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Polypharmacy, part 4. Medication review encourages best use and reduces adverse effects.

The Bottom Line

  • Make sure you have a medication review by a pharmacist, doctor or nurse periodically.
  • Medication reviews reduce the number of medications and medications-related problems, and inappropriate prescribing.
  • Medication reviews do encourage the proper use of medications, health promotion and education about your medications.

We have arrived at the fourth and final part of this series on polypharmacy. In Part 3 we discussed the availability of online databases to help you detect potential medication interactions and side effects. In Part 4 we discuss the importance of a medication review.

Why is a medication review important with polypharmacy?

A medication review with a doctor, pharmacist or nurse can help ensure people are on the best set of medications for their health problems. The aim of a medication review is to help someone be on the best medications to treat their specific illness. Another important aim is to prevent or reduce the risk of future health problems. A medication review focuses on ensuring that the patient is receiving:

  1. the right medication, 
  2. for the right reason, 
  3. at the right dose, 
  4. by the right route (pill, liquid, etc.), 
  5. at the right frequency, 
  6. at the right time and 
  7. at the right place (1) 

 

What does the research show us about medication reviews?

Medication reviews are often done by physicians, pharmacists or other healthcare providers who help people manage their medications. Physicians and pharmacists will often work with each other and together with people taking medications (2). A recent Cochrane systematic review (2) on this topic was done by researchers from the United Kingdom and New Zealand. This study suggests that medication reviews may reduce inappropriate prescribing and medication-related problems; at the same time it encourages the appropriate use of medications, provides people with important education, and encourages them to take better care of their health. The benefit of pharmaceutical care was seen even more when everybody on the health team (doctors, specialists, pharmacists, and nurses) worked together. 

Another helpful approach identified by this study, that looked at different ways to improve how medications are prescribed, was the use of interactive computer software designed to help health care professionals with clinical decisions (2). These systems have become more accessible to physicians, not just pharmacists. Another Cochrane systematic review (3) carried out by Danish researchers showed that medication reviews reduce emergency department visits. There is weaker evidence about whether medication reviews impact adverse drug effects and hospital events such as mortality or hospital admissions (2). 

What are some important things to know about medication reviews?

The Canadian Medical Association Journal provides a tip sheet that has questions that you can ask to:

  1. know your medications, 
  2. communicate with the doctor and pharmacist, and 
  3. find a way to keep your medications organized (4) 

The tip sheet can be located at the following link: (http://www.cmaj.ca/content/175/8/876).

Using the electronic drug interaction checker databases mentioned in Part 3 before visiting a healthcare professional is important. It could also help identify questions you may have for your health care provider before your next visit.

News reports, magazines, and television are also reporting polypharmacy as a growing problem. The news media often highlight how people can weigh the risks versus the benefits of their medications for themselves (5;6). Currently, the Ontario Pharmacy Research Collaboration (7) is conducting research about medication approaches that aim to improve medication management. Things that help with this include guidelines for your doctor about taking people off medications such as MedsChecks, Pharmaceutical Opinions, and other interventions.  Taking you off some medications is called 'deprescribing'. When your doctor is deprescribing medications it means that he or she will monitor you during a "process of tapering, withdrawing, discontinuing, or stopping" medications (8). Deprescribing will reduce the effects of polypharmacy and associated negative side effects. In the end it will reduce your risk because it reduces inappropriate or ineffective medication use (8). More information about deprescribing can be found at http://en.wikipedia.org/wiki/Deprescribing.

What is the bottom line about polypharmacy? 

Medications can be very helpful but they can also be harmful. As one ages the benefit and risk profile of a medication may change. Medications may interact with one another when used together to cause increased or decreased effects. 

Pay attention to how you feel and periodically ask a pharmacist, physician or other prescriber to do a medication review. In this medication review you can revisit the need for each medication. Doing a review will ensure the least harm and most benefit overall.

This four-part series of blog posts explores various aspects of polypharmacy. Part 1 defined the issue. In Part 2, we discuss how aging changes the way our body responds to medications, including when taking multiple medications. Part 3 looks at online drug interaction checkers. Part 4 examines medication reviews.


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References

  1. College of Nurses of Ontario. College of Nurses of Ontario (CNO). Medication (Practice Standard). Toronto, Canada; 2011. 
  2. Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2012; 5:CD008165.
  3. Christensen M, Lundh A. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev 2016; 2:CD008986.
  4. Hogan DB, Kwan M. Patient sheet: tips for avoiding problems with polypharmacy. CMAJ. 2006; 175(8):876.
  5. CBC News. Seniors take five drugs or more. 10-30-2011. http://www.cbc.ca/news/technology/seniors-take-5-drugs-or-more-study-1.974202
  6. Lapook J. Multiple medications: growing "polypharmacy" problem. 3-22-2011. http://www.cbsnews.com/8301-18563_162-57402912/multiple-medications-growing-polypharmacy-problem
  7. Ontario Pharmacy Research Collaboration (OPEN). 2013. http://www.open-pharmacy-research.ca
  8. Wikipedia Foundation Inc. Deprescribing. 2013. http://en.wikipedia.org/wiki/Deprescribing

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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