Polypharmacy Affects Quality of Care for many Seniors

Medications are a mainstay in the US health care system. According to CDC statistics, three out of four doctor visits involve a medication in some way.

So it’s not too surprising that nearly half of Americans have used at least one prescription medication in the past month. Among Americans ages 60 and older, more than a third are taking five or more drugs. This is called polypharmacy, which by one common definition means using five to 10 prescription drugs.

Health experts are turning more attention to polypharmacy, which can be particularly risky for seniors. A variety of health care stakeholders, including pharmacy benefit managers, are researching the consequences of polypharmacy and preventive strategies to reduce it.

Chronic diseases lead many seniors to take multiple medications  

About 25 percent of the US population has multiple chronic conditions, such as heart disease, cancer, diabetes, arthritis and mental issues like depression, according to federal statistics. The risk rises with age; roughly three out of four seniors ages 65 and older may have multiple chronic diseases.

Often, seniors who are using a high number of medications to treat these conditions may meet another definition of polypharmacy, which is “the use of more medications than are medically necessary.” Perhaps they’re taking medications that aren’t indicated or aren’t likely to work.

The consequences of polypharmacy, however, extend well beyond merely taking ineffective medications. Negative outcomes linked to multiple prescription use include:

• Higher health care costs. One study linked polypharmacy to 30-percent higher medical costs, in part due to outpatient visits and hospitalizations.
• Adverse drug events. In one study, individuals taking five or more medications had an 88-percent higher risk of such an event.
• Drug interactions
• Medication nonadherence
• Functional decline
• Impaired cognition. In one group of 294 seniors, 22 percent of those taking five or fewer medications had cognitive impairments, compared to 54 percent of those taking 10 or more medications.
• Falls
• Urinary incontinence

A comprehensive approach involving patients, physicians and pharmacists can reduce polypharmacy and its associated risks.

Strategies abound for managing polypharmacy

Express Scripts, a pharmacy benefit manager (PBM), recommends that physicians perform medication reviews with their patients who are taking multiple prescriptions. Important questions to ask include: Are these all necessary? Could any have harmful interactions? Are any available in generic form?

“Doing so can eliminate inappropriate or duplicative medications and often result in better health outcomes and lower costs,” the company notes, adding that pharmacists – including those within PBMs – can also perform these reviews.

According to OptumRX, other ways that PBMs and health plans can address polypharmacy include:

• Member education programs. PBMs can use pharmacy claims data to detect members who may be at risk of medication interactions, then offer them a meeting with a pharmacist to review their medications.
• Safety programs. A PBM might, for example, create a lifestyle program that may improve patients’ health and reduce their need for a medication.
• Drug interaction alerts. Shortly after a prescription is filled, PBMs can alert members and physicians that the drug may contribute to a medication interaction.

Independent review organizations can play a role in reducing polypharmacy

Seniors with several chronic conditions often receive treatment from multiple physicians. Because independent review organization (IRO) experts can examine a patient’s entire file, containing multiple medical records, our unique vantage point lets us see all the medications a patient is taking.

Our physician reviewers at AMR evaluate why patients are taking each of their medications. Often, providers respond that “I inherited the patient that way, and they have been taking that medication for years.”

Many of our reviews involve a peer-to-peer call between one of our physician reviewers and the patient’s prescribing physician to address medications. Often we can recommend changes to the patient’s medication regimen that will improve outcomes.