Talk:Polypharmacy

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I

I took out some of Ombudsman (talk · contribs)'s new additions. I agree with most edits, but:

  • Polypharmacy is not always "too much". A diabetic with coronary artery disease, chronic bronchitis and painful polyneuropathy will need >10 drugs. Sad fact. Nothing to do with their doctors or the pharmaceutical industry. But this is referred to as polypharmacy, because it's a damn lot of pills, and efforts to reduce them (e.g. long-acting preparations) are desirable.
  • Vaccines is not polypharmacy. Sorry. Original research. A child with a splenectomy will need 5-yearly streptococcal, meningococcal and haemophilus influenzae vaccines. Otherwise it runs an unreasonable risk of dying from a simple strep throat. Sad fact. Lot of vaccines: yes. But vaccines are not classified as pharmaceuticals, and the use of numerous vaccines is not called polypharmacy apart from by Ombudsman.
  • One in four Americans is taking potentially dangerous prescription drugs. Oh really? So no more amoxicillin for poor Ombudsman with a chest infection, as this is a potentially dangerous prescription drug.

Oh, and where are your references? JFW | T@lk 13:47, 30 November 2005 (UTC)[reply]

Ombudsman returned a lot of content I deleted. I have made select removals again, this time explaining each move with an adequate edit summary. Putting them back without discussion here (or adequate source support) will meet with an RFC from my side. JFW | T@lk 20:17, 30 November 2005 (UTC)[reply]
I hope you don't mind I've invited some pals from Wikipedia talk:WikiProject Drugs[1]. JFW | T@lk 20:33, 30 November 2005 (UTC)[reply]

Reinserting content

Ombudsman, you reinserted some things with the edit summary "restore link; clarify use of term; isn't it better to present reality, rather than deleting content simply to infer the notion doctors are seldom led to overprescribe by unscrupulous pharma marketing?".

I have no idea what you mean by "deleting content simply to infer [...]". What does pharma marketing have to do with the price of cheese? This was not mentioned in the article, so I really don't understand what you're getting at. JFW | T@lk 21:20, 30 November 2005 (UTC)[reply]

Why do you keep on hammering about prescription? In the long run, what really harms the patient is actually taking them! JFW | T@lk 01:08, 1 December 2005 (UTC)[reply]

NO TEARS

This is an interesting review, but I wonder if it has gained enough acceptance to be cited here. JFW | T@lk 20:37, 30 November 2005 (UTC)[reply]

It would be helpful to cite the article rather than just hyperlinking to it, since many of us do not have internet access to multiple medical journals. Citing the publication and article would give us the chance to perhaps look it up at the library. I'm curious what you are referring to but can't look it up. Thanks for considering it. Esbullin (talk) 22:02, 9 March 2009 (UTC)[reply]
Well yes but to be fair to the good Dr you could have copied the link, googled it, and found this: http://www.ncbi.nlm.nih.gov/pubmed/15321901 which tells you this: BMJ. 2004 Aug 21;329(7463):434. Using the NO TEARS tool for medication review. Lewis T., none of which took very long. Yay, woo, etc, hope this helps. Cheers, 92.19.161.66 (talk) 22:19, 9 March 2009 (UTC)[reply]

Dead Link

At the very bottom: http://www.med.unc.edu/aging/polypharmacy/ 68.14.57.240 (talk) 13:45, 2 April 2008 (UTC)[reply]

At risk vs. Least at risk

I'm new here, so I hope I did this right. I reverted the previous change from "at risk" to "least at risk" demographic groups, since the change didn't make sense (psychiatric and disabled people were included in both groups) and since one of the references appears to have been vandalized. I included Cooldesk's addition regarding education but switched it from high education being a protective factor to low education being a risk factor. ratman (talk) 22:33, 22 May 2008 (UTC)[reply]

Queen's University Student Editing

Hello, we are a group of medical student’s from Queen’s University. We are working to improve this article over the next month and will posting our planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. Doannghi.dl (talk) 20:16, 11 November 2019 (UTC)[reply]

Queen's University Student Editing

Hello, we are a group of medical students editing this page as part of our class assignment. We have compiled a list of suggestions to improve this article and would appreciate community feedback before we proceed with these edits. Below is a list of our suggestions. Text in italics will be removed from the original article. References that we will insert are cited here, existing citations are indicated only by square brackets and reference numbers:

We propose to replace the following content in the Polypharmacy#Medical Uses section:

