Inappropriate polypharmacy is a significant problem among the elderly, and it has been linked to adverse health consequences. A priority is determining the optimal approaches to optimize proper polypharmacy. As a result, polypharmacy, or the use of many medications to improve clinical outcomes for patients, is gaining popularity (Rankin et al., 2018; Whitman et al., 2021). The study’s primary goal is to determine which therapies are most beneficial alone or in combination. Effectiveness is demonstrated in promoting proper polypharmacy use and lowering medication-related issues in the elderly. Researchers used CENTRAL, MEDLINE, Embase, CINAHL, and two trial registrations to find further studies until February 7, 2018, and hand-searching reference lists.
The researchers used random, non-randomized, controlled before-after studies and interrupted time series. Eligible studies described prescribing interventions designed to improve appropriate polypharmacy in people 65 and older who were prescribed polypharmacy (four or more medicines) and used a validated tool to assess prescribing appropriateness (Rankin et al., 2018). These are what are known as implicit tools (Garfinkel & Bilek, 2020). Such tools might be based on one’s judgment or the professional assessment of others. Furthermore, it is explicit techniques such as criterion-based, which include lists of pharmaceuticals to avoid in the elderly.
During the research, two review writers independently assessed the risk of bias in included studies by reviewing abstracts of eligible studies, extracting data, and assessing the risk of bias in included studies. To get summary estimates of impact and 95 percent confidence intervals, researchers combined study-specific data and utilized a random-effects model (CIs) (Rankin et al., 2018). The GRADE method was used to assess the overall certainty of the evidence for each outcome. Researchers found 32 studies, 20 of which came from this update. There were 18 randomized trials included in the study (Rankin et al., 2018). Computerized decision help was one of the interventions. Thirty-one were multi-faceted pharmacological and care-based treatments that were sophisticated and multi-faceted. To answer this topic, researchers gathered and examined all relevant studies. The review authors discovered 32 relevant studies, including 28,672 older individuals from 12 countries (Rankin et al., 2018). This research compared strategies aimed at improving medication adherence to standard care.
When the findings of these investigations were merged, the evidence gained was relatively poor. It is unclear if efforts aimed at improving proper polypharmacy resulted in clinically meaningful improvements. The number of PPOs may be reduced marginally if pharmaceutical treatment is provided (Rankin et al., 2018). Doctors should carefully analyze sources of information and suggestions in order to strike the optimal balance between avoiding the “risk/treatment dilemma” and preventing prescription misuse. Controlling procedures to support fidelity and controlling the interventions selected is obvious. To maintain uniformity, employees must be trained well, including practicing the new experience.
The papers in this review were of poor quality, and future research should focus on study design rigor. More study is needed to see if existing methods for a thorough drug evaluation (such as the hyper pharmacotherapy assessment tool) can help with proper polypharmacy (Mangin et al., 2018; Uchida et al., 2019). Details on the creation and delivery of the intervention were limited. Uncertainty over which intervention aspects are most important for effective results must be addressed (Rankin et al., 2018). The Medical Research Council’s recommendations for future intervention studies aimed at proper polypharmacy might be helpful. If an incorrect prescription persists, there appears to be a ceiling impact (about 75% of the time) (Rankin et al., 2018). Prescribers’ responses to interventions may be revealed through qualitative interviews. It is necessary to investigate and comprehend poor prescription practices.
Based on the study, in which the central patients of the study were the elderly, it can be concluded that the problems of polypharmacy are for all types of patients. New practices of a subtler and detailed approach are much more effective in treating people. This saves them money and avoids serious problems caused by side effects and incompatible drugs. Moreover, this study shows that new approaches in polypharmacy allow deepening the research potential of the topic.
References
Garfinkel, D., & Bilek, A. (2020). Inappropriate medication use and polypharmacy in older people. BMJ, m2023.
Mangin, D., Bahat, G., Golomb, B. A., Mallery, L. H., Moorhouse, P., Onder, G., Petrovic, M., & Garfinkel, D. (2018). International group for reducing inappropriate medication use & polypharmacy (IGRIMUP): Position statement and 10 recommendations for action. Drugs & Aging, 35(7), 575–587.
Rankin, A., Cadogan, C. A., Patterson, S. M., Kerse, N., Cardwell, C. R., Bradley, M. C., Ryan, C., & Hughes, C. (2018). Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews, 2018(9).
Uchida, M., Suzuki, S., Sugawara, H., Suga, Y., Kokubun, H., Uesawa, Y., Nakagawa, T., & Takase, H. (2019). A nationwide survey of hospital pharmacist interventions to improve polypharmacy for patients with cancer in palliative care in Japan. Journal of Pharmaceutical Health Care and Sciences, 5(1).
Whitman, A., Erdeljac, P., Jones, C., Pillarella, N., & Nightingale, G. (2021). Managing polypharmacy in older adults with cancer across different healthcare settings. Drug, Healthcare and Patient Safety, Volume 13, 101–116.