Defining Polypharmacy

This study introduces the concept of Polypharmacy, including the risks and impacts. It has shown how a person can develop this situation and manage it in the health care system. It also presents the symptoms, challenges that the healthcare user and healthcare provider have faced based on a case study.

David has stomach pain due to an attack of the bacteria Helicobacter pylori. David has recently undergone colonoscopy and gastroscopy for diagnosis. In diagnosis, H. pylori has been identified in David. In this situation, David has used paracetamol and ibuprofen regularly. This action of David has led to Polypharmacy as he has taken medication without any assistance for the long term.

According to Krustev, Milushewa & Tachkov (2022), Polypharmacy refers to the regular use of at least five medications common in the older adults and among the younger population at risk and can increase the risk of adverse levels medical outcomes. Different risk factors may lead to Polypharmacy (Wastesson et al., 2018).

The application or usage of unnecessary or excessive medications can lead to inappropriate Polypharmacy. Effects of different drugs fall and impairment of cognitive level, harmful interactions of drugs, and drug disease interactions (Nascimento et al., 2017). In this case scenario, David is at risk of Polypharmacy as he has to take several medications. David has a list of medical history where he has already taken various drugs, and now he has been prescribed several drugs that can lead to Polypharmacy. The patient has already identified the symptoms such as dark urine, muscle pain which indicates the adverse effect of drugs.

Polypharmacy can worsen the frailty, which refers to collecting the health issues that an older adult may face. Older adults can identify different signs: loss of appetite, tiredness, diarrhea or eliminated alertness, hallucinations and confusion, weakness, dizziness, falls, rashes in skin, depression, excitability, and anxiety. In recent reports, the most adverse impact of Polypharmacy is dry mouth syndrome or xerostomia. It is associated with poor health outcomes, including medication non-adherence, adverse levels of drugs and can affect the quality of life in the older population (Rovira et al., 2022). They can be at greater risk for the adverse level of drug reactions because of metabolic changes and eliminating drug clearance, which is linked with aging. It can lead to ADRs that are mostly due to the medications. Excessive usage of drugs can cause a dry mouth. It may lead to poor quality of life, confusion, decreased medication compliance, and it can lead to unnecessary expenses of drugs (Nascimento et al., 2017). However, there is no doubt that Polypharmacy is linked with poor health results, including medication non-adherence, adverse drug effects and other issues in older adults (Krustev, Milushewa & Tachkov, 2022).

Explaining the Risk of Polypharmacy

This Polypharmacy negatively impacts the healthcare system as hospital admission increases and increases the mortality rate. Prevention of Polypharmacy is the key to saving costs for the healthcare systems (Shaikh et al., 2018). It is a barrier in front the healthcare providers to provide quality care. In this Polypharmacy, patients with Polypharmacy may be admitted to the hospital due to bad reactions to drugs. Primary healthcare services may face issues to provide health care to older people in Polypharmacy (Sharma, 2020). The chronic illness of Polypharmacy causes an adverse level of complications in order to provide healthcare to older people. Wrong medication in Polypharmacy can lead to the patient’s hospitalization, making it more complicated to care for the patients.

In this case scenario, the patient has interacted with metformin, atorvastatin, Clarithromycin and others. Metformin may lead to very bad liver problems (Wakeman & Archer, 2020). It may cause dark urine and muscle pain. In this case scenario, the patient is also facing the same kind of issues, and this medication leads to an upset stomach. Atorvastatin may lead to the muscle tissues’ inability to function properly. It has developed early symptoms, including pain in the muscle, weakness or tenderness, and dark urine (Shrestha, Shrestha & Khanal, 2019). In this scenario, David is facing tremendous muscle pain, and the colour of his urine is getting darker day by day. It reflects that David may have gone through adverse levels of medical effects (Khezrian et al., 2020). Clarithromycin can develop liver problems. This liver problem may indicate symptoms such as dark-coloured urine, upper stomach pain and itchiness. In this situation, a person can face loss of appetite or may develop the yellowing of the skin or the whiteness of the eyes (Farrell et al., 2018). It may cause liver injury with jaundice. This Clarithromycin may cause kidney injury.

In this case scenario, David is facing issues or symptoms which result from the drug interaction. These symptoms may indicate that David has developed liver problems because of consuming or interacting with these medications. All evidence and reports have evidence that these medications have adverse effects that can lead to this chronic condition for a patient (Wakeman & Archer, 2020).

In order to address the Polypharmacy related issues in older adults people, there is a need to make strategies such as

• In order to identify Polypharmacy, there is a need to visually inspect the medications of patients at each visit.
• There is a need to identify the interaction of drugs, the risk of falling on medications and swallowing the risk medications (Dalugama, Pathirage & Kularatne, 2018)
• The health professionals can ask about the herbal type of supplements and the need to counter the medications
• Health professionals need to work diligently with the patients and families for securing an accurate list of the medications (Alanazi, Alenazi & Alenzi, 2021)
• The healthcare providers can reorganize the list of medicines by considering the EHR of a patient.
• However, the prescriptions need to review twice or thrice to reduce inappropriate medications

In this way, the health care providers can identify and manage Polypharmacy. However, performing medication reconciliations during the care of transition, eliminating duplicate medications, assessing for drug-drug interactions, and reviewing the dosages that can eliminate the events of Polypharmacy. There is a need to ensure the patient’s safety, reduce hospitalization numbers, and decrease costs.

