Intercepting the Iatrogenic Cascade: A Narrative Review of Feedback Loops, Diagnostic Inflation, and System-Level Interventions in Polypharmacy Management
Abstract
Background: Polypharmacy, a cornerstone of modern chronic disease management, paradoxically fuels a self-perpetuating cycle of patient harm and diagnostic excess. The prescribing of multiple medications by primary care and pharmacy teams often initiates a cascade where adverse drug effects manifest as new laboratory abnormalities or clinical symptoms. These iatrogenic signals are misinterpreted as de novo disease, prompting further imaging and specialist referrals, thereby increasing system burden and patient risk. Aim: This narrative systematic review investigates the complex feedback loops linking polypharmacy to diagnostic inflation and evaluates the efficacy of system-level interventions designed by health administration to intercept this cascade. Methods: A systematic search of PubMed, EMBASE, CINAHL, and Web of Science (2010-2024) was conducted. The review analyzes interdisciplinary workflows involving family medicine, pharmacy, clinical laboratory, radiology, and specialist services. Results: The evidence identifies a clear "prescribe-interpret-react" cycle, where drug-induced renal impairment or hyponatremia commonly triggers unnecessary renal ultrasonography and endocrinology consults. Integrated interventions, particularly pharmacist-led medication therapy management (MTM) embedded in primary care and clinical decision support systems (CDSS) that link lab trends to medication lists, significantly reduce inappropriate testing and adverse drug events. Effective administrative models are characterized by shared electronic health record (EHR) dashboards, protected pharmacist time for comprehensive review, and formalized deprescribing protocols. Conclusion: Fragmented care systems amplify polypharmacy-related harm. Proactive, system-redesign strategies that enhance information synthesis and interdisciplinary accountability are critical to breaking the cascade, improving patient safety, and containing low-value care.
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References
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Copyright (c) 2024 Haitham Yahya Saeed Alzubaidi, Ahmed Ali Abdu Wafi, Turki Theeb M Alotaibi, Saleh Alenazi, Fahad Mohammed Saud Alshammari, Naif Halfan Awaad Alasmari, Majed Sanat Sanhat Alotaibi, Abdullah Ibrahim Hassan Al Name, Zainab Mohammad Alotaibi, Yasmeen Jaffar Abdualkareem Almanassif, Aziza Fahad Awad Aldhaferri, Wejdan Saleh Manah
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