The Polypharmacy Patient: An Interprofessional Model for Deprescribing and Safe Care Transitions
Abstract
Background: Polypharmacy, the concurrent use of multiple medications, is a pervasive public health challenge associated with increased adverse drug events, hospitalizations, and diminished quality of life. This risk is magnified during transitions of care, where medication discrepancies and inappropriate prescribing are common. Aim: This narrative review synthesizes evidence on interprofessional models for proactively identifying and managing polypharmacy, with a specific focus on collaborative deprescribing frameworks and ensuring medication safety during care transitions. Methods: A comprehensive search of PubMed, CINAHL, Scopus, and PsycINFO (2010-2024) was conducted, integrating literature from geriatrics, clinical pharmacy, nursing, and health services research. Results: Effective management requires a structured, team-based approach. Key elements include pharmacist-led medication reviews informed by laboratory monitoring of organ function, nursing/health assistant assessments of real-world adherence and functional status, social work interventions to address socioeconomic barriers, and surgical service protocols for perioperative medication management. Successful models hinge on clear communication, shared documentation, and defined roles. Conclusion: A proactive, interprofessional model is essential to mitigate the risks of polypharmacy. Future efforts must standardize deprescribing processes and integrate them seamlessly into transitional care pathways to improve patient safety and outcomes.
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References
Al-Arkee, S., Mason, J., Lane, D. A., Fabritz, L., Chua, W., Haque, M. S., & Jalal, Z. (2021). Mobile apps to improve medication adherence in cardiovascular disease: systematic review and meta-analysis. Journal of medical Internet research, 23(5), e24190. https://doi.org/10.2196/24190
Bulajeva, A., Labberton, L., Leikola, S., Pohjanoksa-Mäntylä, M., Geurts, M. M., de Gier, J. J., & Airaksinen, M. (2014). Medication review practices in European countries. Research in Social and administrative pharmacy, 10(5), 731-740. https://doi.org/10.1016/j.sapharm.2014.02.005
Chen, J., Wijesundara, J. G., Patterson, A., Cutrona, S. L., Aiello, S., McManus, D. D., ... & Houston, T. K. (2021). Facilitators and barriers to post-discharge pain assessment and triage: a qualitative study of nurses’ and patients’ perspectives. BMC Health Services Research, 21(1), 1021. https://doi.org/10.1186/s12913-021-07031-w
Csep, A. N., Voiţă-Mekereş, F., & Manole, F. (2023). A Review of Polypharmacy in the Elderly and Its Management Strategies. Archives of Pharmacy Practice, 14(2-2023), 106-110. https://doi.org/10.51847/eWhICm6ro1
Davies, L. E., Spiers, G., Kingston, A., Todd, A., Adamson, J., & Hanratty, B. (2020). Adverse outcomes of polypharmacy in older people: systematic review of reviews. Journal of the American Medical Directors Association, 21(2), 181-187. https://doi.org/10.1016/j.jamda.2019.10.022
de Wildt, K. K., van de Loo, B., Linn, A. J., Medlock, S. K., Groos, S. S., Ploegmakers, K. J., ... & AD F ICE_IT study team. (2023). Effects of a clinical decision support system and patient portal for preventing medication-related falls in older fallers: Protocol of a cluster randomized controlled trial with embedded process and economic evaluations (AD F ICE_IT). PLoS one, 18(9), e0289385. https://doi.org/10.1371/journal.pone.0289385
Douketis, J. D., Spyropoulos, A. C., Murad, M. H., Arcelus, J. I., Dager, W. E., Dunn, A. S., ... & Moores, L. K. (2022). Perioperative management of antithrombotic therapy: an American College of Chest Physicians clinical practice guideline. Chest, 162(5), e207-e243. https://doi.org/10.1016/j.chest.2022.07.025
Duncan, H. F., Kirkevang, L. L., Peters, O. A., El‐Karim, I., Krastl, G., Del Fabbro, M., ... & Kopp, I. (2023). Treatment of pulpal and apical disease: the European Society of Endodontology (ESE) S3‐level clinical practice guideline. International Endodontic Journal, 56, 238-295. https://doi.org/10.1111/iej.13974
Hosseini, L., Hajibabaee, F., & Navab, E. (2023). Reviewing polypharmacy in elderly. Iranian Journal of Systematic Review in Medical Sciences, 1(1), 15-24.
