JOURNAL CLUB

The Prevalence Of Polypharmacy In South Indian Patients:

A Pharmacoepidemiological Approach

Mohammed S.S* et.al

By,

Dr.N.Pratyusha 10B0501

Introduction

Polypharmacy:

Defined as a condition in which a patient

receives too many drugs for too long time,

or drug in exceedingly high doses often

result in polypharmacy.

Potential risks of polypharmacy:Drug- Drug interactions

Drug- Food interactions

Adverse drug reactions

Increased hospitalisation

Medication errors

Eventually leading to increased pateint costs and

non-compliance to treatment.

Purpose of the study:

To develop a prescription database and to

compare different methods of identifying

drug users exposed to polypharmacy.

Methodology:

Study site: Govt Dist HQ hospital, Ooty

Study period : 9 months

Type of study: prospectively and retrospectively

Inclusion criteria: prescriptions containing more

than 1 drug and of age 2-70 yrs

Exclusion criteria: age less than 2 yrs, psychiatric

and cancer disorders

Classification:

According to BNF:

Minor Polypharmacy :

Concurrent use of 2 to 4 drugs

Major Polypharmacy :

Use of 5 or more drugs

Results:

Total number of prescriptions- 1003

Major polypharmacy- 600

Minor polypharmacy- 403

Total number of males- 670

Total number of females- 330

Fig1: Age vs total number of prescriptions

Quantitative estimation of polypharmacy:

1.Polypharmacy Vs GenderNumber of drugs

Male Female Total Percentage

2-4 227 176 403 40.18%

Greater than or

equalto 5

443 157 600 59.82%

2.Polypharmacy Vs Age

Both minor and major polypharmacy is

seen high in the age group of 19-60 yrs

that is 78.41% and 87.33% respectively.

3.Polypharmacy Vs Hospital stays

Hospital stay was found to be more for

major polypharmacy that is 45.50% (one

to two weeks of stay)

Quantitative estimation of therapeutic categories of prescriptions:

1.Therapeutic class Vs polypharmacy

Major polypharmacy is more prevalent in cardiovascular

diseases followed by infectious diseases.

2.Therapeutic class Vs Age group

Elderly- GI and cardiovascular drugs

Young- Infectious and CV drugs

3. Therapeutic class Vs Hospital stay

Short term therapy- GI and infectious diseases

Long term therapy- CV and respiratory diseases

Discussion

Polypharmacy was a frequent condition in indian

population especially among elderly individuals.

Patient case sheets were used for the estimation

of prevalence and incidence.

More prevalent in the age group of 19-60 yrs.

Higher prevalence of polypharmacy was seen in

men than women.

Discussion cntd..

Length of hospital stay is found to be more in

major polypharmacy compared to minor.

Prevalence of cardiovascular drugs and GI drugs

were more often involved in polypharmacy

among the elderly and infectious, cardiovascular

drugs were prominent among young individuals

exposed to polypharmacy.

Suggestions to reduce the problems associated with polypharmacy, based on the study:

Ask patients to bring all medicines to the counseling center

(the brown bag approach)

Restrict pro re nata prescribing

Encourage physicians to prescribe using evidence-based

medicine

Select a drug that may treat more than one condition

Check for contraindications and potential drug

interactions before prescribing a drug

Start with low doses and titrate dose according to effect

Monitor for adverse reactions and check potential drug

interactions

Educate the patient about the drug therapy and teach the

patient to prioritize the currently used drugs

Routinely check and encourage compliance

Periodically simplify the therapeutic regimen and stop

drugs if possible

Place limits on the duration of drug prescribing

Conclusion:The use of medication to disease condition is necessary, but unnecessary

load of drugs to patient will increase the safety problems.

Polypharmacy can be avoided by sharing the decisions for making

treatment goals and plans.

The medication regimen can be simplified by eliminating

pharmacological duplication, decreasing dosing frequency and regular

review of drug regimen.

The goal should be to prescribe the least complex drug regimen for the

patient as possible while considering the medication problems,

symptoms and ofcourse the cost of therapy.

Thank you