In the U.S., polypharmacy affects an estimated 65% of adults 65 and older. As the population ages and the prevalence of chronic conditions rises, more patients are prescribed multiple medications to manage their health. While these treatments are often necessary, polypharmacy increases the likelihood of additional health risks. Without proper oversight, patients may experience unnecessary side effects, reduced quality of life, and even avoidable hospitalizations due to medication-related complications.
For pharmacists, addressing polypharmacy is a critical aspect of patient care. To address health risks and prevent adverse health events, health plans partnering with pharmacists can utilize medication therapy management (MTM) programs to provide a structured approach to reviewing and optimizing medication regimens, ensuring that each prescription is necessary, effective, and safe.
What is polypharmacy?
Polypharmacy is commonly defined as the concurrent use of multiple medications by a single patient, typically five or more. While it’s often necessary for managing chronic conditions, polypharmacy presents significant challenges for both patients and healthcare providers–particularly pharmacists who play a critical role in ensuring medication safety and effectiveness.
In clinical practice, polypharmacy is not inherently problematic. For example, a patient with diabetes, hypertension, and heart disease may require multiple medications to achieve optimal health outcomes. However, concerns arise when unnecessary, duplicative, or inappropriate medications are prescribed, increasing the risk of adverse drug events (ADEs), medication nonadherence, and drug interactions.
Pharmacists frequently encounter two primary forms of polypharmacy: appropriate polypharmacy and problematic polypharmacy. Appropriate polypharmacy refers to the evidence-based use of multiple medications that effectively manage a patient’s conditions with minimal risk. In contrast, problematic polypharmacy occurs when patients take medications that may no longer be necessary, interact harmfully, or contribute to medication overload. This issue is particularly prevalent among older adults and individuals with complex medication regimens, where deprescribing strategies may be necessary to optimize therapy.
Given the increasing prevalence of polypharmacy, especially among aging populations and those with multiple chronic conditions, pharmacists must take an active role in medication therapy management to mitigate risks, improve medication adherence, and enhance patient outcomes. Through comprehensive medication reviews (CMRs), drug interaction screenings, and collaboration with prescribers, pharmacists can help ensure that polypharmacy remains beneficial rather than burdensome.
Understanding polypharmacy risks and patient outcomes
While polypharmacy is often necessary for managing chronic conditions, it introduces several risks that can negatively impact patient outcomes. Pharmacists, particularly those engaged in MTM programs, play a crucial role in identifying and mitigating these risks to ensure medication regimens remain safe, effective, and appropriate.
Key risks of polypharmacy include:
- Adverse drug events: The more medications a patient takes, the higher the likelihood of experiencing an adverse drug event. In fact, patients who take more than five medications have a 50% chance of experiencing ADEs. Polypharmacy increases the potential for drug-drug interactions, heightened side effects, and unintended pharmacodynamic or pharmacokinetic effects. Older adults, in particular, are more vulnerable due to age-related changes in drug metabolism and elimination.
- Medication nonadherence: Complex medication regimens can lead to confusion, unintentional errors, and decreased adherence. Patients may struggle to follow prescribed dosing schedules, leading to missed doses, incorrect administration, or intentional discontinuation of certain medications. This nonadherence can result in disease progression, hospitalizations, or treatment failure.
- Increased risk of drug interactions: With multiple medications being taken simultaneously, there’s a higher probability of interactions that can diminish therapeutic efficacy or, conversely, cause toxicity. For instance, certain antihypertensive drugs can interact with NSAIDs (nonsteroidal anti-inflammatory drugs), reducing their effectiveness and leading to uncontrolled blood pressure.
- Cognitive impairment and falls: Some medications commonly used in polypharmacy regimens, such as sedatives, anticholinergics, and opioids, can contribute to dizziness, confusion, or impaired coordination. In older adults, this significantly raises the risk of falls, fractures, and hospitalizations.
- Hospitalizations and healthcare costs: Polypharmacy has been linked to about 30% of hospital admissions due to medication-related complications. Inappropriate prescribing, poor medication reconciliation, and unmonitored drug interactions contribute to preventable healthcare expenditures. Additionally, insurance plans are covering fewer medications, which only adds to the overall costs of managing chronic illnesses.
- Reduced quality of life: Patients experiencing side effects or burdensome medication regimens may feel overwhelmed, leading to decreased quality of life. Symptoms such as fatigue, dizziness, or gastrointestinal distress can make daily activities more challenging, ultimately impacting overall well-being.