Considerations often associated with thoughtful, therapeutic polypharmacy include: 1. Drugs given for a single somatic locale act on biochemical mechanisms present throughout the body such that their nonlinear interactions can produce an (unknown except empirically) global physiological state of health;[16] 2. The more independent variables, "handles", to manipulate, the greater the likelihood of finding and stabilizing a small available parametric space of healthy function while minimizing unwanted effects.[17]

While polypharmacy is typically regarded as undesirable, prescription of multiple medications can be appropriate and therapeutically beneficial in some circumstances. “Appropriate polypharmacy” is described as prescribing for complex or multiple conditions in such a way that necessary medicines are used according to best evidence to preserve safety and well-being. Polypharmacy is clinically indicated in some conditions, including diabetes mellitus, but should be discontinued when evidence of benefit from the prescribed drugs no longer outweighs potential for harm (described below in Contraindications).[1]

We propose to replace the following content in the Polypharmacy#Contraindications section:

Polypharmacy is associated with an increased risk of falls in the elderly. Certain medications are well known to be associated with the risk of falls, including cardiovascular and psychoactive medications. The use of four or more of these medicines is known to be associated with a significantly higher, cumulative risk of falls. Although often not practical to achieve, withdrawing all medicines associated with falls risk can halve an individual's risk of future falls.

Polypharmacy is associated with an increased risk of falls in the elderly.[2][3] Certain medications are well known to be associated with the risk of falls, including cardiovascular and psychoactive drugs.[4][5] There is some evidence that the risk of falls increases cumulatively with the number of medications.[6][7]

We propose to replace the following content in the Polypharmacy#Contraindications section:

Every medication has potential adverse side-effects. With every drug added, there is an additive risk of side-effects. Also, many medications have potential interactions with other substances. 15% of older adults are potentially at risk for a major drug-drug interaction.[18] When a new drug is prescribed, the risk of interactions increases exponentially. Doctors and pharmacists aim to avoid prescribing medications that interact; often, adjustments in the dose of medications need to be made to avoid interactions, such as with warfarin, as it may lose its effect.

Every medication has potential adverse side-effects. With every drug added, there is an additive risk of side-effects. Also, many medications have potential interactions with other substances. 15% of older adults are potentially at risk for a major drug-drug interaction.[18] Older adults are at a higher risk for a drug-drug interaction due to the increased number of medications prescribed and metabolic changes that occur with aging.[8] When a new drug is prescribed, the risk of interactions increases exponentially. Doctors and pharmacists aim to avoid prescribing medications that interact; often, adjustments in the dose of medications need to be made to avoid interactions. For example, warfarin interacts with many medications and supplements that can cause it to lose its effect.[9]

We propose to insert the following content into the Polypharmacy#Pill burden section:

Barriers faced by both physicians and patients have made it challenging to apply deprescribing strategies in practice.[10] For physicians, these include fear of consequences of deprescribing, the prescriber’s own confidence in their skills and knowledge to deprescribe, the feasibility of deprescribing, and the complexity of having multiple providers.[11][12] For patients, attitudes or beliefs about the medications, fears and uncertainties surrounding deprescribing, and influence of physicians, family, and the media are also reported barriers to deprescribing.[13]

We propose to replace the following content in the Polypharmacy#Pill burden section:

For instance, adults with multiple common chronic conditions such as diabetes, hypertension, lymphedema, hypercholesterolemia, osteoporosis, constipation, and clinical depression can often be prescribed more than a dozen different medications daily.

For instance, adults with multiple common chronic conditions such as diabetes, hypertension, lymphedema, hypercholesterolemia, osteoporosis, constipation, inflammatory bowel disease, and clinical depression can often be prescribed more than a dozen different medications daily.[14]

We propose to insert the following content into the Polypharmacy#Pill burden section:

The use of memory tricks has also been seen to improve adherence and reduce pill burden in several countries.[15] These include associating mealtimes with medications with mealtimes, recording the dosage on the box, storing the medication in a special place, leaving it in plain sight in the living room, or putting the prescription sheet on the refrigerator. The development of applications has also shown some benefit in this regard.

