Polypharmacy Management 101

Polypharmacy is the regular use of five or more medications at the same time.

Polypharmacy is associated with more hospitalizations and higher care costs for both patients and healthcare systems and is more prevalent among older adults who may be managing multiple conditions at the same time as well as dealing with the effects of aging.

What is Polypharmacy Management?

Polypharmacy management involves the process of reducing or optimizing the number and types of medications taken by a patient. According to the World Health Organization, effective polypharmacy management could save about $18 million of global total health expenditure.

Polypharmacy management will become more important in the U.S. as the rate of chronic disease rises and as the population ages.

What are Chronic Diseases?

Chronic diseases are generally defined as conditions that last a year or more and require ongoing medical care or limit activities of daily living (or both). Some examples of chronic conditions are include:

• Arthritis
• Asthma
• Cancer
• Crohn’s disease
• Cystic fibrosis
• Depression
• Diabetes
• Epilepsy
• Heart disease
• Obesity

Today, about 129 million people in the U.S. have at least one chronic illness. By 2030, that number will go up to about 170 million. About 42% of Americans are managing two or more chronic diseases and 12% are managing five or more.

A Growing Concern: Taking Multiple Prescription Drugs

An increasing number of people with chronic conditions leads to a higher rate of people taking prescription medicine. Currently, about 66% of Americans take one prescription drug. The number of Americans taking more than one prescription is rising.

In 2023, these groups were taking 4+ drugs daily:

• 25% of Americans under 55
• 37% of Americans between 55-65
• 54% of Americans over 65

Patient Risks and Challenges

Taking multiple prescription drugs comes with risks and challenges, including:

• Drug interactions: Medications can interfere with each other, reducing effectiveness or causing harm. One medication could also make a different condition get worse or cause a new one.
• Side effects: More medications mean an increased chance of unwanted symptoms.
• Medication errors: There can be a higher risk of missed or wrong doses and confusion about different drugs.
• Adherence issues: Keeping track of multiple medicines can be difficult and could lead to missed or wrong doses.
• Cognitive impact (especially for older people): Multiple medicines could lead to confusion or memory loss.

Addressing Patient Risks and Challenges

Pharmacists can perform polypharmacy management to address issues and challenges. Their work can include general oversight, including:

• Medication review: Involves assessing benefits and drawbacks of each medicine patient is taking.
• Deprescribing: Tapering or stopping medicines.
• Monitoring: Monitoring patients for adverse effects and adjusting medicines as needed.
• Patient education and engagement: Teaching patients about the medications they are taking, including how and why to take them.
• Intervention if needed.
• Coordination with other healthcare providers.

Final thoughts

As more Americans suffer from chronic disease, take multiple medications, and grow older, polypharmacy management will assume an increasingly relevant role in healthcare.

Further reading

• Pharmacy deserts: A growing problem in the U.S.
• Too far to fill: The growing problem of pharmacy deserts in America
• Five ways AI can improve medication adherence

References

• About Chronic Diseases. Centers for Disease Control and Prevention.
• Chronic Diseases and Conditions. New York State Department of Health.
• Benavidez, Gabriel A., Zahnd, Whitney E., Hung, Peiyin, Eberth, Jan M. Chronic Disease Prevalence in the US: Sociodemographic and Geographic Variations by Zip Code Tabulation Area.
• Health for Life. American Hospital Association. Fall 2007.
• Gallant, Andrew. A Growing Number of Americans Report Taking Prescription Medications Daily.
• Kirzinger, Ashley, Neuman, Tricia, Cubanski, Juliette, and Brodie, Mollyann. Data Note: Prescription Drugs and Older Adults.
• Prescription Drugs. Georgetown University.
• The dangers of polypharmacy and the case for deprescribing in older adults. National Institute on Aging.
• Taking multiple medicines safely. University of Florida Health.
• Sherman, Justin J., Davis, Leslie, and Daniels, Kori. Addressing the Polypharmacy Conundrum.
• Hall-Tierney, Anne D., Scarbrough, Catherine, and Carroll, Dana. Polypharmacy: Evaluating Risks and Deprescribing.
• Hoel, Robert William, Gidding Connolly, Ryan M., and Takahashi, Paul Y. Polypharmacy Management in Older Patients.
• Jandu, Jagmohan S., Mohanaselvan, Arvindselvan, Dahal, Ranjan, and Bista, Sangita. Strategies to Reduce Polypharmacy in Older Adults.
• Medication Safety in Polypharmacy. World Health Organization.

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