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Pharmacy
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Polypharmacy
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Polypharmacy

A special issue of Pharmacy (ISSN 2226-4787).

Deadline for manuscript submissions: closed (31 May 2020) | Viewed by 16594

Special Issue Editors

Dr. Caroline Sirois

E-Mail Website
Guest Editor
Department of Social and Preventive Medicine, Laval University, Quebec, QC G1V 0A6, Canada
Interests: polypharmacy; potentially inappropriate medications; multimorbidity; pharmacy practice; pharmacoepidemiology; artificial intelligence; causal inference; public health
Dr. Carlotta Lunghi

E-Mail Website
Guest Editor
Department of Health Sciences, Université du Québec à Rimouski, Lévis, QC G6V 0A6, Canada
Interests: pharmacoepidemiology; drug utilization research; polypharmacy; multimorbidity; mental health; medication adherence; care trajectories; administrative databases

Special Issue Information

Dear Colleagues,

The use of medications is at its highest level. The proportion of individuals taking multiple medications is concomitantly increasing in both older and younger populations. Nevertheless, this polypharmacy is still poorly understood. The wide variety of definitions used, the different combinations of medications that make it up, the heterogeneity of the diseases of the populations studied make it difficult to lay down clear conclusions about the prevalence of the condition and its associated impacts. However, it is essential to better understand polypharmacy and inappropriate prescriptions as well as their effects to ensure optimal care for individuals and to support health systems that are struggling under the pressure of sustained medication use.

We invite you to share your research on the broad topic of polypharmacy to improve knowledge about this condition. All aspects of polypharmacy, such as prevalence/incidence, determinants, impact of polypharmacy on health, economic considerations, and evaluation of interventions to reduce inappropriate prescriptions are welcome. We hope that this Special Issue will shed light on several unknowns related to polypharmacy to guide clinical practice and public health policies.

Prof. Caroline Sirois
Prof. Carlotta Lunghi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Pharmacy is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Polypharmacy
  • Potentially inappropriate medications
  • Multimorbidity
  • Older adults
  • Deprescribing

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Published Papers (4 papers)

