Polypharmacy resulted in over 115,000 hospital admissions in 2002 and recent data suggests the problem has gotten worse over time. In the field of medication safety, polypharmacy is a topic of major discussion. Recent data cited by the NIH estimates that polypharmacy affects approximately 37% of Americans over 19 years of age and as high as 79% of patients in certain populations such as those with diabetes, the elderly, and people with heart conditions. Not only does polypharmacy increase the risk of patient harm, it also increases the cost to patients due to increased testing & monitoring and duplication of care.
What is polypharmacy?
There are a few different definitions for the term polypharmacy, depending on the use. The classic definition is
The simultaneous use of multiple drugs to treat a single ailment or condition.
In the fields of Pharmacology and Patient Safety, polypharmacy has also been described as
- the use of five or more medications by a single patient;
- patients filling prescriptions at more than one pharmacy; and
- the prescribing of medications by multiple healthcare providers for the treatment of a single condition
Because all three of these have similar risk to patient safety, a more modern definition of polypharmacy is
The use of multiple medications by a patient, often prescribed by multiple providers and filled at multiple pharmacies leading to drug interactions, side effects, and increased complexity in management & cost.
The Dangers of Polypharmacy
Increased Risk of Adverse Drug Reactions (ADRs) – The more medications a person takes, the higher the chance of experiencing harmful drug reactions due to unexpected interactions or sensitivities.
Drug-Drug Interactions – Some medications can interfere with each other making them less effective. Other medications increase the effect of each other, leading to increased risk of dangerous side effects such as excessive bleeding, kidney/liver failure, fainting & falling, or heart rhythm abnormalities.
Cognitive Impairment – Certain medications when used used in combination can cause confusion, memory issues, or even delirium, particularly in older adults.
Medication Non-Compliance – Complex regimens can be difficult to follow, increasing the likelihood of missed doses, incorrect timing, or accidental overdoses.
Increased Risk of Falls and Fractures – Medications such as sedatives, antihypertensives, and muscle relaxants can cause dizziness, drowsiness, or low blood pressure, leading to falls.
Organ Toxicity (Liver & Kidney Damage) – Some medications accumulate in the body, causing liver or kidney damage.
Masking of Symptoms or Misdiagnosis – Polypharmacy can obscure the underlying cause of new symptoms, leading to misdiagnoses and additional, possibly unnecessary tests & treatments.
Increased Healthcare Costs – More medications mean higher out-of-pocket expenses, insurance burdens, and potential costs from treating side effects or hospitalizations.
Reducing the Risk of Harm
Polypharmacy is a complex medication safety issue that has gotten worse over time due to factors such as
- patients see more physicians for specialized care,
- pharmaceutical companies advertising directly to consumers,
- drugs by mail,
- tele-health medical counseling, and
- rising costs of prescription medications
You may notice that the majority of this list are items intended to make medical care better and more accessible – both admirable goals. However, every time a new prescriber (medical specialist, tele-health counselor) or distributor (drugs-by-mail, price-shopping local pharmacies) enters the picture the chance for medication errors increases. To reduce the risk of medication errors it is vital that every healthcare provider prescribing your medications and every pharmacy filling your medications have a complete view of your medical history, food & medication allergies, and current medication profile.
Simple Solutions to Reduce Polypharmacy Risk
Here are three easy things you can do to reduce the risk of harm from polypharmacy:
1. Keep an Up-To-Date List of Your Current Medications – Providing a complete list of your current medications & supplements to every healthcare provider (HCP) you see (in-person or tele-health) greatly reduces the risk of adverse drug reactions and diagnostic errors because
- Some symptoms may be the effect of a medication rather than disease
- Some medications are dangerous when taken with other medications
- Some diagnostic tests cannot be completed when taking certain medications
Having a complete and up-to-date list of your medications assists medical professionals perform a process called medication reconciliation, an important step in reducing medication errors. If you choose not to keep an up-to-date list of current medications the alternative is to place all of your medications, vitamins, and supplements in a bag and take them with you to your appointment.
Safe Meds VIP Tip: Having a printed list on paper is better for most in-person appointments and pharmacies – they can copy it or scan it into your electronic health record (EHR), reducing possible transcription errors. Many tele-health and online patient health portals have the ability to upload a Word or pdf list of your medications that can be viewed by your HCP. This list should also be shared with every pharmacy that fills a prescription.
2. See Specialists From The Same Healthcare System – A possible advantage to using providers from the same healthcare system is a shared EMR or Electronic Medical Record. When your doctors can see the notes, diagnosis information, lab results, and prescribed medications from your other providers it decreases the likelihood of a prescribing error. Nearly every EMR used today will alert a prescribing provider if they enter a new medication that is contraindicated or potentially dangerous based on information entered anyplace in the record. Some EMRs will notify the prescribing provider to counsel a patient if an existing medication should be stopped.
Safe Meds VIP Tip: If your primary physician refers you to a specialist, ask if they share an EMR. If not, how will your primary physician be notified of your condition and treatment?
3. Get All Your Prescriptions Filled at the Same Pharmacy – Similar to the reasons why it’s safer to see healthcare providers from the same healthcare system, the same is true for where you get your prescriptions filled. The majority of pharmacies in the U.S. today use software that runs a safety cross check when you get a prescription filled. At smaller pharmacies without the software a pharmacist will do the cross check personally. The pharmacist may contact the prescribing provider to clarify the intended treatment or counsel you on potential dangers when these alerts are encountered. These cross checks are not done when a person uses multiple pharmacies to fill their prescriptions, increasing the risk of potentially serious medication interactions. If you must use more than one pharmacy, ensure that each is given a complete list of your current medications to reduce the risk of drug-drug interactions.
Safe Meds VIP Tip: Keep your safety, time, and travel costs in mind when deciding where to get your prescriptions filled. When using tools to find discount drug prices at local pharmacies, compare the total cost of all your medications at the same pharmacy to balance your safety with your lifestyle & budget.
Communicate, Compare, & Comply
To summarize and integrate polypharmacy with the Safe Meds VIP framework
Communicate
- Provide every healthcare provider you see and pharmacy used to fill prescriptions with a complete list of your current medications or bring all of your medications with you.
- Ask your provider questions related to your care and treatment so that you fully understand what meds to take, which to stop, and the potential side effects.
- If you have concerns about possible side effects, tell your provider. It’s vital to have an honest discussion to ensure compliance with your care plan. Ask them if you can get a “trial prescription” of 5-10 days to assess the side effects before getting a 30 day supply filled.
Compare
- When comparing primary care physicians & specialists, try to see doctors that are part of a healthcare system and share an EMR.
- When choosing a pharmacy to get your prescriptions filled, compare the costs of all your medications at the same pharmacy then choose the one that fits your time, lifestyle, & budget needs.
Comply
- Stop taking medications if directed to do so by your healthcare provider.
- Take medications as directed.
- Don’t stop taking medications without consulting with your doctor.
Congratulations Safe Meds VIP! You are now aware of what polypharmacy is, the dangers polypharmacy present, and three easy ways to mitigate it’s risk.
Additional Resources:
- Taking Multiple Medications? You May Want to Consider Cutting Back (Nania, AARP)
- Polypharmacy: A hidden epidemic for seniors (Elwell, UCI Health)
- For Healthcare providers – Medication Safety in Polypharmacy (WHO)
- For healthcare providers – Polypharmacy: Evaluating Risks and Deprescribing (AAFP, 2019)