It's High Time to Prevent Polypharmacy in US Healthcare - MedCity News - Latest Global News

It’s High Time to Prevent Polypharmacy in US Healthcare – MedCity News

When making medical decisions, it is critical that physicians have full access to their patients’ complete and accurate medication histories. Put simply, treatment decisions made without this information or based on outdated or otherwise incorrect data can lead to a variety of adverse and often potentially fatal consequences.

However, in the United States, the traditional medication reconciliation processes that providers use to obtain and verify the accuracy of their patients’ medication histories are often incredibly time-consuming and riddled with procedural inefficiencies and unnecessary complexity. Additionally, it is difficult to obtain a current—and accurate—list of medications prescribed at various care sites, especially from out-of-network providers—and patients and families struggle to fill the gaps. Therefore, medication regimens often differ from provider to patient.

In older adults, the scope of medication regimens may increase as patients seek care from multiple providers and experience increased hospitalizations and transitions of care, resulting in treatment decisions often coupled with an increased risk of polypharmacy, or concurrent use of multiple medications be taken to treat a single disease. Today, polypharmacy is not only a major public health problem but also a significant contributor to rising healthcare costs. Each year, polypharmacy results in more than $177 billion in additional costs – primarily due to drug-related hospitalizations.

As things stand, there is no perfect solution to the medication reconciliation process and polypharmacy prevention in the United States. But recent advances resulting from collaboration among healthcare clinicians, computer scientists, data scientists and policymakers in Connecticut offer clinicians across the country a blueprint for deploying new tools that make medication use safer. enable more informed treatment decisions and ultimately improve the quality of life for millions of patients.

Increasingly recognized dangers of polypharmacy

The prevalence of polypharmacy has been steadily increasing in the United States for decades. For example, the number of older Americans taking at least five medications more than tripled from 1994 to 2014, rising from 13.8% to 42.4%.

Since then, this upward trend has continued, even as we continue to understand the myriad negative consequences of polypharmacy, including its well-known association with a significantly higher risk of hospitalization or death. More specifically, patients who take more than five prescription medications at the same time have a 50% risk of an adverse drug reaction, and polypharmacy in general is the fifth leading cause of death in the United States, accounting for about 30% of hospitalizations per year.

And while polypharmacy is more commonly associated with older adults and seniors, who are more likely to be prescribed multiple medications and are particularly vulnerable to adverse drug reactions and other complications, polypharmacy and its associated risks are by no means limited to a single population. In fact, a recent study from the University of Maryland found that more children and adolescents across the country are taking multiple psychiatric medications at the same time, showing a 9.5% increase in polypharmacy from 2015 to 2020 among Medicaid patients age 17 or younger .

The dangers of polypharmacy and its ever-increasing reach in the American population make it imperative that we improve the accuracy and efficiency of medication reconciliation processes. But reversing this trend has historically been a major challenge for healthcare. Although no one agrees that polypharmacy needs to be addressed, this is due to the complexities associated with polypharmacy – including how to ensure that Pharmacists have access to the most up-to-date information about a patient’s medication history, regardless of where they receive care – often the case has been overlooked as a priority action point for states. Polypharmacy is also a term that describes the problem but is not action-oriented. To change medication regimens, physicians need accurate information and training on how to appropriately discontinue medications.

However, it is high time to focus on developing tools and workflows that address polypharmacy and support medication reconciliation. In Connecticut, recent progress toward a more novel and effective solution could serve as the start of a roadmap for dramatically improving medication safety across the country.

We are paving a new path for medication compatibility

In theory, the medication reconciliation process is the first and most effective line of defense against potentially harmful or even fatal cases of polypharmacy and other medication errors, such as misuse of inappropriate treatments that have negative health effects. Additionally, the need for immediate, unencumbered access to medication history often becomes even more urgent in an emergency scenario.

For example, one of the biggest risks associated with polypharmacy for adults over 60 years of age who typically take more than one medication due to chronic illnesses is oversedation and falls. This contributes to higher rates of household injuries and motor vehicle accidents. In rheumatology patients, new evidence suggests that polypharmacy “contributes to adverse outcomes and alters treatment response.” And among older adults with two or more chronic illnesses, polypharmacy is associated with a higher risk of adverse drug reactions. Patients taking four or more medications are at increased risk of falls.

