Polypharmacy

Polypharmacy is the use of multiple medications to deal with multiple diseases or the use of medications that are not indicated [1]. As multi-morbidity increases with age – estimated to range from 55% to 99% [2], medications (prescription, over-the-counter, and herbal preparations) are widely used by elderly. As many as 44% of hospitalized frail older patients were found in one study to have been discharged on at least one unnecessary medication; common culprits include proton-pump inhibitors, central nervous system medications, and vitamin and mineral supplements [3].

The biggest challenge in poly-pharmacy management is that health professionals experience difficulties in applying ideal medication reviews in daily practice. This is often due to not having the easy to view information about how a patient is being managed across all of their diseases, or a lack of knowledge about how their own choices of treatment can be affected by other diseases and treatments. Studies show that physicians provided with time and structured assessment instruments for medication review are able to identify and correct medication problems in a large percentage of their patients [4] [5].

C3-Cloud is developing solutions to support clinicians in reviewing and adjusting the medication list of their patients with multiple conditions. The integrated patient record repository ensures that the clinician can see all of the conditions and their treatments in one place. Decision support software provides guidance on the best non-clashing medication choice for any new proposed treatment, and the computerised multi-condition guidelines advise on the best aligned care plan for each patient.

These unified C3-Cloud solutions can be used by the multi-disciplinary team during personalized care plan design and execution. C3-Cloud will allow the team to automatically match each of the patient’s conditions with his or her medications for detecting areas of mismatch, detect duplicate drugs in treatment regimes and contraindications across multiple treatment plans. They can be more confident the patient is on the right medications and right dosage therapy.

 

References

[1] Bushardt, R.L., Massey, E.B., Simpson, T.W., Ariail, J.C. & Simpson, K.N. Polypharmacy: misleading, but manageable. Clin. Interv. Aging 3, 383–389 (2008).

[2] Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: A systematic review of the literature. Ageing Res Rev 2011;10(4):430-39.

[3] Hajjar ER, Hanlon JT, Sloane RJ, et al. Unnecessary drug use in frail older people at hospital discharge. J Am Geriatr Soc. 2005 Sep;53(9):1518-1523

[4] Pit SW, Byles JE, Cockburn J. Medication review: patient selection and general practitioner’s report of drug-related problems and actions taken in elderly Australians. J Am Geriatr Soc. Jun; 2007 55(6):927-934.

[5] Drenth-van Maanen AC, van Marum RJ, Knol W, van der Linden CM, Jansen PA. Prescribing optimization method for improving prescribing in elderly patients receiving polypharmacy: results of application to case histories by general practitioners. Drugs Aging. 2009; 26(8):687-701