Polypharmacy, the simultaneous use of multiple drugs to treat a single ailment or condition, is a major health problem among the elderly population that contributes to adverse drug side events, health risks, hospital readmissions, morbidity, and mortality. Therefore, a staff education program geared toward reduction of such adverse drug events was implemented at a single site. The purpose of the project was to determine if the staff education program would increase knowledge of adverse drug events due to geriatric polypharmacy. The Orem theory provided the theoretical support for the project, and the Iowa model guided the evidence-based practice change process. Topics covered in the education program included medication safety, appropriate drug usage, medication interactions, and other use issues of commonly prescribed drugs for elderly patients. Twenty staff members from 1 assisted-living facility were recruited for the education intervention. Assessments of staff member knowledge were collected before and after the education intervention. Descriptive statistics were used to compare preintervention and postintervention knowledge. Scores on the pretest ranged from 10% to 50% correct on the 10 items, and posttest scores ranged from 40% to 70% correct on the same items. The project is expected to produce social change due to reduced incidence of geriatric polypharmacy and, ultimately, decreased adverse drug effects resulting in patient morbidity, hospitalization, and mortality.

Adequate medication management is a focus of effective care that is often overlooked in caring for adults with comorbid psychiatric and physical conditions, especially in patients who are treated by multiple care providers and have a variety of health issues at the same time. The purpose of this project was to develop evidence-based policies and practice guidelines to reduce polypharmacy in elderly patients in a rural outpatient psychiatric clinic. Bandura's self-efficacy theory was used to inform the project for its value in assessing motivation, capacity for self-regulation, and perceptions of individual ability. An interdisciplinary team of stakeholders explored best practices for electronic health records (EHR) in a rural mental health facility, created policy and practice guidelines, and developed implementation and evaluation plans to guide the initiative as it moves forward. The team included physicians, psychiatrists, psychologists, nurse practitioners, nursing support staff, social workers, and substance abuse counselors. The team explored approaches for implementing EHR-based medication management based on research in the current literature and goals/objectives of each department. Team members identified major issues and proposed guideline changes based on evidence in their own fields. The team then collaborated to develop policies and practice guidelines in a series of meetings designed to build consensus for supporting a unified set of products to be accepted by all departments. The resulting policies and practice guidelines are accompanied by plans for implementation and evaluation that provide the institution with a comprehensive solution to polypharmacy in elderly patients. This project may improve overall quality of care by reducing medication and preventing health complications related to polypharmacy.

Introduction:  If a person uses many different drugs at the same time it can be termed “polypharmacy”. Polypharmacy is mostly seen in the elderly and often associated with negative aspects of drug treatment. Some negative consequences of using many drugs are a higher risk of drug-drug interactions and side effects and a lower patient compliance. The number of drugs defining polypharmacy can vary. But what does the number really tell? Aim:  The aim of this work is to get a better picture of the medication of the elderly in Sweden and Germany. Which are the most common drugs used by the elderly with excessive polypharmacy (use of 10 or more drugs) in Sweden and Germany? Materials and Methods: A cross-sectional observational study was done using individual based drug dispensing data on elderly 65 years and older from the Swedish Prescribed Drug Register (1,4 million elderly) and Germany’s (AOK) drug register (5,3 million elderly). Period prevalence for the time interval October to December 2010 was calculated. Results:  Many interesting differences were found comparing the drug treatment of the elderly with excessive polypharmacy in Sweden and Germany. In Sweden the most common drugs for this population were paracetamol (56%), acetylsalicylic acid (52%) and furosemide (42%), in Germany the use of torasemide (35%), simvastatin (35%) and pantoprazole (33%) dominated. Differences between the countries can partly depend on how common a disease is in a country, but also which drugs are available as OTC-drugs, the availability of guidelines/formularies and how physicians in a country follow them and differences in the availability of drugs in the market. Conclusions:  When assessing drug use in terms of polypharmacy, the focus should not lie on the amount of drugs; the importance is which drugs are administered. Through international comparisons strengths and weaknesses of different countries’ drug treatment of the elderly can be found. The countries should support each other and make interventions. Hopefully a better drug treatment will be reached.

