Hypothesis and Practices to Avoid Polypharmacy in Family Medicine

*Jose Luis Turabian
Specialist In Family And Community Medicine, Health Center Santa Maria De Benquerencia, Spain

*Corresponding Author:
Jose Luis Turabian
Specialist In Family And Community Medicine, Health Center Santa Maria De Benquerencia, Spain
Email:jturabianf@hotmail.com

Published on: 2019-12-09

Abstract

The basic concept of the use of multiple medicines (polypharmacy) is quite simple: the prescription of more medications than are clinically appropriate.The incidence of drug-drug interactions (DDIs) increases with the number of drugs used, with prevalence and incidence of clinically observable DDIs is between 5- 25% of patients on pharmacological treatment. DDIs also contribute substantially to differences in drug response. DDIs are the source of adverse drug reactions (ADRs). 10 % of ADRs are due to DDIs. The use of 5 drugs used chronically is a figure from which there is an independent relationship with the inappropriate use of medicines: the frequency of ADRs is 6% when a patient takes two medications, 50% when he takes five, and almost 100% when he takes eight or more medications. In this scenario, it could be hypothesized that the presence of polypharmacy is an indicator of malpractice and poor quality of family medicine service. Thus, some techniques could be suggested for judiciously avoid polypharmacy in family medicine: 1) Use drugs only in authorized indications; 2) Use only indicated drug combinations; 3) Avoid starting treatment with two drugs from the same drug group; 4) avoid using the last commercialized drug, of which there is almost no experience; 5) Avoid using higher doses than indicated at the beginning of prescription; 6) Avoid using a drug longer than indicated, and 7) Not treating ADRs with other drugs.

Keywords

Polypharmacy; Sanitary Attention; Multimorbidity; Inappropriate Prescribing; Family Medicine; Framework; Teaching.

The basic concept of the use of multiple medicines (polypharmacy) is quite simple: the prescription of more medications than are clinically appropriate.

The concept of the use of multiple medicines(polypharmacy) or “polymedicated patient” varies depending on the source consulted, but the basic definition is quite simple: the prescription of more medications than are clinically appropriate[1,2].Thus, two possible situations could be distinguished according to the intervention: appropriate polypharmacy(when the patient takes many drugs, but all of them have clinical indication; here, it would be possible, not to reduce, but to improve the therapeutic adequacy), and the inadequate polypharmacy (here, it would be to reduce the maximum possible number of inappropriate drugs) [3]. However, in general, polypharmacy has been defined in quantitative terms, although there seems to be no consensus on where to establish the limit from which we would be talking about polypharmacy, and in any case, they are almost always arbitrary criteria. For some authors, taking only two medications would be polypharmacy, and for others, it would be the daily consumption of four, five or even eight drugs. The most widespread number seems to be that of 5 drugs used chronically, a figure from which, there is an independent relationship with the inappropriate use of medicines.