● Patient’s responsiveness to treatment plan ● Patient’s reference to consulting online sources and social media Evidence-based practice! Patients’ medication insight, beliefs, and attitudes can vary based on their age, trust in healthcare professional, and personal experience. Sheils research shows that patients who seek information on the internet after a visit with a provider were found to be more nonadherent to treatment plans within three weeks relative to those who did not go online for validating information (Sheils et al., 2024). Patients’ beliefs pertaining to health-related treatment can be understood in the following contexts (Sheils et al., 2024): ● Necessity beliefs : Beliefs that stem from the perceived need for treatment, including pharmacological, that will lead to the positive outcomes and benefits which can include symptom relief and prevention of condition exacerbation ● Concern beliefs : Beliefs that drive the perception that there can be negative outcomes which include addiction, negative side effects, and poor effectiveness and unintended side effects (Table 3). Poorly managed polypharmacy can have negative implications for a patient who may be older, compromised, and vulnerable to impaired health outcomes with a U.S. annual cost of over $50 billion (Delara et al., 2022). According to Cheng (2022), Americans spent an average of $1126 annually, per person, on prescription drugs, relative to $522 per person in other parts of the world.
● The need for immediate response and attention may be perceived as more significant than worrying about potential long-term impact. Healthcare professionals should be informed to recognize potential medication interactions that can present long-term issues. While this knowledge is integral to the therapeutic treatment plan, it is important for the provider to be aware of the patient’s respective insight, understanding, and personal beliefs as it pertains to trusting the provider and the impact of medication. Patient belief regarding medication will have a notable impact on their willingness and capacity to adhere to the treatment plan. Nonadherence to a medication plan, which is estimated to impact 30% - 50% of patients, is a factor in managing multimorbidity and polypharmacy. Patient insight and beliefs can stem from (Sheils et al 2024): ● Consultation with other healthcare professionals ● Observations from patients’ shared experiences ● Cynicism about pharmaceutical manufacturers Understanding implications of polypharmacy Longevity and quality of life have been expanded due to the successful development of modern medicine. The prescribing of multiple medications that are clinically required as part of a treatment plan is considered appropriate polypharmacy (Delara et al., 2022). To maintain recommended treatment adherence and utilization of medications, a prescriber must recognize that integration of multiple medications can come with harmful indications ● Perception of prescription ineffectiveness ● Prior experience of being over-prescribed ● Mistrust of generic versus brand name
Table 3: Polypharmacy Challenges Polypharmacy Associations Presentation Increased risk of death
● 3-4 fold increased risk of death (Jorring Pallesen et al., 2022) ● Older age and polypharmacy are leading indicators of fall risk ● 28%-35% of people over age 65 experience falls ● Falls lead to increased morbidity and mortality
Falls (Xu et al., 2022)
Drug interactions (Masnoon et al., 2017)
● Can cause decreased renal function ● Reduce body mass ● Cause weakness ● May cause cognitive impairment ● Limit functional mobility ● Risk increases 13% for patients taking 2 medications; for patients taking more than 6 medications the risk is 82% ● Older adults are shown to have difficulties managing multiple medications ● Difficulties are found to stem from changes in doses and medications ● Exacerbation of existing conditions (i.e., patients with congestive heart failure and peptic ulcers used first generation calcium blockers and the use of aspirin) ● Impacts approximately 15% of polypharmacy patients ● Consistent lab work to monitor bodily functionality is key for older adults to minimize hospitalization episodes due to polypharmacy ● Clinical pharmacists can conduct prescription reviews to limit toxic interactions and encourage proper adherence ● Causality between polypharmacy and increased risk in older adults is reportable
Non-adherence (Hoel et al., 2021)
Drug disease interactions (Canio 2022)
Hospitalization (Hoel et al 2021)
There is some indication that the term “appropriate polypharmacy” is applied to ensure that clinically sound practice is applied. When a patient is being concurrently treated for multiple chronic conditions, it is important to recognize that the pharmaceutical treatment for one illness may result in
There are many conditions that will require the use of multiple medications, but this type of situation requires ongoing follow up and management, with the input of a clinical pharmacist who can evaluate and identify available options. Clearly it is up to the prescriber to recognize potential polypharmacy risks that increase opportunities for adverse events that may lead to poor health outcomes.
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