Syftet var att beskriva vilka omvårdnadsproblem som kan uppstå i samband med polyfarmacihos äldre personer. Litteraturstudien gjordes med beskrivande design. Datainsamling viadatabaserna PubMed och Cinahl. Resultatet baserades på 12 kvantitativa artiklar. Resultatetvisade att det fanns samband mellan polyfarmaci och flera specifika omvårdnadsproblembland äldre personer. Det omvårdnadsproblem som förekom mest bland de artiklar somstuderades var fall och frakturer. Det framkom att antalet använda läkemedel kundeidentifieras som en riskfaktor för fall och fraktur, men även att läkemedelstyp kunde påverka.Resultatet visade också att yrsel och balanssvårigheter kunde ha ett samband medpolyfarmaci. Andra omvårdnadsproblem som kunde kopplas samman med polyfarmaci varförsämrad nutritionsstatus, så som viktnedgång och undernäring. Det fanns också en kopplingmellan gastrointestinala problem och användandet av många läkemedel. Slutsatsen var att detfanns samband mellan polyfarmaci och flera omvårdnadsproblem bland äldre personer. Totaltfyra kategorier av omvårdnadsproblem identifierades utifrån de studerade artiklarna: fall ochfraktur, försämrad nutritionsstatus och malnutrition, mag- och tarmproblematik samt yrseloch balanssvårigheter. / The aim was to describe the nursing problems that may arise in connection withpolypharmacy in the elderly. The literature review was done with descriptive design. Datacollection through PubMed and Cinahl. The result was based on 12 quantitative articles. Theresults showed that there was a correlation between polypharmacy and several specificnursing problems among older people. The nursing problems that occurred most among thestudied articles were falls and fractures. It was revealed that the number of used medicinescould be identified as a risk factor for falls and fractures, but also drug type could influence.The results also showed that dizziness and balance problems could be associated withpolypharmacy. Other nursing problems that could connect with polypharmacy was impairednutritional status, such as weight loss and malnutrition. There were also a connection betweengastrointestinal problems and usage of many drugs. The conclusion was that a correlationbetween polypharmacy and several nursing problems among older people were found. A totalof four categories of nursing problems were identified in the studied articles: falls andfractures, impaired nutritional status and malnutrition, gastrointestinal problems, dizzinessand balance problems.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

