Polypharmacy Interventions Have Potential to Improve Patient Outcomes

As the world population is aging, prevalence of chronic disease onset increases. Polypharmacy is high in cardiometabolic disease populations—specifically patients with stroke, heart disease, and diabetes.

While polypharmacy may help individuals manage these medical conditions, research shows that inadequate management and consumption of multiple medications may lead to:

• drug-drug interactions causing significant morbidity and mortality
• adverse drug reactions
• financial burden
• medication nonadherence
• hospitalizations

Studies pertaining to polypharmacy have been increasing over the last decade—yet, interventions aimed to prevent and manage polypharmacy are limited. These interventions may have potential to improve patient outcomes. The International Journal of Clinical Pharmacy recently published a review investigating available evidence of polypharmacy interventions in cardiometabolic diseases and determining outcome measures.

The review identified 6 studies that met specific criteria for interventions to better manage and reduce polypharmacy in patients with stroke, heart disease, and diabetes. All the studies provided complex, multifaceted interventions. The researchers addressed interventions when they identified problems in 4 important health outcomes:

• quality of life
• drug-related problems
• surrogate markers, such as A1c in diabetes studies
• health care utilization and costs

Each study investigated complex interventions, but the methods behind each of these interventions lacked detail on how investigator developed and chose them. Most interventions were pharmacist-led and consisted of medication review, drug-related problem identification, medication management, and patient education.

The study had a handful of limitations:

• The literature search only provided 6 experimental trials—each utilized different methods and intervention techniques
• All studies used in the review had high risk of bias along with differences in the definition of polypharmacy, interventions, and outcomes
• The review’s findings were limited to diabetes and heart disease only due to lack of literature on patients experiencing strokes and cardiometabolic multimorbidity

Overall, findings for polypharmacy interventions in people with cardiometabolic diseases are inconsistent. The study analysts conclude that longer, more frequent interventions with more direct patient care can improve patients’ quality of life and health care costs while decreasing drug-related problems. Researchers must provide additional descriptive interventions with organized methods to prove the findings from this review.

Samuel Breiner is a 2021 PharmD candidate at The University of Connecticut in Storrs.

REFERENCE

Lum M, Cheung M, Harris D, et.al. A scoping review of polypharmacy interventions in patients with stroke, heart disease and diabetes [published online ahead of print, 2020 Apr 21]. Int J Clin Pharm. 2020 Apr;42(2):378-392. doi: 10.1007/s11096-020-01028-x.