Summary
Polypharmacy occurs when a medical regimen includes at least one unnecessary medication. Factors that contribute to this problem include: patient characteristics of increasing age, multiple medical problems, therapy expectations, and decisions to self-treat; physician factors such as excessive prescribing; and system problems of multiple providers and lack of a coordinating provider. Complications include increased adverse drug reactions and noncompliance, which can lead to increased hospitalization and associated costs. Polypharmacy can be avoided by patient education and sharing the decisions for making the treatment goals and plan. The medication regimen can be simplified by eliminating pharmacologic duplication, decreasing dosing frequency, and regular review of the drug regimen. The goal should be to prescribe the least complex drug regimen for the patient as possible, while considering the medical problems and symptoms and the cost of therapy.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Stedman’s medical dictionary, 24th ed. Baltimore: Williams and Wilkins, 1984.
Omori DM, Potyk RP, Kroenke K. The adverse effects of hospitalization on drug regimens. Arch Intern Med. 1991;151:1562–4.
Kroenke K, Pinholt E. Reducing polypharmacy in the elderly: a controlled trial of a physician feedback. J Am Geriatr Soc. 1990;38:31–6.
Britton ML, Lurvey PL. Impact of medication profile review on prescribing in a general medicine clinic. Am J Hosp Pharm. 1991;48:256–70.
Meyer TJ, Van Kooten D, Marsh S, Prochaza AV. Reduction of polypharmacy by feedback to clinicians. J Gen Intern Med. 1991;6:133–6.
Beers MH, Ouslander JG. Risk factors in geriatric drug prescribing: a practical guide to avoiding problems. Drugs. 1989;37:105–12.
Colt HG, Shapiro AP. Drug-induced illness as a cause for admission to a community hospital. J Am Geriatr Soc. 1989;37:323–6.
Cadieux RJ. Drug interactions in the elderly. Postgrad Med. 1989;86:179–86.
Nolan L, O’Malley K. Prescribing for the elderly: part II. Prescribing patterns: differences due to age. J Am Geriatr Soc. 1988;36:245–54.
Health Care Financing Administration. Expenses incurred by Medicare beneficiaries for prescription drugs. Washington, DC: Department of Health and Human Services, 1989;May:29.
German PS, Burton LC. Medication and the elderly. J Ageing Health. 1989;1:4–34.
Shimp LA, Ascione FJ, Glazer HM, Atwood BF. Potential medication-related problems in non-institutionalized elderly. Drug In-tell Clin Pharm. 1985;19:766–72.
Grymonpre RE, Mitenko PA, Sitar DS, Aoki FY, Montgomery PR. Drug-associated hospital admissions in older medical patients. J Am Geriatr Soc. 1988;36:1092–8.
Melmon KX. Preventable drug reactions: causes and cures. N Engl J Med. 1971;284:1361–5.
Harris DW, Karandikar DS, Spencer MG. Returned medicines campaign in Birmingham. Lancet. 1979;1:599–601.
Nolan L, O’Malley K. Prescribing for the elderly: part I. Sensitivity of the elderly to adverse drug reactions. J Am Geriatr Soc. 1988;36:142–9.
Kellaway GSM, McCrae E. Intensive monitoring for adverse drug effects in patients discharged from acute medical wards. N Z Med J. 1973;78:525–8.
Williamson J, Chopin JM. Adverse reactions to prescribed drugs in the elderly: a multicentre investigation. Age Ageing. 1980;9:73–80.
McInnes GT, Brodie MJ. Drug interactions that matter. A critical reappraisal. Drugs. 1988;36:83–110
Eraker SA, Kirscht JP, Becker MH. Understanding and improving patient compliance. Ann Intern Med. 1984;100:258–68.
Stewart RB, Cluff LE. A review of medication errors and compliance in the ambulant patient. Clin Pharmacol Ther. 1972;13:463–8.
Bergman AB, Werner RJ. Failure of children to receive penicillin by mouth. N Engl J Med. 1963;268:1334–8.
Morrow D, Leirer V, Sheikh J. Adherence and medication instructions. Review and recommendations. J Am Geriatr Soc. 1988;36:1147–60.
Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med. 1990;150:841–5.
German PS, Klein LE. Drug side effects and doctor/patient relationship among elderly patients. J Soc Admin Pharm. 1984;2:67–73.
Leape LL, Brennan TA, Laird N, et al. The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med. 1991;324:377–84.
