Reducing polypharmacy through deprescribing in the emergency department.

Hsiu-Wu Yang, Ching-Hsiang Yu, Teng-Yi Huang, Chia-Hui Huang, Yu-Jang Su
Author Information
  1. Hsiu-Wu Yang: Emergency Department, Toxicology Division, MacKay Memorial Hospital, Taipei, Taiwan.
  2. Ching-Hsiang Yu: Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
  3. Teng-Yi Huang: Social Service Department, MacKay Memorial Hospital, Taipei, Taiwan.
  4. Chia-Hui Huang: Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan.
  5. Yu-Jang Su: Emergency Department, Toxicology Division, MacKay Memorial Hospital, Taipei, Taiwan. ORCID

Abstract

Polypharmacy, the use of multiple medications, is a prevalent issue globally that contributes to increased healthcare costs and places additional burdens on patients' organs. This study aims to deprescribe and prevent Polypharmacy in the emergency department. We conducted a retrospective review of randomly selected medical records from the Internal Medicine Department of Taipei MacKay Emergency Department, spanning from August 1, 2023, to October 31, 2023. For cases identified as involving Polypharmacy, pharmacists provided medication education using the Team Resource Management Polypharmacy Interview Guide, while social workers contacted patients via phone to recommend follow-up visits for deprescribing. patients experiencing Polypharmacy were significantly older than those on appropriate medication regimens (79.8 vs 67.3 years, P���=���.002). After deprescribing interventions, the average number of medications for Polypharmacy patients was 5.9 higher than for those receiving appropriate prescriptions (9.2 vs 3.3, P���=���.001). The most common conditions associated with Polypharmacy were diabetes mellitus, hypertension, and arrhythmia. Polypharmacy poses a significant medication management challenge, with affected patients taking an average of 6.9 more medications than those on appropriate treatment regimens. The resource management module of our team successfully reduced the incidence of Polypharmacy by 8.4% in the emergency department.