However, in practice, medication reconciliation is often rendered inefficient and ultimately ineffective due to a lack of strategic coordination to address critical gaps in healthcare professionals’ access to information. These include poor or nonexistent collaboration among community pharmacies to integrate dispensing data, siled electronic health records, and a general lack of universal standards for managing prescription data across the U.S. health care system.

Recognizing the increasingly urgent need to address these challenges, the Connecticut General Assembly passed Special Law 18-6 in 2018, requiring the creation of a Medication Reconciliation and Polypharmacy Task Force. Within a year, the group delivered several recommendations for policy improvements and promoting interoperability and standardizing prescription drug data. The working group evolved into a committee of the Office of Health Strategy. The committee helped establish the creation of a “Best Possible Medication History – BPMH” as the end goal, recognizing that medication reconciliation will never result in a 100% accurate medication plan. The committee’s efforts formed the basis for and ultimately led to the development and recent launch of a new medication management tool.

By breaking down many of the information silos that have existed within the state’s healthcare system and infrastructure, and bringing together the many key stakeholders that influence a patient’s medication supply, the tool has empowered providers across Connecticut to store more efficiently, Access and send critical medication data to the point of care. Additionally, polypharmacy has been significantly reduced and deduplication processes have been improved. In fact, in the most recent 12-month period, duplicate prescriptions fell significantly in more than 3 million patients statewide, with drug lines decreasing from 187.6 million to 21.5 million. [Editor’s Note: This Medication Management Tool was launched by Connie, a Health Information Exchange in the state of Connecticut, where Jean Searles, one of the authors of this article is Executive Director.]

Although more work is needed, the efforts of physicians, lawmakers, nonprofits, and industry partners in Connecticut show that improving medication reconciliation in the United States is not a lost cause. The key to success: a shared awareness, determination and strategic coordination between various stakeholders across the healthcare industry.

Will it take years of hard work to ensure a foolproof medication reconciliation process is available to all providers across the country? Pretty sure. However, the idea that millions of Americans today have to worry about the safety of the drug combinations they are prescribed is unacceptable. Together, we should be prepared to do everything we can to put a stop to polypharmacy and its negative effects once and for all.

Photo: Stas_V, Getty Images

Jenn Searls, MHA, is executive director at Connie, the official health information exchange for the state of Connecticut. Prior to joining Connie, Ms. Searls was Chief Operating Officer at SOHO Health, where she led the effort to develop the former Saint Francis Healthcare Partners into a regional clinically integrated network for the 1,700 providers and five hospitals affiliated with Trinity Health of New England are connected. There she was responsible for building a new health infrastructure for the population as part of the transition to value-based care. Previously, she was Chief Information Officer at ProHealth Physicians, where she orchestrated the successful transition from paper records to electronic medical records and served as co-leader of a multidisciplinary team that led the organization and all of its practices toward achieving Level 3 recognition as a ” Patient Centered Medical Home” (at the time the largest single PCMH submission in NCQA history).

Dr. Sean Jeffery, PharmD, BCGP, FASCP, AGSF, is Director of Pharmacy Services at Integrated Care Partners, a physician-led, clinically integrated network responsible for Hartford Healthcare’s value-based practice transformation. Dr. Jeffery is responsible for managing Medicare Part D Star Pharmacy quality measures, population health management, and supporting an integrated care management team and employed physician group. Dr. Jeffery is also a Professor of Pharmacy Practice at the University of Connecticut School of Pharmacy and is currently the 2nd Vice President of the Connecticut Pharmacist Association. Before joining Integrated Care Partners, Dr. Jeffery served as a consultant pharmacist for the VA Connecticut Geriatrics Consult Service from 1998 to 2015. During this time, Dr. Jeffery also completed a Post Graduate Year-2 Geriatrics Pharmacy Residency Program and served as Director there 2002 – 2015.

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