Polypharmacy Is Not Just For Getting "High"!

In the article Medication Issues in Urgent Care, Dr. Bhogal points out the complexity of treating elderly patients with multiple medical problems.  More than 40% of senior citizens take more than 5 prescribed medications per month.  20% of Medicare patients have 5 or more chronic conditions and 50% of these take 5+ medications per month.

This subject is so complex elucidating drug-drug interactions, allergic reactions, inappropriate medications, dose-related adverse drug events, and prescribing cascaded- adding a new medication to remedy the side effects f already prescribed medications. 

 

Polypharmacy is a term used to describe a patient who is prescribed four or more medications and generally are adults over the age of 65.  We have often suggested that we no longer list all the medications, but weight them.  Many patient have 3 different version of attain they are taking.  Their medication list does not always include over-the-counter medications, herbals, vitamins, and supplements.

 

The average practitioner cannot keep up with all the medications and interactions without the help of a warning system.  Probably the most common cause of weakness and dizziness after ruling out life-threatening conditions is medication related.

 

The practitioner must have access to the appropriate information.  However, when one looks up any medication, the side effects go on for 3 pages and do not necessarily place the potential problems in any hierarchal order.

 

This is one place where the electronic health record with their CPOE and ePrescribing modules can potentially give real-time information to the providers.  The ability to pull medication history, check drug-drug and drug-allergy interactions for a patient in real-time allows the providers to reconsidered their treatment plan.  Medication reconciliation is a major time consumer, but ultimately needs to be done by the primary care physician or surrogates.  Urgent cares are now providing more and more primary care, so they will need to adapt to this new paradigm.  Everyone always worried about allergies, but drug-drug and drug-allergy interactions, dose-related side effects and cascading prescriptions has added a new complexity.