Polypharmacy: an undervalued component of complexity in the care of elderly patients

Use of a structured medication history to establish medication use at admission to an old age psychiatric clinic: a prospective observational study

OBJECTIVE

Medication reconciliation results in fewer adverse drug events. The first step in medication reconciliation is to carry out a structured interview about medication use. It is not known whether such an interview is useful in inpatient old age psychiatry. The object of this study was to determine at admission the number of discrepancies in medication use, comparing the structured history of medication use (SHIM) procedure with the usual procedure for taking the medication history.

METHODS

A prospective observational study was conducted. All consecutive patients aged 55 years and older admitted from January until April 2011 to the inpatient old age psychiatric clinic of a large psychiatric teaching hospital in The Hague, the Netherlands, were eligible for inclusion; 50 patients were included. In every patient, the usual procedure (medication history-taking at admission by the treating physician) was compared with the SHIM procedure administered by the researcher. The SHIM procedure consists of a structured interview with the patient about the actual use of medication, incorporating the information from the community pharmacy and the patient's medications brought to the interview. The main outcome was the number of discrepancies in recorded medication use between the SHIM and the usual procedure.

RESULTS

In total, 100 discrepancies (median 2 per patient, range 0-8) in medication use were identified; 78 % (n = 39) of the patients had at least one discrepancy. Of the discrepancies, 69 % were drug omissions, and 31 % were drug additions or discrepancies in the frequency or dosage of medications. Eighty-two percent of all discrepancies were potentially clinically relevant. In 24 % of the patients, the discrepancies had clinical consequences.

CONCLUSION

The number of discrepancies that were found suggests that the usual procedure for taking the medication history can be improved. The SHIM procedure enables a comprehensive and accurate overview of the medication used by older patients admitted to a psychiatric hospital, and contributes to the prevention of clinically relevant adverse drug events.

Polypharmacy and food-drug interactions among older persons: a review

Polypharmacy is generally defined as the use of 5 or more prescription medications on a regular basis. The average number of prescribed and over-the-counter medications used by community-dwelling older adults per day in the United States is 6 medications, and the number used by institutionalized older persons is 9 medications. Almost all medications affect nutriture, either directly or indirectly, and nutriture affects drug disposition and effect. This review will highlight the issues surrounding polypharmacy, food-drug interactions, and the consequences of these interactions for the older adult.

The prevalence of herbs use in conjunction with conventional medicines in Jamaica

Due to the global rise in the popularity of herbal medicines, adversities resulting from concomitant use of both prescription drugs and herbs are becoming an increasingly important public health issue.

OBJECTIVES

To estimate the prevalence of the use of herbal medicines among persons on prescription medicines in Jamaica. Findings are thought to aid in estimates of the risk of adversities from drug-herb interactions through laboratory investigations and to provide awareness among policy makers responsible for the design of appropriate pharmacovigilance systems in the country.

METHODS

A survey was conducted in eighteen pharmacies throughout Jamaica and patients or parents/carers of children who were on at least one prescription medicine were administered a structured questionnaire by trained interviewers.

RESULTS

Of 399 persons invited to participate in the study 365 (91.5% response rate) agreed to do so and were included in the study. This study population consisted of 306 adults and 60 children and of that 243 adults (80.6%) and 45 children (75.6%) engaged in the concomitant use of herbs and drugs. Patients with a variety of disease conditions, in both rural and urban environs engaged in concomitant herb-drug use. Persons with higher salary (P<0.1) and those with health insurance (P<0.02) tended to have a lower prevalence of herb-drug concomitant use. Among persons indicating such practices the most commonly cited reason for concurrent use of prescription medicine and herbal preparations was the belief that there was no harm in taking both (269, 94.0%) followed by the belief that the prescription medicine alone was not adequate cure (211, 71%). Only 55 (18%) respondents who practised such co-medication indicated that their doctors knew of their use of herbal preparations.

CONCLUSION

There is a high prevalence of herb-drug concomitant use in Jamaica, and an awareness within the medical community and those monitoring adversities would serve well to mitigate risks from potential drug-herb interactions.