We propose to insert the following content into the Polypharmacy#Intervention section:

Deprescribing was also deemed feasible and effective in other settings such as residential care, communities and hospitals. This preventative measure should be considered for anyone who exhibits one of the following: (1) a new symptom or adverse event arises, (2) when the person develops an end-stage disease, (3) if the combination of drugs is risky, or (4) if the disease doesn’t get worse if the patient stops taking the drug.[16]

  1. ^ Polypharmacy and medicines optimisation : making it safe and sound. ISBN 9781909029187.
  2. ^ WHO global report on falls prevention in older age. World Health Organization. ISBN 9789241563536.
  3. ^ Seniors' falls in Canada. Second report. ISBN 9781100232614.
  4. ^ Park, H; Satoh, H; Miki, A; Urushihara, H; Sawada, Y (December 2015). "Medications associated with falls in older people: systematic review of publications from a recent 5-year period". European journal of clinical pharmacology. 71 (12): 1429–40. doi:10.1007/s00228-015-1955-3. PMID 26407688.
  5. ^ de Vries, M; Seppala, LJ; Daams, JG; van de Glind, EMM; Masud, T; van der Velde, N; EUGMS Task and Finish Group on Fall-Risk-Increasing, Drugs. (April 2018). "Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs". Journal of the American Medical Directors Association. 19 (4): 371.e1-371.e9. doi:10.1016/j.jamda.2017.12.013. PMID 29396189.
  6. ^ Zia, A; Kamaruzzaman, SB; Tan, MP (April 2015). "Polypharmacy and falls in older people: Balancing evidence-based medicine against falls risk". Postgraduate medicine. 127 (3): 330–7. doi:10.1080/00325481.2014.996112. PMID 25539567.
  7. ^ Fried, TR; O'Leary, J; Towle, V; Goldstein, MK; Trentalange, M; Martin, DK (December 2014). "Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review". Journal of the American Geriatrics Society. 62 (12): 2261–72. doi:10.1111/jgs.13153. PMID 25516023.
  8. ^ Merel, SE; Paauw, DS (July 2017). "Common Drug Side Effects and Drug-Drug Interactions in Elderly Adults in Primary Care". Journal of the American Geriatrics Society. 65 (7): 1578–1585. doi:10.1111/jgs.14870. PMID 28326532.
  9. ^ Merel, SE; Paauw, DS (July 2017). "Common Drug Side Effects and Drug-Drug Interactions in Elderly Adults in Primary Care". Journal of the American Geriatrics Society. 65 (7): 1578–1585. doi:10.1111/jgs.14870. PMID 28326532.
  10. ^ Reeve, E; Thompson, W; Farrell, B (March 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. doi:10.1016/j.ejim.2016.12.021. PMID 28063660.
  11. ^ Reeve, E; Thompson, W; Farrell, B (March 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. doi:10.1016/j.ejim.2016.12.021. PMID 28063660.
  12. ^ Anderson, K; Stowasser, D; Freeman, C; Scott, I (8 December 2014). "Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis". BMJ open. 4 (12): e006544. doi:10.1136/bmjopen-2014-006544. PMID 25488097.
  13. ^ Reeve, E; Thompson, W; Farrell, B (March 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. doi:10.1016/j.ejim.2016.12.021. PMID 28063660.
  14. ^ Ha, CY (February 2014). "Medical management of inflammatory bowel disease in the elderly: balancing safety and efficacy". Clinics in geriatric medicine. 30 (1): 67–78. doi:10.1016/j.cger.2013.10.007. PMID 24267603.
  15. ^ Pérez-Jover, V; Mira, JJ; Carratala-Munuera, C; Gil-Guillen, VF; Basora, J; López-Pineda, A; Orozco-Beltrán, D (10 February 2018). "Inappropriate Use of Medication by Elderly, Polymedicated, or Multipathological Patients with Chronic Diseases". International journal of environmental research and public health. 15 (2). doi:10.3390/ijerph15020310. PMID 29439425.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  16. ^ Page, AT; Clifford, RM; Potter, K; Schwartz, D; Etherton-Beer, CD (September 2016). "The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis". British journal of clinical pharmacology. 82 (3): 583–623. doi:10.1111/bcp.12975. PMID 27077231.

Thank you. We appreciate your time and welcome any feedback or suggestions Jnt91 (talk) 02:29, 19 November 2019 (UTC)[reply]

Thank you for sharing these proposed article improvements. Great job adding your references and formatting this in a way that it is clear to the community what you propose to add.JenOttawa (talk) 15:25, 20 November 2019 (UTC)[reply]

Is the picture nessecary?

In the picture we see multiple different German brands of methlyphenidate, does it improve the article to show multiple different forms of the same medication? This may confuse readers as to what polypharmacy is.