Identifying Effect of Polypharmacy on the Older Person and the Healthcare System

There are several evidence-based resources or toolkits present that are helping the nurses. The nurses can use the reviews from PubMed by using the clinical queries. Otherwise, some databases such as CINAHL, MEDLINE, Scopus, Natural Medicine, Cochrane Database of the systematic review, Embase, Global Health and SocINDEX can be used to identify the current best practices regarding the choice of drug. Otherwise, some guidelines are available on the internet regarding the usage of medications that registered nurses can use (Farrell et al., 2018).

In order to treat the patient of the case study pharmacist for primary care, the family doctor and the registered nurse are involved. In this multidisciplinary team, a registered nurse can observe the health professionals’ decisions and actions. Moreover, the registered nurses can prioritize the patients and may follow up on their health situation. In simple words, they can check and may follow up on the schedule of giving the medications (Farrell et al., 2018). They can observe the signs of potential health issues during the final wellness assessments. The registered nurse can follow the person-centred care model and discuss the treatment decisions with the family member, patient, and caregiver. After that, the registered nurse needs to follow up on the changes for upcoming months in intervals. The nurse can conduct a follow-up for one year, which is possible to measure the sustainable effects that result from the intervention plan (Krustev, Milushewa & Tachkov, 2022). 

Conclusion

It can be concluded that this Polypharmacy can make more complications in healthcare delivery. Before making any decision regarding drug interactions, the physicians or doctors need to be well aware of the patient’s side effects and immunity. Nurses are mainly responsible for monitoring the health status of the patients.  Therefore, not only the health professionals, but the nurses also need to be aware of the complications of drugs and side effects on the patients.

References

Alanazi, N. S., Alenazi, T. S., & Alenzi, K. A. (2021). Hepatotoxicity induced by fluvastatin: A reversible acute cholestatic liver injury. The American Journal of Case Reports, 22, e931418-1. 10.12659/AJCR.931418

Dalugama, C., Pathirage, M., & Kularatne, S. A. M. (2018). Delayed presentation of severe rhabdomyolysis leading to acute kidney injury following atorvastatin-gemfibrozil combination therapy: a case report. Journal of medical case reports, 12(1), 1-5. https://link.springer.com/article/10.1186/s13256-018-1685-0

Farrell, B., Thompson, W., Black, C. D., Archibald, D., Raman-Wilms, L., Grassau, P., … & Winslade, N. (2018). Health care providers’ roles and responsibilities in management of Polypharmacy: Results of a modified Delphi. Canadian Pharmacists Journal/Revue des Pharmaciens du Canada, 151(6), 395-407. https://doi.org/10.1177/1715163518804276

Khezrian, M., McNeil, C. J., Murray, A. D., & Myint, P. K. (2020). An overview of prevalence, determinants and health outcomes of Polypharmacy. Therapeutic advances in drug safety, 11, 2042098620933741. https://doi.org/10.1177/2042098620933741

Krustev, T., Milushewa, P., & Tachkov, K. (2022). Impact of Polypharmacy, Drug-Related Problems, and Potentially Inappropriate Medications in Geriatric Patients and Its Implications for Bulgaria—Narrative Review and Meta-Analysis. Frontiers in Public Health, 10. 10.3389/fpubh.2022.743138

Nascimento, R. C. R. M. D., Álvares, J., Guerra, A. A., Gomes, I. C., Silveira, M. R., Costa, E. A., … & Acurcio, F. D. A. (2017). Polypharmacy: a challenge for the primary health care of the Brazilian Unified Health System. Revista de saude publica, 51. https://doi.org/10.11606/S1518-8787.2017051007136 

Rovira, C., Modamio, P., Pascual, J., Armengol, J., Ayala, C., Gallego, J., … & Ramirez, A. (2022). Person-centred care provided by a multidisciplinary primary care team to improve therapeutic adequacy in polymedicated elderly patients (PCMR): randomized controlled trial protocol. BMJ open, 12(2), e051238. https://bmjopen.bmj.com/content/12/2/e051238.abstract

Shaikh, F., Pasch, L. B., Newton, P. J., Bajorek, B. V., & Ferguson, C. (2018). Addressing multimorbidity and Polypharmacy in individuals with atrial fibrillation. Current cardiology reports, 20(5), 1-12. https://link.springer.com/article/10.1007/s11886-018-0975-x

Sharma, U. (2020). Republished: Statin-induced delayed rhabdomyolysis. Drug and Therapeutics Bulletin, 58(2), 30-31. https://dx.doi.org/10.1136/dtb.2019.231125rep

Shrestha, S., Shrestha, S., & Khanal, S. (2019). Polypharmacy in elderly cancer patients: Challenges and the way clinical pharmacists can contribute in resource?limited settings. Aging Medicine, 2(1), 42-49. https://doi.org/10.1002/agm2.12051

Wakeman, M., & Archer, D. T. (2020). Metformin and micronutrient status in type 2 diabetes: does Polypharmacy involving acid-suppressing medications affect vitamin B12 levels?. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 13, 2093. 10.2147/DMSO.S237454

Wastesson, J. W., Morin, L., Tan, E. C., & Johnell, K. (2018). An update on the clinical consequences of Polypharmacy in older adults: a narrative review. Expert opinion on drug safety, 17(12), 1185-1196. https://doi.org/10.1080/14740338.2018.1546841