Soumerai SB, Avorn J. Efficacy and cost-containment in hospital pharmacotherapy: state of the art and future directions. Milbank Q. 1984;62:447–74.
Monson R, Bond CA, Schuna A. Role of the clinical pharmacist in improving drug therapy. Clinical pharmacists in outpatient therapy. Arch Intern Med. 1981;141:1441–4.
Bond CA, Monson R. Sustained improvement in drug documentation compliance, and disease control. A four year analysis of an ambulatory care model. Arch Intern Med. 1984;144:1159–62.
Carter BL, Helling DK, Jones ME, Moessner H, Waterbury CA. Evaluation of family physician prescribing: influence of the clinical pharmacist. Drug Intell Clin Pharm. 1984;18:817–21.
Koepsell TD, Gurtel AL, Diehr PH, et al. The Seattle evaluation of computerized drug profiles: effects on prescribing practices and resource use. Am J Public Health. 1983;73:850–5.
Johnson RE, Campell WH, Azevedo DJ, Christensen DB. Studying the impact of patient drug profiles in an HMO. Med Care. 1976;14:799–807.
Hershey CO, Porter DK, Breslau D, et al. Influence of simple computerized feedback on prescription charges in an ambulatory clinic. Med Care. 1986;24:472–81.
Avorn J, Soumerai SB. Improving drug therapy decisions through educational outreach: a randomized controlled trial of academically-based “detailing”. N Engl J Med. 1983;308:1457–63.
Tamai IY, Rubenstein LZ, Josephson KR, Yamaguchi JA. Impact of computerized drug profiles and a consulting pharmacist on outpatient prescribing patterns: a clinical trial. Drug Intell Clin Pharm. 1987;21:890–5.
Rodriguez LR, Halperin AK, Gordon B, Weber C. An ambulatory care clinic to control polypharmacy. VA Pract. 1987;4:61–70.
Mason J, Colley CA. Cost effectiveness of an ambulatory care clinical pharmacist [abstract]. Presented at the American Society of Hospital Pharmacists Midyear Clinical Meeting, New Orleans, LA, December 11, 1991.
Eisen SA, Miller DK, Woodward RS, et al. The effect of prescribed daily dose frequency on patient medication compliance. Arch Intern Med. 1990;150:1881–4.
Cooper JK, Love DW, Raffoul PR. Intentional prescription non-adherence (noncompliance) by the elderly. J Am Geriatr Soc. 1982;30:329–33.
Kazis LE, Friedman RH. Improving medication compliance in the elderly—strategies for the health care provider. J Am Geriatr Soc. 1988;36:1161–2.
Kitchin LI, Castell DO. Rationale and efficacy of conservative therapy for gastroesophageal reflux disease. Arch Intern Med. 1991;151:448–54.
Gillin JC, Byerly WF. The diagnosis and management of insomnia. N Engl J Med. 1990;322:239–48.
Van Deventer GM, Schneidman D, Walsh JM. Sucralfate and cimetidine as single agents and in combination for the treatment of active duodenal ulcer. Am J Med. 1985;79(suppl 2C):39–44.
Takemoto T, Kimura K, Okita K, et al. Efficacy of sucralfate in the prevention of recurrence of peptic ulcer—a double blind multicenter study with cimetidine. Scand J Gastroenterol. 1987;22(suppl 140):49–60.
Schotborough RH, Hameeteman W, Dekker W, et al. Combination therapy of sucralfate and cimetidine, compared with sucralfate monotherapy, in patients with peptic reflux esophagitis. Am J Med. 1989;86(suppl 6A):77–80.
Wandless I, Muckow JC, Smith A, et al. Compliance with prescribed medicines: a study of elderly patients in the community. J R Coll Gen Pract. 1979;29:391–6.
Widmer RB, Cadoret R, Troughton E. Compliance characteristics of 291 hypertensive patients from a rural Midwest area. J Fam Pract. 1983;17:619–25.
Luxenburg J, Feigenbaum LZ. The use of reserpine for elderly hypertensive patients. J Am Geriatr Soc. 1983;31:556–9.
Peck CL, King NJ. Increasing patient compliance with prescriptions. JAMA. 1982;248:2874–7.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Colley, C.A., Lucas, L.M. Polypharmacy. J Gen Intern Med 8, 278–283 (1993). https://doi.org/10.1007/BF02600099
Issue Date:
DOI: https://doi.org/10.1007/BF02600099