O Diabetes Mellitus Tipo 2 (DM 2) e um distÃrbio endÃcrino de difÃcil tratamento. A terapia medicamentosa visa manter o controle metabÃlico necessÃrio para reduzir o risco de complicaÃÃes crÃnicas, bem como melhorar a qualidade de vida dos portadores desse agravo. Por ser um distÃrbio metabÃlico progressivo e complexo, a evoluÃÃo do diabetes depende do manejo do paciente relativo ao seu tratamento, muitas vezes demandando o uso da polifarmÃcia, para manter a normoglicemia. O objetivo do estudo foi avaliar a ocorrÃncia de adesÃo ou nÃo ao tratamento farmacolÃgico e a correlaÃÃo com a polifarmÃcia entre os pacientes com diabetes tipo 2 atendidos na rede pÃblica de saÃde no municÃpio de Fortaleza, CearÃ. Trata-se de um estudo transversal e exploratÃrio, constituÃdo por 235 portadores de DM Tipo 2, selecionados de forma sequenciada durante o atendimento no Centro de SaÃde AnastÃcio MagalhÃes (CSAM) (116/235) e AmbulatÃrio de Diabetes do Hospital UniversitÃrio Walter CantÃdeo (HUWC) (119/235). Para mensurar a prevalÃncia e adesÃo ao tratamento foi empregado o mÃtodo do autorrelato sendo considerado adesÃo adequada quando o paciente relatava fazer uso de pelo menos 90% do tratamento proposto. A polifarmÃcia foi definida como a utilizaÃÃo de 2 ou mais medicamentos e classificada em polifarmÃcia alta (acima de 5 medicamentos), moderada (4 a 5 medicamentos) e baixa (2 a 3 medicamentos). Para a anÃlise dos dados, foram utilizados os programas estatÃsticos Stata e Graph pad prism 5.0, sendo aplicado os testes t de Student, qui-quadrado e ANOVA com nÃvel de significÃncia com p<0,05. O grupo estudado foi constituÃdo em sua maioria por indivÃduos do gÃnero feminino 68,9%, com media de idade de 59,3 anos ( 12,7), a maioria casados (51,9%), com predomÃnio de baixa escolaridade e renda (48,4% com 5 a 9 anos de estudo e 49,5% com mÃdia familiar de 1 salÃrio mÃnimo. A principal comorbidade verificada foi a hipertensÃo arterial (30%), a complicaÃÃo crÃnica mais incidente foi a retinopatia diabÃtica (36,5%). A maioria dos pacientes (50,2%) tinha entre 1 e 10 anos de doenÃa e relatava ter apoio familiar na conduÃÃo do tratamento (62%). A terapia com polifarmÃcia foi evidenciada em 88,4% dos casos, havendo predomÃnio de polifarmÃcia moderada. Foram utilizados em mÃdia 7,5 comprimidos por pessoa dentre 19 tipos de fÃrmacos prescritos. A adesÃo a terapÃutica prescrita foi relatada por 88,2% dos pacientes avaliados, nÃo havendo associaÃÃo com a polifarmÃcia. A partir destes dados, se conclui que a polifarmÃcia à uma condiÃÃo de elevada prevalÃncia e que nÃo està invariavelmente associada a pior adesÃo a terapÃutica. Embora a combinaÃÃo de fÃrmacos de modo racional possa maximizar a eficiÃncia do tratamento, deve-se dispensar atenÃÃo especial aos perfis clinico-epidemiolÃgicos de maior potencial de benefÃcio. / The Diabetes Mellitus type 2 (DM2) is an worldwide endocrine disorder. The therapy drug-based aims maintain metabolic control and improving the quality of life (QoL) of patients. The evolution of diabetes depends upon the management of the treatment by the patient, requiring the use of polypharmacy to maintain the levels of the glucose. We evaluated the occurrence of adherence or non-adherence to the drug therapy and the correlation with polypharmacy among patients with DM2 treated in the public system healthcare in Fortaleza, CearÃ. The study was designed as exploratory cross-sectional comprising 235 patients with DM2, selected during the interview in the Health Centre Outpatient AnastÃcio MagalhÃes and University Hospital Walter Cantidio. The data were collected by self-report method. The criteria to adherence was considered follow at least 90% of the proposed treatment. Polypharmacy was defined as the use of two or more drugs and classified as; high (>5), moderate (4 to 5) and low (2 to 3) drugs. The statistical analysis was performed using Stata 5.0 and Graph pad prism 5.0, tests used were the Student t test, chi-square, ANOVA, with significance level of 95% (p <0.05). The study group consisted of 68.9% women, mean age of 59.3 years ( 12.7), mostly married (51.9%), with a predominance of few years of education and low income (48.4 % with 5-9 years of education and 49.5% with an average family of 1 minimum wage. We assessed the comorbidities and the results was the retinopathy (36.5%) as the most frequent complication followed by hypertension (30%). Furthermore most patients (50.2%) had between 1 and 10 years of disease and reported to have family support in the conduct of treatment (62%). Regarding the polypharmacy therapy was observed in 88.4% of cases, with a prevalence of moderate type. Were used on average 7.5 pills/person among 19 types of prescribed drugs. Adherence to prescribed therapy was reported by 88.2% of patients, with no association to polypharmacy. These results indicate that polypharmacy is a highly prevalent condition and is not invariably associated with poor adherence to therapy. Although the combination of drugs in a rational way often can maximize the efficiency of treatment, has to consider the clinical-epidemiologic profiles as greatest potential benefit.