Huang, A. R., Mallet, L., Rochefort, C. M., Eguale, T., Buckeridge, D. L., & Tamblyn, R. (2012). Medication-related falls in the elderly: causative factors and preventive strategies. Drugs & aging, 29(5), 359-376. https://doi.org/10.2165/11599460-000000000-00000
Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing hospital readmission rates: current strategies and future directions. Annual review of medicine, 65(1), 471-485. https://doi.org/10.1146/annurev-med-022613-090415
Maher, R. L., Hanlon, J., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly. Expert opinion on drug safety, 13(1), 57-65. https://doi.org/10.1517/14740338.2013.827660
Marshall, D. A., Grazziotin, L. R., Regier, D. A., Wordsworth, S., Buchanan, J., Phillips, K., & Ijzerman, M. (2020). Addressing challenges of economic evaluation in precision medicine using dynamic simulation modeling. Value in health, 23(5), 566-573. https://doi.org/10.1016/j.jval.2020.01.016
Matsuyama, Y., Okazaki, H., Kotani, K., Asada, Y., Ishikawa, S., Lebowitz, A. J., ... & van der Vleuten, C. (2021). Professional identity formation-oriented mentoring technique as a method to improve self-regulated learning: A mixed-method study. The Asia Pacific Scholar, 6(4), 49. https://doi.org/10.29060/TAPS.2021-6-4/OA2443
McCarthy, C., Clyne, B., Boland, F., Moriarty, F., Flood, M., Wallace, E., ... & SPPiRE Study team. (2022). GP-delivered medication review of polypharmacy, deprescribing, and patient pri orities in older people with multimorbidity in Irish primary care (SPPiRE Study): A cluster randomised controlled trial. PLoS medicine, 19(1), e1003862. https://doi.org/10.1371/journal.pmed.1003862
McDonald, E. G., Wu, P. E., Rashidi, B., Wilson, M. G., Bortolussi-Courval, É., Atique, A., ... & Lee, T. C. (2022). The MedSafer study—electronic decision support for deprescribing in hospitalized older adults: a cluster randomized clinical trial. JAMA internal medicine, 182(3), 265-273. doi:10.1001/jamainternmed.2021.7429
Mekonnen, A., Redley, B., Crawford, K., Jones, S., de Courten, B., & Manias, E. (2022). Associations between hyper-polypharmacy and potentially inappropriate prescribing with clinical and functional outcomes in older adults. Expert opinion on drug safety, 21(7), 985-994. https://doi.org/10.1080/14740338.2022.2044786
Menz, B. D., Stocker, S. L., Verougstraete, N., Kocic, D., Galettis, P., Stove, C. P., & Reuter, S. E. (2021). Barriers and opportunities for the clinical implementation of therapeutic drug monitoring in oncology. British Journal of Clinical Pharmacology, 87(2), 227-236. https://doi.org/10.1111/bcp.14372
Midão, L., Giardini, A., Menditto, E., Kardas, P., & Costa, E. (2018). Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Archives of gerontology and geriatrics, 78, 213-220. https://doi.org/10.1016/j.archger.2018.06.018
Mouazer, A., Tsopra, R., Sedki, K., Letord, C., & Lamy, J. B. (2022). Decision-support systems for managing polypharmacy in the elderly: A scoping review. Journal of Biomedical Informatics, 130, 104074. https://doi.org/10.1016/j.jbi.2022.104074
O’Mahony, D., Cherubini, A., Guiteras, A. R., Denkinger, M., Beuscart, J. B., Onder, G., ... & Curtin, D. (2023). STOPP/START criteria for potentially inappropriate prescribing in older people: version 3. European geriatric medicine, 14(4), 625-632. https://doi.org/10.1007/s41999-023-00777-y
Reeve, E., Thompson, W., & Farrell, B. (2017). Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. European journal of internal medicine, 38, 3-11. https://doi.org/10.1016/j.ejim.2016.12.021