2A02:8388:C80:6280:8C01:DA28:EB56:B812 (talk) 15:49, 30 July 2020 (UTC)[reply]

Completely agree. The photo is *not* an example of polypharmacy as they're all the same drug.73.61.14.10 (talk) 14:25, 11 September 2020 (UTC)[reply]

Queen's University Student Editing Initiative

Hello, we are a group of medical students from Queen's University. We are working to improve this article over the next month and will be posting planned changes on this talk page. We look forward to working with the existing Wikipedia medical editing community to improve this article and share evidence. We welcome feedback and suggestions as we learn to edit. Thank you. 4js82bv73kd8 (talk) 20:19, 23 November 2020 (UTC)[reply]

1. Interventions

We propose to replace the following content in the Polypharmacy#Interventions section: It is unclear if specific interventions to improve adequate polypharmacy in older adults have significant clinical results; they seem to reduce inappropriate prescribing and medication-related problems in early research, but more research is needed. The effectiveness of specific interventions to improve the appropriate use of polypharmacy such as pharmaceutical care and computerised decision support is unclear. This is due to low quality of current evidence surrounding these interventions [1]

Thanks for the suggestion. This is just a small thing, but please be sure to include the citation immediately after the punctuation, with not spaces, like this.[1]

References

  1. ^ a b Rankin, A; Cadogan, CA; Patterson, SM; Kerse, N; Cardwell, CR; Bradley, MC; Ryan, C; Hughes, C (3 September 2018). "Interventions to improve the appropriate use of polypharmacy for older people". The Cochrane database of systematic reviews. 9: CD008165. doi:10.1002/14651858.CD008165.pub4. PMID 30175841.

We propose to remove the following content in the Polypharmacy#Interventions section: A team approach is a relatively new method gaining popularity due to its effectiveness in managing patient care and obtaining the best outcomes. A team can include a primary provider, pharmacist, nurse, counselor, physical therapist, chaplain and others involved in patient care. Combining the ideas and points of view of the different providers allows a more holistic approach to the health of a patient. In 2013, the United States legislature mandated that every Medicare D patient receive an annual Medication Therapy Management (MTM) review by a team of healthcare professionals.[40] Mfo1209 (talk) 17:18, 4 December 2020 (UTC)[reply]

Thanks for this suggestion @Mfo1209:. Great work so far! When you are adding your citation to the actual wikipedia article, please review the notes on how to auto-populate the entire citation field (versus just sharing the PMID). You can paste in your PMID and then click "generate" so that the other details are pulled from MedLine. Please see the lecture from last week for the details or send me a message if you need help. Here is what your citation looks like when you use the tool.[1]JenOttawa (talk) 17:22, 4 December 2020 (UTC)[reply]

References

  1. ^ Rankin, Audrey; Cadogan, Cathal A.; Patterson, Susan M.; Kerse, Ngaire; Cardwell, Chris R.; Bradley, Marie C.; Ryan, Cristin; Hughes, Carmel (2018). "Interventions to improve the appropriate use of polypharmacy for older people". The Cochrane Database of Systematic Reviews. 9: CD008165. doi:10.1002/14651858.CD008165.pub4. ISSN 1469-493X. PMC 6513645. PMID 30175841.

2. Lead

We propose to restructure the following content in the Polypharmacy#Introduction section: Reorganize the introduction as follows: definition, prevalence, disadvantages, advantages.

We propose to reorganize the first two paragraphs such that the definition alone appears in the first paragraph and shift down the sentences starting with “Polypharmacy is most common in the elderly…” and ending with “…decreased mobility and cognition” to a second paragraph.

Hi! by introduction, I am assuming you mean the lead of the article (the Wikipedia term for introduction)? Before you change around the lead, please consult the following Wikipedia Guideline: https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Lead_section that includes suggestions for order, inclusions/exclusions etc. @Megan1130:JenOttawa (talk) 18:02, 4 December 2020 (UTC)[reply]

We propose to add the following updated definition in the Polypharmacy#Introduction section: a. “Polypharmacy is most commonly defined as the use of five or more medications daily by an individual. However, the definition of polypharmacy is still debated and can vary from two to 11 concurrent medications. Some studies also generally define polypharmacy as the use of multiple concurrent medications or simultaneous long term use of different drugs by the same individual”.[1]

b. We propose to replace the following content in the Polypharmacy#Introduction section:Polypharmacy is most common in the elderly, affecting about 40% of older adults living in their own homes.