Polypharmacy, the use of five or more medications, is a public health epidemic that leads to high health care utilization and costs in older adults globally. Health care organizations and professionals have used interdisciplinary collaboration (IC) interventions to reduce polypharmacy and health care costs with little benefit. There is limited research and integration of IC with an evidence-based practice (EBP) guideline among primary care providers (PCPs) in the primary care setting. The aims of this Doctor of Nursing Practice (DNP) project were to conduct a knowledge and needs assessment via Qualtrics survey to identify PCPs’ current knowledge, practices, and perceptions regarding IC and the American Geriatrics Society (AGS) Beers Criteria on reducing older adult polypharmacy in an urban primary care setting; and to assess PCPs’ interest in participating in IC with a pharmacist using the AGS Beers Criteria. The responses obtained from the Qualtrics survey revealed PCPs were comfortable in communicating to older adults about polypharmacy; however, PCPs with longer practice experiences displayed misconceptions due to lack of familiarity and interest in participating in IC using the AGS Beers Criteria. Overall, 70% of PCPs felt comfortable about participating in IC alone, 50% of PCPs were familiar with IC, and 60% of PCPs used the AGS Beers Criteria. Even though 60% of PCPs felt comfortable about participating in IC based on AGS Beers Criteria with a pharmacist, only 50% of PCPs were interested in participating IC with a pharmacist using AGS Beers Criteria. Barriers and recommendations are discussed further in this DNP Project paper.

Introduction: Older persons usually suffer from multiple chronic disorders and consequently use more medications than younger adults and often polypharmacy. Polypharmacy is, unfortunately, one of the risk factors for negative outcomes in the old age. The aim of this diploma thesis was to summarize by narrative literature review the negative outcomes of polypharmacy in older adults documented in pharmacoepidemological studies published between 2005 and 2015 years. The outputs of this diploma thesis create part of results of the research subgroup "Aging and Changes in the Therapeutic Value of Medications in the Aged" (Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles Univerzity) and the EU COST Action initiative IS1402 (2015-2018). Methods: Using datasets of Web of Science, PubMed and Embase, the narrative literature review was conducted in the period 2014 - 2015, in which we summarized outcome studies dealing with negative outcomes of polypharmacy in older patients published between 2005- 2015 years. Key words for the literature review were: "seniors, older patients, elderly, older age, polypharmacy, polymedication, multiple drug use, negative outcomes, impact, hospitalization, mortality, averse reactions, averse drug events, costs, expenditures. We identified 563 studies...

Persons exposed to adverse childhood experiences (ACEs) are at increased risk of developing long-term negative health consequences. ACEs have a cumulative negative impact on mental health outcomes in particular. Evidence suggests that those in forensic psychiatric settings are disproportionally exposed to ACEs, lending to potentially greater complexity in the relationship between ACEs, psychiatric comorbidity, and behavioral problems. Additionally, within this population a common intervention for mental health symptomology includes pharmacology, particularly as health issues compound. As a medication regimen becomes more complex, the risk for negative consequences – including drug interactions, side effects, and even death – increases. Limited empirical research describing associations between ACEs, mental health outcomes, and polypharmacy is available. Furthermore, no published studies to date have examined these relationships in forensic inpatient mental health populations, despite the evidence that these populations are disproportionately exposed to maltreatment and household dysfunction in childhood, frequently have higher rates of physical and mental health problems, and are usually treated with multiple forms of medications in response to health and behavioral needs. To address gaps in existing research, the relationship between ACEs, mental health outcomes, and prescription practices will be examined within a forensic inpatient sample. The current study seeks to investigate the impact of ACEs on mental health outcomes and the relationship to polypharmacy practices within a forensic psychiatric setting. A total of 182 patients residing in a secure forensic psychiatric hospital were selected. The sample is predominantly male (80.8%, n=147) and majority Caucasian (55.5%, n=101) or African American (40.1%, n=73), with a mean age of 43.5 (SD=13.2). Participants range from persons with at least one mental health disorder (100%, n=182) to persons with at least one chronic illness (74.5%, n=132). It is expected that greater experiences of childhood maltreatment and household dysfunction will result in greater negative mental health outcomes and associated behaviors. This relationship is expected to contribute to polypharmacy practices among prescribing physicians. Because high rates of polypharmacy yield a potential for increased aversive health outcomes, understanding the association between ACEs and other predictive factors and polypharmacy practice has valuable implications for the treatment and rehabilitation of persons in forensic mental health settings.

Magister Pharmaceuticae - MPharm / Access to quality healthcare in South Africa is known to be unequal, with those who can afford it, receiving the best quality healthcare services in the private sector, and those who cannot afford it, having to receive healthcare in the public sector. The South African government is implementing the National Health Insurance to remove unequal access to healthcare services. However, the aim of this study is to evaluate the current usage of medicine.