Riordan, D. O., Walsh, K. A., Galvin, R., Sinnott, C., Kearney, P. M., & Byrne, S. (2016). The effect of pharmacist-led interventions in optimising prescribing in older adults in primary care: a systematic review. SAGE open medicine, 4, 2050312116652568. https://doi.org/10.1177/2050312116652568
Rochon, P. A., & Gurwitz, J. H. (2017). The prescribing cascade revisited. The Lancet, 389(10081), 1778-1780. https://doi.org/10.1016/S0140-6736(17)31188-1
Rodgers, J. E., Thudium, E. M., Beyhaghi, H., Sueta, C. A., Alburikan, K. A., Kucharska-Newton, A. M., ... & Stearns, S. C. (2018). Predictors of medication adherence in the elderly: the role of mental health. Medical Care Research and Review, 75(6), 746-761. https://doi.org/10.1177/1077558717696992
Rojas-Ocaña, M. J., Teresa-Morales, C., Ramos-Pichardo, J. D., & Araujo-Hernández, M. (2023, May). Barriers and facilitators of communication in the medication reconciliation process during hospital discharge: Primary healthcare professionals’ perspectives. In Healthcare (Vol. 11, No. 10, p. 1495). MDPI. https://doi.org/10.3390/healthcare11101495
Roller‐Wirnsberger, R., Thurner, B., Pucher, C., Lindner, S., & Wirnsberger, G. H. (2020). The clinical and therapeutic challenge of treating older patients in clinical practice. British journal of clinical pharmacology, 86(10), 1904-1911. https://doi.org/10.1111/bcp.14074
Scott, I. A., Hilmer, S. N., Reeve, E., Potter, K., Le Couteur, D., Rigby, D., ... & Martin, J. H. (2015). Reducing inappropriate polypharmacy: the process of deprescribing. JAMA internal medicine, 175(5), 827-834. doi:10.1001/jamainternmed.2015.0324
Starmer, A. J., Spector, N. D., Srivastava, R., West, D. C., Rosenbluth, G., Allen, A. D., ... & Landrigan, C. P. (2014). Changes in medical errors after implementation of a handoff program. New England Journal of Medicine, 371(19), 1803-1812. DOI: 10.1056/NEJMsa1405556
Sun, Y., Wang, M., Zhou, Y., Wang, L., Zhang, H., Lv, Y., & Li, G. (2019). The mediating effect of family function and medication adherence between symptoms and mental disability among Chinese patients with schizophrenia: a cross-sectional study. Psychology, health & medicine, 24(5), 559-569. https://doi.org/10.1080/13548506.2018.1533248
Tran, G., & Zafar, S. Y. (2018). Financial toxicity and implications for cancer care in the era of molecular and immune therapies. Annals of translational medicine, 6(9), 166. https://doi.org/10.21037/atm.2018.03.28
Vázquez-Serrano, J. I., Peimbert-García, R. E., & Cárdenas-Barrón, L. E. (2021). Discrete-event simulation modeling in healthcare: a comprehensive review. International journal of environmental research and public health, 18(22), 12262. https://doi.org/10.3390/ijerph182212262
Yousuf Zafar, S. (2016). Financial toxicity of cancer care: it’s time to intervene. Journal of the National Cancer Institute, 108(5), djv370. https://doi.org/10.1093/jnci/djv370
Zuckerman, S. L., Berven, S., Streiff, M. B., Kerolus, M., Buchanan, I. A., Ha, A., ... & Lehman, R. A. (2023). Management of anticoagulation/antiplatelet medication and venous thromboembolism prophylaxis in elective spine surgery: concise clinical recommendations based on a modified Delphi process. Spine, 48(5), 301-309. DOI: 10.1097/BRS.0000000000004540
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Copyright (c) 2024 Mona Atallah Alanazi, Abdullah Ali Saad Alghamdi, Jamila J Sultan Almoriry, Waleed Majed Almutiri, Waleed Ali Ahmed Maghfuri, Khalid Salem Alqahtani, Yazeed Mohammed Alqahtani, Ahmed Ibrahim Mohammed Habadi, Ibrahim Abdullah Al-Zubni, Hamad Mubarak Alddousari, Rubayyi Abdullah Shabib Alqahtani, Mohammed Hassan Hadi Jli
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