The effects of pharmacist interventions on patients with polypharmacy

Main Article Content

Elinor C. Chumney
Leslie C. Robinson

Keywords

Pharmacists, Polypharmacy, Drug Therapy

Abstract

Polypharmacy, the state of being prescribed or taking more medications than clinically appropriate, can result in a variety of negative outcomes for both patients and healthcare facilities.  These include negative outcomes such as adverse drug effects, hospitalizations, and poor patient health, as well as economic outcomes such as increased drug cost and costs associated with increased utilization of health services. Available data suggests pharmacists have the potential to have a large effect in combating this problem through a variety of interventions such as reducing the number of medications taken, reducing the number of doses taken, increasing patient adherence, preventing adverse drug reactions (ADRs), improving patient quality of life and decreasing facility and drug costs.  A small number of studies have been performed on the pharmacists’ role in addressing the problem of polypharmacy; however, they include various populations, settings, and measured outcomes. Furthermore, some of the results are conflicting. Nonetheless, this review of the available literature concludes that pharmacist interventions can improve patient outcomes. With the ever-increasing costs of healthcare, the substantial cost savings for patients as well as institutions provided by these interventions are further justification for widespread implementation of pharmacist interventions at healthcare institutions.

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References

1. Zarowitz BJ, Stebelsky LA, Muma BK, Romain TM, Peterson EL. Reduction of high-risk polypharmacy drug combinations in patients in a managed care setting. Pharmacotherapy 2005;25(11):636-45.

2. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA. Recent patterns of medication use in the ambulatory adult population of the United States. The Slone Survey. JAMA 2002;287:337-44.

3. Gurwitz JH, Field TS, Harrold LR. et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 2003;289(9):1107-16.

4. Gomez ER, Demoly P. Epidemiology of hypersensitivity drug reactions. Cur Opin Allergy Clin Immunol 2005;5:309-16.

5. Krska J, Cromarty JA, Arris F, et al. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing 2001;30:205-11.

6. Galt KA. Cost avoidance, acceptance, and outcomes associated with a pharmacotherapy consult clinic in a Veterans Affairs Medical Center. Pharmacotherapy 1998;18(5):1103-11.

7. Jameson J, VanNoord G, Vanderwoud K. The impact of a pharmacotherapy consultation on the cost and outcome of medical therapy. J Fam Pract 1995;41(5):469-72.

8. Jameson JP, VanNoord GR. Pharmacotherapy consultation on polypharmacy patients in ambulatory care. Ann Pharmacother 2001;35(7-8):835-40.

9. Hanlon JT, Weinberger M, Samsa GP, et al. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med 1996;100(4):428-37.

10. Allard J, Hebert R, Rioux M, Asselin J, Voyer L. Efficacy of a clinical medication review on the number of potentially inappropriate prescriptions prescribed for community-dwelling elderly people. CMAJ 2001;164(9):1291-6.

11. Farrell VM, Hill VL, Hawkins JB, Newman LM, Learned RE Jr. Clinic for identifying and addressing polypharmacy. Am J Health Syst Pharm 2003; 60(18):1830-5.

12. Lim WS, Low HN, Chan SP, Chen HN, Ding YY, Tan TL. Impact of a pharmacist consult clinic on a hospital-based geriatric outpatient clinic in Singapore. Ann Acad Med Singapore 2004;33(2):220-7.

13. Hanlon JT, Landsman PB, Cowan K, et al. Physician agreement with pharmacist-suggested drug therapy changes for elderly outpatients. Am J Health Syst Pharm 1996;53:2735-7.

14. Furniss L, Burns A, Craig SKL, Scobie S, Cooke J, Faragher B. Effects of a pharmacist’s medication review in nursing homes. Br J Psychiatry 2000;176:563-7.

15. Trygstad TK, Christensen D, Garmis J, Sullivan R, Wegner SE. Pharmacist response to alerts generated from Medicaid pharmacy claims in a long-term care setting: results from the North Carolina polypharmacy initiative. JMCP. 2005;11(7):575-83.

16. Christensen D, Trygstad T, Sullivan R, Garmise J, Wegner SE. A Pharmacy management intervention for optimizing drug therapy for nursing home patients. Am J Geriatr Pharmacother. 2004;2(4):248-56.

17. Leape LL, Cullen DJ, Clapp MD, et al. Pharmacist participation on physician rounds and adverse drug events in the intensive care unit. JAMA. 1999;281(3):267-70.

18. Doucette WR, McDonough RP, Klepser D, McCarthy R. Comprehensive medication therapy management: identifying and resolving drug-related issues in a community pharmacy. Clin Ther 2005;27(7):1104-11.

19. Schrader SL, Dressing B, Blue R, Jensen G, Miller D, Zawada ET. The medication reduction project: combating polypharmacy in South Dakota elders through community-based interventions. S D J Med. 1996;49(12):441-8.

20. Shaughnessy, AF. Common drug interactions in the elderly. Emerg Med. 1992;24:21-31.

21. Rollason V, Vogt N. Reduction of polypharmacy in the elderly: a systematic review of the role of the pharmacist. Drugs Aging 2003;20(11):817-32.

22. Garrett DG, Martin LA. The Asheville Project: participants’ perception of factors contributing to the success of a patient self-management diabetes program. J Am Pharm Assoc 2003;43(2):185-90.

23. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. Atlanta, GA: Division of Diabetes Translation, Centers for Disease Control and Prevention, US Dept of Health and Human Services; November 2005.

24. Miller DR, Safford MM, Pogach LM. Who has diabetes? Best estimates of diabetes prevalence in the Department of Veterans Affairs based on computerized patient data. Diabetes Care 2004; 27(suppl 2):B10-B21.

25. Pogach LM, Hawley G, Weinstock R, et al. Diabetes prevalence and pharmacy use in the Veterans Health Administration (1994): use of an ambulatory care pharmacy-derived database. Diabetes Care 1998;21:368-373.

26. Maciejewski ML, Maynard C. Diabetes-related utilization and costs for inpatient and outpatient services in the Veterans Administration. Diabetes Care 2004;27(suppl 2):B69-B73.

27. Kerr E, Gerzoff RB, Krein SL, et al. Diabetes care quality in the Veterans Affairs Health Care System and commercial managed care: the TRIAD study. Ann Intern Med. 2004; 141:272-281.

28. McBean AM, Jung K, and Virnig BA. Improved care and outcomes among elderly Medicare managed care beneficiaries with diabetes. Am J Manag Care 2005;11(4):213-22.