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Research

13 pages, 816 KiB  
Article
A Descriptive Quantitative Analysis on the Extent of Polypharmacy in Recipients of Ontario Primary Care Team Pharmacist-Led Medication Reviews
by Nichelle Benny Gerard, Annalise Mathers, Christoph Laeer, Eric Lui, Tom Kontio, Payal Patel and Lisa Dolovich
Pharmacy 2020, 8(3), 110; https://doi.org/10.3390/pharmacy8030110 - 30 Jun 2020
Cited by 6 | Viewed by 4709
Abstract
Pharmacist-led medication reviews have been shown to improve medication management, reducing the adverse effects of polypharmacy among older adults. This paper quantitatively examines the medications, medication discrepancies and drug therapy problems of recipients in primary care. A convenience sample of 16 primary care [...] Read more.
Pharmacist-led medication reviews have been shown to improve medication management, reducing the adverse effects of polypharmacy among older adults. This paper quantitatively examines the medications, medication discrepancies and drug therapy problems of recipients in primary care. A convenience sample of 16 primary care team pharmacists in Ontario, Canada contributed data for patients with whom they conducted a medication review over a prior four-week period. Data were uploaded using electronic data capture forms and descriptive analyses were completed. Two hundred and thirty-seven patients (on average, 67.9 years old) were included in the study, taking an average of 9.2 prescription medications (±4.7). Majority of these patients (83.5%) were categorized as polypharmacy patients taking at least five or more prescribed drugs per day. Just over half of the patients were classified as having a low level of medication complexity (52.3%). Pharmacists identified 2.1 medication discrepancies (±3.9) and 3.6 drug therapy problems per patient (±2.8). Half these patients had more than one medication discrepancy and almost every patient had a drug therapy problem identified. Medication reviews conducted by pharmacists in primary care teams minimized medication discrepancies and addressed drug therapy problems to improve medication management and reduce adverse events that may result from polypharmacy. Full article
(This article belongs to the Special Issue Polypharmacy)
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10 pages, 236 KiB  
Article
Medication Complexity among Disadvantaged African American Seniors in Los Angeles
by Edward Adinkrah, Mohsen Bazargan, Cheryl Wisseh and Shervin Assari
Pharmacy 2020, 8(2), 86; https://doi.org/10.3390/pharmacy8020086 - 16 May 2020
Cited by 5 | Viewed by 3142
Abstract
Background. Several publications highlight data concerning multiple chronic conditions and the medication regimen complexity (MRC) used in managing these conditions as well as MRCs’ association with polypharmacy and medication non-adherence. However, there is a paucity of literature that specifically details the correlates [...] Read more.
Background. Several publications highlight data concerning multiple chronic conditions and the medication regimen complexity (MRC) used in managing these conditions as well as MRCs’ association with polypharmacy and medication non-adherence. However, there is a paucity of literature that specifically details the correlates of MRC with multimorbidity, socioeconomic, physical and mental health factors in disadvantaged (medically underserved, low income) African American (AA) seniors. Aims. In a local sample in South Los Angeles, we investigated correlates of MRC in African American older adults with chronic disease(s). Methods. This was a community-based survey in South Los Angeles with 709 African American senior participants (55 years and older). Age, gender, continuity of care, educational attainment, multimorbidity, financial constraints, marital status, and MRC (outcome) were measured. Data were analyzed using linear regression. Results. Higher MRC correlated with female gender, a higher number of healthcare providers, hospitalization events and multimorbidity. However, there were no associations between MRC and age, level of education, financial constraint, living arrangements or health maintenance organization (HMO) membership. Conclusions. Disadvantaged African Americans, particularly female older adults with multimorbidity, who also have multiple healthcare providers and medications, use the most complex medication regimens. It is imperative that MRC is reduced particularly in African American older adults with multimorbidity. Full article
(This article belongs to the Special Issue Polypharmacy)
17 pages, 273 KiB  
Article
Physicians’, Nurses’ and Pharmacists’ Perceptions of Determinants to Deprescribing in Nursing Homes Considering Three Levels of Action: A Qualitative Study
by Rose-Anna Foley, Lucie Lechevalier Hurard, Damien Cateau, Daria Koutaissoff, Olivier Bugnon and Anne Niquille
Pharmacy 2020, 8(1), 17; https://doi.org/10.3390/pharmacy8010017 - 7 Feb 2020
Cited by 18 | Viewed by 4547
Abstract
Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices [...] Read more.
Background: Polypharmacy and the use of potentially inappropriate medications are frequent safety issues among nursing home (NH) residents. Deprescribing can significantly reduce the number of drugs used, medication costs, and mortality. This qualitative study sought to understand and compare the perceptions and practices of nurses, pharmacists, and physicians regarding deprescribing in Swiss NHs, referring to an implementation approach on three levels of action: the individual, the institution, and the healthcare system. Methods: Two focus groups were held with 21 participants: one focus group with 11 pharmacists, another with 10 nurses and six semi-structured interviews with physicians were conducted and focused on their individual experience and practices. They were audiotaped and fully transcribed, and a content analysis was performed using to MAXQDA (Ver 12) software. Results: (1) At an individual level, physicians were concerned by consequences of deprescribing in terms of safety. Nurses were closest to residents and stressed the importance of finding the right time, creating a bond of trust before deprescribing and considering the purpose of the stay in the NH. Pharmacists relied on structured guides for deprescribing, which led their reflection and practice. All professionals saw the complexity of the clinical situations, as well as residents’ and relatives’ fears of interruption of care. (2) At an institutional level, the professionals stressed the lack of time to discuss patients’ health and treatment, while pre-existing interprofessional collaboration, specifically, quality circles, seemed useful tools to create common knowledge. In order to reduce prescriptions, better coordination between physicians, nurses, pharmacists and specialists seemed crucial. (3) At the health system level, funding still needs to be provided to consolidate the process, go beyond organisational constraints and ensure deprescribing serves the patient’s wellbeing above all. Conclusions: At the individual level of implementation, the different healthcare professionals expressed specific concerns about deprescribing, depending on their defined role in NHs. Their perspective about the different levers to promote deprescribing at institutional and healthcare system levels converge towards interprofessional collaboration supported by the healthcare system. Specific funding and incentives are therefore needed to support a sustainable interprofessional team. Full article
(This article belongs to the Special Issue Polypharmacy)
11 pages, 268 KiB  
Article
Polypharmacy and Pharmacological Treatment of Diabetes in Older Individuals: A Population-Based Study in Quebec, Canada
by Marie-Eve Gagnon, Caroline Sirois, Marc Simard and Céline Plante
Pharmacy 2019, 7(4), 161; https://doi.org/10.3390/pharmacy7040161 - 1 Dec 2019
Cited by 1 | Viewed by 3404
Abstract
Our objectives were to describe the use of pharmacological treatments in older adults with diabetes and to identify the factors associated with the use of a combination of hypoglycemic, antihypertensive and lipid-lowering agents. Using the Quebec Integrated Chronic Disease Surveillance System, we conducted [...] Read more.
Our objectives were to describe the use of pharmacological treatments in older adults with diabetes and to identify the factors associated with the use of a combination of hypoglycemic, antihypertensive and lipid-lowering agents. Using the Quebec Integrated Chronic Disease Surveillance System, we conducted a population-based cohort study among individuals aged 66–75 years with diabetes in 2014–2015. We described the number of medications and the classes of medications used and calculated the proportion of individuals using at least one medication from each of these classes: hypoglycemics, antihypertensives and lipid-lowering agents. We identified the factors associated with the use of this combination of treatments by performing robust Poisson regressions. The 146,710 individuals used an average of 12 (SD 7) different medications, mostly cardiovascular (91.3% of users), hormones, including hypoglycemic agents (84.5%), and central nervous system medications (79.8%). The majority of individuals (59%) were exposed to the combination of treatments and the factor most strongly associated was the presence of cardiovascular comorbidities (RR: 1.29; 99% CI: 1.28–1.31). Older individuals with diabetes are exposed to a large number of medications. While the use of the combination of treatments is significant and could translate into cardiovascular benefits at the population level, the potential risk associated with polypharmacy needs to be documented. Full article
(This article belongs to the Special Issue Polypharmacy)
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