References

  1. Friend DG. Polypharmacy���multiple-ingredient and shotgun prescriptions. N Engl J Med. 1959;260:1015���8.
  2. Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants, and health outcomes of polypharmacy. Ther Adv Drug Saf. 2020;11:2042098620933741.
  3. Fried TR, O���Leary J, Towle V, Goldstein MK, Trentalange M, Martin DK. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc. 2014;62:2261���72.
  4. Anderson LJ, Schnipper JL, Nuckols TK, et al.; Members of the PHARM-DC Group. A systematic overview of systematic reviews evaluating interventions addressing polypharmacy. Am J Health-System Pharmacy. 2019;76:1777���87.
  5. Keller MS, Qureshi N, Mays AM, Sarkisian CA, Pevnick JM. Cumulative update of a systematic overview evaluating interventions addressing polypharmacy. JAMA Netw Open. 2024;7:e2350963.
  6. Mizokami F, Mizuno T, Kanamori K, et al. Clinical medication review type III of polypharmacy reduced unplanned hospitalizations in older adults: a meta-analysis of randomized clinical trials. Geriatr. Gerontol. Int. 2019;19:1275���81.
  7. Lee J, Negm A, Peters R, Wong EKC, Holbrook A. Deprescribing Fall-Risk Increasing Drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open. 2021;11:e035978.
  8. Young EH, Pan S, Yap AG, Reveles KR, Bhakta K. Polypharmacy prevalence in older adults seen in United States Physician Offices from 2009 to 2016. PLoS One. 2021;16:e0255642.
  9. Midao L, Giardini A, Menditto E, Kardas P, Costa E. Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr. 2018;78:213���20.
  10. Page AT, Falster MO, Litchfield M, Pearson SA, Etherton-Beer C. Polypharmacy among Older Australians, 2006���2017: a population-based study. Med J Aust. 2019;211:71���5.
  11. Cho HJ, Chae J, Yoon SH, Kim DS. Aging and the prevalence of polypharmacy and hyper-polypharmacy among older adults in South Korea: a national retrospective study during 2010���2019. Front Pharmacol. 2022;13:866318.
  12. Bhagavathula AS, Vidyasagar K, Chhabra M, et al. Prevalence of polypharmacy, hyperpolypharmacy, and potentially inappropriate medication use in older adults in India: a systematic review and meta-analysis. Front Pharmacol. 2021;12:798418.
  13. Mikeal RL, Brown TR, Lazarus HL, Vinson MC. Quality of pharmaceutical care in hospitals. Am J Hosp Pharm. 1975;32:567���74.
  14. Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990;47:533���43.
  15. Smith SR, Clancy CM. Medication therapy management programs: forming a new cornerstone for quality and safety in Medicare. Am J Med Qual. 2006;21:276���9.
  16. Centers for Medicare & Medicaid Services. Fact Sheet Summary of 2019 MTM Programs. 2019. https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovContra/Downloads/CY2019-MTM-Fact-Sheet.pdf . Accessed September 12, 2024.
  17. B��low C, Clausen SS, Lundh A, Christensen M. Medication review in hospitalised patients to reduce morbidity and mortality. Cochrane Database Syst Rev. 2023;2023:CD011384.
  18. Lin HW, Lin CH, Chang CK, et al. Economic outcomes of pharmacist-physician medication therapy management for polypharmacy elderly: a prospective, randomized, controlled trial. J Formos Med Assoc. 2018;117:235���43.
  19. Hung A, Kim YH, Pavon JM. Deprescribing in older adults with polypharmacy. BMJ. 2024;385:e074892.
  20. Ye L, Yang-Huang J, Franse CB, et al. Factors associated with polypharmacy and the high risk of medication-related problems among older community-dwelling adults in European countries: a longitudinal study. BMC Geriatr. 2022;22:841.
  21. Lee H, Baek Y-H, Kim JH, et al. Trends of polypharmacy among older people in Asia, Australia, and the United Kingdom: a multinational population-based study. Age Ageing. 2023;52:afad014.
  22. Wylie CE, Daniels B, Brett J, Pearson S-A, Buckley NA. A national study on prescribed medicine use in Australia on a typical day. Pharmacoepidemiol Drug Saf. 2020;29:1046���53.
  23. Wang X, Liu K, Shirai K, et al. Prevalence and trends of polypharmacy in US adults, 1999���2018. Glob Health Res Policy. 2023;8:25.
  24. Charlesworth CJ, Smit E, Lee DSH, Alramadhan F, Odden MC. Polypharmacy among adults aged 65 years and older in the United States: 1988���2010. J Gerontol A Biol Sci Med Sci. 2015;70:989���95.
  25. Ishida T, Yamaoka K, Suzuki A, Nakata Y. Effectiveness of polypharmacy reduction policy in Japan: nationwide retrospective observational study. Int J Clin Pharm. 2022;44:357���65.
  26. Ishida T, Suzuki A, Nakata Y. Nationwide long-term evaluation of polypharmacy reduction policies focusing on older adults in Japan. Int J Environ Res Public Health. 2022;19:14684.
  27. Kojima G, Bell C, Tamura B, et al. Reducing cost by reducing polypharmacy: the polypharmacy outcomes project. J Am Med Dir Assoc. 2012;13:818.e11���818.e15.
  28. Campins L, Serra-Prat M, Palomera E, et al. Reduction of pharmaceutical expenditure by a drug appropriateness intervention in polymedicated elderly subjects in Catalonia (Spain). Gac Sanit. 2019;33:106���11.
  29. Aggarwal P, Woolford SJ, Patel HP. Multi-morbidity and polypharmacy in older people: challenges and opportunities for clinical practice. Geriatrics (Basel, Switzerland). 2020;5:85.
  30. Almod��var AS, Nahata MC. Associations between chronic disease, polypharmacy, and medication-related problems among Medicare beneficiaries. J Manag Care Spec Pharm. 2019;25:573���7.
  31. Tang J, Wang K, Yang K, et al. A Combination of Beers and STOPP criteria better detects potentially inappropriate medications use among older hospitalized patients with chronic diseases and polypharmacy: a multicenter cross-sectional study. BMC Geriatr. 2023;23:44.
  32. American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: standards of Care in Diabetes���2024. Diabetes Care. 2024;47(Suppl 1):S158���78. Erratum in: Diabetes Care. 2024;47:1238.
  33. Kim HM, Shin J. Role of home blood pressure monitoring in resistant hypertension. Clin Hypertens. 2023;29:2.
  34. Ribeiro F, Teixeira M, Alves AJ, Sherwood A, Blumenthal JA. Lifestyle medicine as a treatment for resistant hypertension. Curr Hypertens Rep. 2023;25:313���28.
  35. Mangin D, Lamarche L, Templeton JA, et al. Theoretical underpinnings of a model to reduce polypharmacy and its negative health effects: introducing the Team Approach to Polypharmacy Evaluation and Reduction (TAPER). Drugs Aging. 2023;40:857���68.

MeSH Term

Humans
Polypharmacy
Emergency Service, Hospital
Retrospective Studies
Female
Male
Aged
Deprescriptions
Middle Aged
Aged, 80 and over
Taiwan

Word Cloud

Created with Highcharts 10.0.0polypharmacyPolypharmacymedicationsemergencydepartmentmedicationpatientsdeprescribingappropriate39Department2023regimens8vsP���=���averagemanagementusemultipleprevalentissuegloballycontributesincreasedhealthcarecostsplacesadditionalburdenspatients'organsstudyaimsdeprescribepreventconductedretrospectivereviewrandomlyselectedmedicalrecordsInternalMedicineTaipeiMacKayEmergencyspanningAugust1October31casesidentifiedinvolvingpharmacistsprovidededucationusingTeamResourceManagementInterviewGuidesocialworkerscontactedviaphonerecommendfollow-upvisitsPatientsexperiencingsignificantlyolder7967years002interventionsnumber5higherreceivingprescriptions2001commonconditionsassociateddiabetesmellitushypertensionarrhythmiaposessignificantchallengeaffectedtaking6treatmentresourcemoduleteamsuccessfullyreducedincidence4%Reducing

Similar Articles

Cited By

No available data.