PATIENTS WITH POLYPHARMACY The importance of closing the loop at care transitions Marjolein Weda, RIVM
PATIENTS WITH POLYPHARMACYThe importance of closing the loop at care transitions
Marjolein Weda, RIVM
Polypharmacy
Various definitions available.
In the Netherlands: the chronic use of 5 or more medicines.
Polypharmacie: ca. 45% of the elderly (≥ 65 years)
About 20% of people older than 70 years: 10 or more medicinal products
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Polypharmacy (continued)Most older people live at home, without formal care.
More than 200.000 elderly live at:
• home, with care/nursing;
• care homes;
• nursing homes;
• mental care homes.
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Polypharmacy (continued)
Polypharmacy is a risk factor for avoidable, unplanned hospitalizations.
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Problems experiencedMedication related problems:
• Overuse
• Underus
• Interactions
• Double medication
• Incorrect dose
• Non-suitable dosage form
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Problems experienced (continued)Risk factors:
• Decreased cognition;
• Age;
• Decreased kidney functioning;
• Not living at home (dependent on care);
• Non-adherence;
• Specific medicine classes;
• Knowledge of prescribers/pharmacists;
• Number of prescribers.
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Problems experienced (continued)Many actors involved with the care for patients with polypharmacy:
• General practitioners;
• Medical specialists from various disciplines;
• Nurses;
• Pharmacists;
• Paramedical professionals;
• Mental care professionals;
• Informal caregivers.
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Problems experienced (continued)Several steps in the pharmaceutical care process:
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Prescribing Dispensing Using Monitoring
These steps take place at various settings, by various professionals, at various moments in time.
Detection of problemsMany systems available at different settings:
• Electronic prescription system at general practioner;
• Community pharmacy information system;
• (Electronic) prescription system at hospitals;
• Hospital pharmacy information system;
• (Electronic) prescription system at nursing homes;
• Electronic patient care dossier;
• ……….
Numerous commercial & non-commercial parties involved in setting up and maintaining these systems.
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Detection of problems (continued)Vigilance of drug-drug interactions, drug-disease interactions, contra-indications, correct dosing, underuse, overuse, dubble medication.
Vigilance only work well when all information on patient and medication is available at all time points in the pharmaceutical care process (up-to-date medication history, indications, laboratory values, etcetera).
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Problems experienced in practiceNo adequate communication between professionals;
No adequate communication between patient and professional;
No up-to-date medication history available, during transitions in care;
Not always time to reconcile medicinal products used by patients (urgent care);
Unclear who is directing/responsible;
ICT systems not sufficiently facilitating.
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What is happening in practice?
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THANK YOU FOR YOUR ATTENTION
HTTP://WWW.RIVM.NL/DOCUMENTEN_EN_PUBLICATIES/WETENSCHAPPELIJK/RAPPORTEN/2013/JULI/POLYFARMACIE_BIJ_KWETSBARE_OUDEREN_INVENTARISATIE_VAN_RISICO_S_EN_MOGELIJKE_INTERVENTIESTRATEGIE%C3%ABN
Any questions? Feel free to ask.
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