs as truth can cause unintended consequences that may ultimately result in potentially damaging side effects and outcomes that can trigger aspects of additional conditions that will require clinical attention. ● Unintended and misguided side effects can shape the effects of a medication as well as the symptoms, resulting in a misinterpretation of a condition that may require a separate therapeutic plan of action. ● This process can be initiated with an individual’s belief that a medication is perceived as a safe, appropriate, and effective part of a treatment plan for a respective condition that requires a clinical response.
The overall impact of too many prescriptions can be referred to as a “prescription cascade” (Canio, 2022). The concept of a prescribing cascade refers to an occurrence when an adverse drug event presents new symptoms, side effects, and counterindications that can be inadvertently recognized as a separate illness or condition that also requires an additional care plan that can include medication. The cascade effect is impacting patient care, increasing risk and costs, and creating misperception among patients relative to their well-being. This is of great concern for young people who are developing multiple chronic conditions such as diabetes, high blood pressure, and high cholesterol, setting the foundation for future symptoms and stressors that can be misdiagnosed. For older adults who are frail and vulnerable to age-related chronic conditions such as diabetes, high cholesterol, and depression, there is a high rate of polypharmacy in communities addressing high acuity patients, such as a long-term rehabilitation or skilled nursing facility. Older adults living alone are also at risk, but the presumption is that they can sustain independence, regulating, and managing their well-being. Older adults living independently with multiple chronic conditions may in fact require some oversight to ensure that they are adhering to medication protocols as prescribed. Patients living with multiple conditions frequently receive care from different doctors and clinicians. To minimize a prescription cascade event when there is a transition in care and treatment plan modification, it is incumbent on polypharmacy is colliding with the expansive needs of the largest cohort of older adults over age 65 in history. Understanding patient behavior relative to medication should be considered an imperative tool in treating patients who are vulnerable to the negative aspects of the polypharmacy cycle of treatment. Patients who are unaware of negative consequences and counterindications are more likely to follow a treatment plan when informed. Nonadherence to medication protocols may occasionally be unintentional, but it is often due to a lack of information that can lead a patient to become noncompliant. People have a perception about the impact and effects of medication which transcends the need to recognize and accept potential adverse effects they can have within a treatment context. According to Sheils et al. (2024), understanding patient perspectives and their engagement in “medication behaviors” which can include taking each medication as prescribed, addressing symptoms properly, and individual expectations of the potential outcomes. Recognizing individual motivation in varied contexts can impact how a person understands the effects of the respective medication. Patients and medication beliefs ● Healthcare professionals must be aware of cultural and individual beliefs that shape behavior and responsiveness to illness and changes in well-being.
Understanding individual patient beliefs about medication The increase of multimorbidity and subsequent
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Book Code: MTX1326
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