Polypharmacy

Question 1

What does Multi-Morbidity mean?

Answer 1

Patient having more than one chronic conditions. For example a patient having atrial fibrillation and type 2 diabetes.

Question 2

What does Poly-Pharmacy mean?

Answer 2

This is the use of many medications together (often more than 4 or 5). It could also mean when a patient have a medication that doesn’t match their diagnosis. (e.g. treating a s/e)

Question 3

What is hyper poly-pharmacy?

Answer 3

This is the use of ten or more regular medicines by a patient.

Question 4

What is appropriate poly pharmacy?

Answer 4

Multiple medicines all of which are clinically indicated and useful. It overall achieves the patients health outcome. Some medical conditions are best treated with multiple medicines like HIV infections

Question 5

What is Oligopharmacy?

Answer 5

This is the deliberate avoidance of polypharmacy, using less than 5 regular medicines and minimising the number of doses a patient has to take. Linked to end of life care but is also useful when a patient has adherence issues.

Question 6

What is problematic polypharmacy?

Answer 6

where a patient is taking multiple medications some of which they do not need and may be causing a drug interaction or food interaction or severed adverse effects. This can be avoided and is usually caused by inconsistencies in drug history etc.

Question 7

What is Pseudo polypharmacy?

Answer 7

The health care records show that patient is taking more medications than they are actually taking. Or Patient avoids medication on purpose because of a side effect but it has not been updated on their record.

Question 8

What is deprescribing?

Answer 8

This is the process of stopping or reducing medicines with the aim of eliminating problematic polypharmacy, an then monitoring the individual for unintended adverse effects or worsening of disease.

Question 9

What are the ways in which polypharmacy can occur?

Answer 9

1. Multiple prescribers: lots of different people making decisions about a patients care but not communicating with others. This is the GPs role but they may not want to solve this as it is outside of their remit.
2. Transfer of care: Patient moves from hospital to care home and have some more medicines started but not updated on patient record.
3. Reflex Prescribing: this is where a patient has a complaint and treats this using some GSL medication which (unmonitored) triggers other conditions within the patient which need to be treated with other medication. This causes a cascading effect where the patient is given more treatment to solve the side effects of their previous treatment.
4. Prescribing vortex: Cyclical version of reflex prescribing. Drug A causes a side effect that can only be treated with Drug B. But Drug B causes a side effect that can only be treated by Drug A . Example oral bisphosphonate—> GI s/e —-> PPI —> increased risk of fractures—–> oral bisphosphonate.

Question 10

What are some of the things that should be placed at the centre of patient discussion?

Answer 10

Allowing the patient to communicate their concerns.
Identifying access issues.
Identify adherence issues.
Identify day to day management issues
Identify Clinical issues.

Question 11

How can you involve the patient in decision making.

Answer 11

-Encourage patients to express their feelings
-Put yourself in your patient’s shoes, what does the patient want to get out of their medication?
-Use a shared decision-making approach to involve the patient
-Ask if they would like to discuss their options with someone else in their family or a member of the team
-Reassure them that they can come back and discuss their medicines and review any decisions.