Underserved Communities: Rampant Polypharmacy, Opportunity to Improve Care

Approximately 72% of Medicare beneficiaries have at least 2 chronic medical conditions (most often diabetes, heart disease, and asthma/COPD), and roughly 40% have 4 or more.

When the Medicare beneficiary is African American, the likelihood of having 4 or more chronic medical conditions rises to 47% (compared to 38% among white beneficiaries). Once a beneficiary has 5 or more chronic conditions, there is an increased likelihood that he or she will see 13 physicians every year and fill 50 or more prescriptions. The potential for polypharmacy is obvious.

A team of researchers recently examined the correlation between polypharmacy and factors associated with underserved community-dwelling older African-American adults. Their study, published in the Journal of Aging Research, indicates that this population needs better health care provider coordination and medication management.

Underserved communities or regions have relative or absolute health care resource deficiencies. Many of these communities are quite large—as is the one examined in this study—but most pharmacists are aware of sections of their own communities that are medically stressed. The authors noted that health care-related problems in underserved communities go beyond polypharmacy. These patients often receive duplicate testing, confusing medical advice, and contraindicated interventions.

The researchers collected data from 400 community-dwelling underserved older African-American adults in 2013 and 2014. Of note, 37% of participants carried a diabetes diagnosis.

Nationally, 39% of Americans aged 65 years or older take 5 or more medications. In this population, 75% took more than 5 medications and 30% took more than 10 medications. Female participants were significantly more likely to be taking the highest number of medications, with 35% of women taking 10 or more. The researchers indicated that this high rate of medication use may be attributed to the compromised level of care and significant health disparities in the area.

The researchers also looked at medications identified by the 2012 Beers Criteria as potentially inappropriate. They found that 70% of participants in this study used at least 1 of these medications. Participants were also at high risk for use of medications classified as "avoid" (27%) or "use conditionally" (43%).

Approximately 28% of participants used more than 1 pharmacy concurrently. They called out previous studies that have shown that filling prescriptions at multiple pharmacies increases the likelihood of nonadherence.

The researchers highlighted a need to develop innovative, effective strategies to address polypharmacy and inappropriate medication use in socioeconomically deprived neighborhoods. Medication reconciliation activities are 1 method that often reduces the number of medications used by patients. The researchers also noted that home-based and multidisciplinary approaches can help.

Reference

Bazargan M, Smith J, Movassaghi M, Martins D, et al. Polypharmacy among underserved older African American adults. J Aging Res. 2017;2017:6026358. doi: 10.1155/2017/6026358. Epub 2017 May 23.