The prevalence of polypharmacy is estimated to be between 10% and 90% depending on the definition used, the age group studied, and the geographic location.[2] 4js82bv73kd8 (talk) 20:46, 4 December 2020 (UTC)[reply]

Hi, it is not clear what you are replacing here. Is this sentence your new sentence? If so, do you mind including your reference so that it can also be considered by the community before you edit? If you have any questions please do not hesitate to reach out.JenOttawa (talk) 17:58, 4 December 2020 (UTC)[reply]

References

  1. ^ Masnoon, N; Shakib, S; Kalisch-Ellett, L; Caughey, GE (10 October 2017). "What is polypharmacy? A systematic review of definitions". BMC geriatrics. 17 (1): 230. doi:10.1186/s12877-017-0621-2. PMID 29017448.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  2. ^ Khezrian, M; McNeil, CJ; Murray, AD; Myint, PK (2020). "An overview of prevalence, determinants and health outcomes of polypharmacy". Therapeutic advances in drug safety. 11. doi:10.1177/2042098620933741. PMID 32587680.

3. Medical uses

We propose to replace the following content in the Polypharmacy#Medical Uses section:

Change the heading “Medical Uses” to “Appropriate Medical Uses”.

Hi! @Megan1130: Most headings and subheadings in Wikipedia are suggested to follow the Medical Manual of Style (WP:MEDMOS). For drugs, it is suggested that Polypharmacy#Medical uses be used as per this list: https://en.wikipedia.org/wiki/Wikipedia:Manual_of_Style/Medicine-related_articles#Drugs,_treatments,_and_devices. Also, Wikipedia has chosen the style that only the first word in a heading have a capital letter. This is just a small thing. So the subheading would look like Medical uses. These are just small Wikipedia things, some have explanations, some are just set this way in order to somewhat standardize article. If you have any questions please let me know. JenOttawa (talk) 17:58, 4 December 2020 (UTC)[reply]

References

Hi! @JenOttawa: Thank-you for sharing this link, the headings in the article make sense after seeing this. We opted to change this after all, as polypharmacy itself is not a specific drug, and we felt that this structure didn't allow for the clearest possible communication.

4. Contraindications

We propose to replace the following content in the Polypharmacy#Contraindications Uses section:

Remove the “Special Populations” subheading from “Contraindications” to create its own section.[User:Megan.McGill|Megan.McGill]] (talk • contribs) 17:38, 4 December 2020 (UTC)[reply]

I agree with removing special populations. Instead, I'd recommend changing it to Vulnerable Populations. Pablosuarez ucsf (talk) 21:15, 16 September 2022 (UTC)[reply]

5. Pill burden

We propose to replace the following content in the Polypharmacy#Pill Burden section:

a. “High pill burden decreases compliance with drug therapy, resulting from the need to take a large quantity of pills or other forms of medication on a regular basis.”

Poor medical adherence is a common challenge among individuals who have increased pill burden and are subject to polypharmacy[1]

b. “The use of a polypill regimen as opposed to a multi-pill regimen also alleviates pill burden and increases adherence.”[2]

c. Remove the following sentences: (i)“The adverse reactions of these combinations of drugs are not reliably predictable. Obesity is implicated in many of the aforementioned conditions, and it is not uncommon for a clinically obese patient to receive pharmacologic treatment for all of these.Because common conditions tend to accumulate in the elderly, pill burden is a particular issue in geriatrics”

d. Change the sentence: “The adverse reactions of these combinations of drugs are not reliably predictable” Proposed change: “The combination of multiple drugs has been associated with an increased risk of adverse drug events”[3]

References

  1. ^ Baumgartner, A; Drame, K; Geutjens, S; Airaksinen, M (22 February 2020). "Does the Polypill Improve Patient Adherence Compared to Its Individual Formulations? A Systematic Review". Pharmaceutics. 12 (2). doi:10.3390/pharmaceutics12020190. PMID 32098393.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  2. ^ Baumgartner, A; Drame, K; Geutjens, S; Airaksinen, M (22 February 2020). "Does the Polypill Improve Patient Adherence Compared to Its Individual Formulations? A Systematic Review". Pharmaceutics. 12 (2). doi:10.3390/pharmaceutics12020190. PMID 32098393.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  3. ^ Maher, Robert L.; Hanlon, Joseph; Hajjar, Emily R. (January 2014). "Clinical consequences of polypharmacy in elderly". Expert Opinion on Drug Safety. 13 (1): 57–65. doi:24073682. {{cite journal}}: Check |doi= value (help)

Wiki Education assignment: UCSF SOM Inquiry In Action-- Wikipedia Editing 2022

This article was the subject of a Wiki Education Foundation-supported course assignment, between 8 August 2022 and 20 September 2022. Further details are available on the course page. Student editor(s): Awalzzz, Haleygamboa (article contribs). Peer reviewers: Pablosuarez ucsf, Ninannoah123.

— Assignment last updated by Ninannoah123 (talk) 00:57, 19 September 2022 (UTC)[reply]

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