PolyPharmacy and Policy Assignment
PolyPharmacy and Policy Assignment
PolyPharmacy and Policy Assignment
Question description
Look at case study number two, PolyPharmacy Problems, p. 166 of Health Policy and Politics, A Nurses Guide, by Milstead. Formulate a policy to reduce the practice of multiple drug prescriptions. What tools might be included in the design phase of the policy process to increase the probability of success? What research from other countries could be helpful in addressing this issue? Support your reasoning for PolyPharmacy and Policy Asignment.
PolyPharmacy and Policy Asignment requirements
The use of multiple medications in a single individual (polypharmacy) is a global phenomenon, creating new challenges for many health services [1], driven by increasing levels of multimorbidity [2] and a culture of single-condition guideline-based prescribing [3].
Polypharmacy is associated with several undesirable consequences [4–8]. However, we have previously demonstrated that the association between polypharmacy and adverse outcomes is attenuated in the most multimorbid individuals [9]. This suggests that overly simplistic analyses of polypharmacy, relating simple medication counts to adverse outcomes, may be misleading [9, 10]. Polypharmacy is typically measured using arbitrary numeric thresholds, but these fail to capture medication appropriateness; therefore, more sophisticated approaches accounting for clinical context are required.
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A number of prescribing indicators that assess medication appropriateness are considered to have face validity [11], and may have
value in improving quality and reducing adverse outcomes [12]. However, such indicators generally do not account for multiple drug use and do not measure polypharmacy per se. In addition, explicit ‘drug specific’ indicators (e.g. Beers criteria [13]) do not apply to all patients, and implicit measures (e.g. the Medication Appropriateness Index [14]) require time consuming input from an experienced clinician.
There is therefore a need to develop a valid and reliable means of measuring polypharmacy that takes account of clinical appropriateness. Further, a framing of polypharmacy appropriateness (rather than appropriate or inappropriate polypharmacy) acknowledges a spectrum of prescribing within the context of polypharmacy, including the need to support individualised prescribing approaches where potentially risky (or ‘inappropriate’) combinations may be fitting for a particular patient. To be usable in clinical practice, this measure should ideally focus on generic prescribing issues (to ensure relevance to all patients, and avoiding simply focusing on a finite number of medications, i.e. implicit indicators), whilst still permitting automation as part of a computerised clinical system. We anticipate that this measure of polypharmacy appropriateness would enable more effective targeting and evaluation of medication optimisation interventions. Used as a first step in identifying which patients may be at risk of inappropriate prescribing, such a measure could facilitate targeted conversations with patients to subsequently ascertain their views on the appropriateness of their current medication regimen.
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