These polypharmacy-related risks directly influence patient health, healthcare utilization, and long-term outcomes. Without proper oversight, excessive medication use can lead to a cycle of prescribing cascades–where additional medications are prescribed to manage the side effects of existing ones–further exacerbating the issue.
The role of medication therapy management in addressing polypharmacy risks
With these risks ever prevalent, it’s critical that patients learn how to appropriately manage their medications. However, that’s more likely to be accomplished with the help of pharmacists and through MTM programs. As frontline medication experts, pharmacists leverage MTM services to identify and resolve medication-related problems, enhance medication adherence, and improve overall patient outcomes.
With MTM programs, pharmacists are equipped to address polypharmacy risks by implementing effective medication management strategies.
Comprehensive medication reviews
CMRs are the cornerstone of MTM and provide pharmacists with an opportunity to assess a patient’s entire medication regimen. Through a structured review, pharmacists can:
- Identify duplicate therapies, unnecessary medications, or inappropriate drug combinations.
- Detect and address potential drug-drug interactions or contraindications.
- Evaluate the appropriateness of each medication based on the patient’s health status and therapeutic goals.
Targeted medication reviews
Unlike CMRs, which are comprehensive, TMRs focus on specific medication-related concerns, such as high-risk drugs, adherence issues, or recent hospitalizations. By conducting regular TMRs, pharmacists can intervene promptly to prevent ADEs and optimize treatment.
Deprescribing and medication optimization
MTM provides a structured approach for deprescribing unnecessary or high-risk medications, particularly in older adults or patients with multiple chronic conditions. By collaborating with prescribers, pharmacists can:
- Recommend dose adjustments or safer alternatives.
- Discontinue medications that are no longer beneficial or may be causing harm.
- Simplify complex regimens to enhance adherence and reduce pill burden.
Patient education and engagement
Many patients are unaware of the potential dangers of taking multiple medications or may struggle with adherence. Through MTM, pharmacists can educate patients on proper medication use, potential side effects, and the importance of adherence while addressing concerns about cost, lifestyle adjustments, or adverse effects. By empowering patients to take an active role in managing their medications safely, pharmacists help improve adherence and reduce the risk of medication-related complications.
Collaboration with healthcare providers
Another crucial role of MTM is fostering collaboration with healthcare providers to ensure prescribing decisions are evidence-based and patient-specific. By communicating directly with prescribers and other healthcare professionals, pharmacists can prevent prescribing cascades, where new symptoms are mistaken for new conditions rather than side effects of existing medications. Additionally, MTM supports transitions of care, such as post-hospitalization medication reconciliation, to minimize readmission risks.
Improving patient outcomes through MTM
By integrating MTM into patient care, pharmacists help minimize the risks of polypharmacy while ensuring that medications contribute positively to health outcomes. Some key benefits include:
- Reduced ADEs through proactive medication monitoring.
- Enhanced medication adherence by simplifying regimens and addressing barriers to compliance.
- Lower healthcare costs by preventing hospitalizations and emergency visits due to medication-related issues.
- Improved patient quality of life by optimizing therapy and minimizing unnecessary medication burden.
However, managing polypharmacy effectively requires pharmacists to have access to the right tools and technology. A comprehensive pharmacy services platform, such as Alliance by Aspen RxHealth, empowers pharmacists with advanced clinical decision support, real-time medication data, and streamlined workflows to enhance MTM delivery.
These platforms facilitate CMRs, TMRs, and seamless collaboration with prescribers to ensure that medication regimens are safe and necessary. By leveraging technology-driven insights, pharmacists can quickly identify high-risk medications, detect potential drug interactions, and recommend deprescribing strategies where appropriate.
Plus, these platforms improve efficiency and scalability for pharmacists and health plans. With features like automated documentation, secure patient communication, and integrated adherence tracking, pharmacists can spend less time on administrative tasks and more time on direct patient care. Additionally, access to real-time claims data and medication history allows pharmacists to make more informed decisions and intervene before medication-related issues escalate.
MTM isn’t just about managing medications. Rather, it’s also about managing medication safety and effectiveness. By incorporating a technology-enabled approach to MTM, pharmacists can enhance patient engagement, improve medication outcomes, and drive better overall healthcare efficiency. With platforms like BeWell with Aspen RxHealth and for in-house teams, Alliance by Aspen RxHealth, pharmacists are equipped with the tools they need to proactively address polypharmacy risks, optimize therapy, and ultimately improve patient health.
To learn more about how Aspen RxHealth can help pharmacists and health plans deliver high-quality care to patients, get in touch today to book a demo!