1932
0
  1. Home
  2. A-Z Publications
  3. Annual Review of Pharmacology and Toxicology
  4. Volume 60, 2020
  5. Article

Annual Review of Pharmacology and Toxicology

Volume 60, 2020

Addressing the Challenge of Polypharmacy

Abstract

Polypharmacy describes the concomitant use of multiple medicines and represents a growing global challenge attributable to aging populations with an increasing prevalence of multimorbidity. Polypharmacy can be appropriate but is problematic when the increased risk of harm from interactions between drugs or between drugs and diseases or the burden of administering and monitoring medicines outweighs plausible benefits. Polypharmacy has a substantial economic impact in service demand and hospitalization as well as a detrimental impact on patients’ quality of life. Apart from causing avoidable harm, polypharmacy can also lead to therapeutic failure, with up to 50% of patients who take four or more medications not taking them as prescribed. Guidance is needed to support patients and clinicians in defining and achieving realistic goals of drug treatment, and system change is necessary to aid implementation. This article outlines lessons from two programs that aim to address these challenges: the Scottish polypharmacy guidance on realistic prescribing and the European Union SIMPATHY project.

Keyword(s): adherence, appropriate polypharmacy, deprescribing, effectiveness, medication review, patient-centered, safety
Loading

Article metrics loading...

/content/journals/10.1146/annurev-pharmtox-010919-023508
2020-01-06
2025-01-26
Loading full text...

Full text loading...

/deliver/fulltext/pharmtox/60/1/annurev-pharmtox-010919-023508.html?itemId=/content/journals/10.1146/annurev-pharmtox-010919-023508&mimeType=html&fmt=ahah

Literature Cited

  1. 1. 
    World Health Organ 2008. Primary health care—now more than ever World Health Rep., World Health Organ New York:
     [Google Scholar]
  2. 2. 
    Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B 2012. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380983637–43
     [Google Scholar]
  3. 3. 
    Ornestein SM, Nietert PJ, Jenkins RG, Litvin CB 2013. The prevalence of chronic diseases and multimorbidity in primary care practice: a PPRNet report. J. Am. Board Fam. Pract. 265518–24
     [Google Scholar]
  4. 4. 
    Scott. Gov. Polypharmacy Model Care Group 2018. Polypharmacy guidance: realistic prescribing Rep., Scott. Gov., Edinburgh . , 3rd ed.. https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/09/Polypharmacy-Guidance-2018.pdf
    [Google Scholar]
  5. 5. 
    Köberlein J, Jürges H. 2013. Multimorbidity, incentives and the use of health services in Europe. Active Ageing and Solidarity Between Generations in Europe: First Results from SHARE After the Economic Crisis A Börsch-Supan, M Brandt, H Litwin, G Weber 243–52 Berlin: de Gruyter
     [Google Scholar]
  6. 6. 
    Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW 2012. Adapting clinical guidelines to take account of multimorbidity. BMJ 345e6341
     [Google Scholar]
  7. 7. 
    Shippee ND, Shah ND, May CR, Mair FS, Montori VM 2012. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. J. Clin. Epidemiol. 65101041–51
     [Google Scholar]
  8. 8. 
    Duerden M, Avery T, Payne R 2013. Polypharmacy and Medicines Optimization: Making It Safe and Sound London: The King's Fund
     [Google Scholar]
  9. 9. 
    Payne RA, Avery AJ. 2011. Polypharmacy: one of the greatest prescribing challenges in general practice. Br. J. Gen. Pract. 6158383–84
     [Google Scholar]
  10. 10. 
    IMS Inst. Healthc. Inform 2012. Advancing the responsible use of medicines: applying levers for change Rep., IMS Inst. Healthc. Inform. Parsippany, NJ: http://pharmanalyses.fr/wp-content/uploads/2012/10/Advancing-Responsible-Use-of-Meds-Report-01-10-12.pdf
    [Google Scholar]
  11. 11. 
    Kongkaew C, Hann M, Mandal J, Williams SD, Metcalfe D et al. 2013. Risk factors for hospital admissions associated with adverse drug events. Pharmacotherapy 338827–37
     [Google Scholar]
  12. 12. 
    World Health Organ 2017. Medication without harm Glob. Patient Saf. Chall., World Health Organ Geneva:
     [Google Scholar]
  13. 13. 
    Mair A. 2019. Medication safety in polypharmacy, Third Global Patient Safety Challenge Rep., World Health Organ Geneva:
     [Google Scholar]
  14. 14. 
    Mair A, Fernandez-Limos F, Alonso A, Harrison C, Hurding S et al. 2017. Polypharmacy management by 2030: a patient safety challenge Rep., SIMPATHY Consort., Coimbra, Port. http://www.simpathy.eu/sites/default/files/Managing_polypharmacy2030-web.pdf
    [Google Scholar]
  15. 15. 
    SIMPATHY 2017. SIMPATHY economic tool Econ. Tool, SIMPATHY Consort., Scotl. http://www.simpathy.eu/resources/change-management
    [Google Scholar]
  16. 16. 
    Scott. Gov. Model Care Polypharmacy Work. Group 2012. Polypharmacy guidance Guidance, Scott. Gov Edinburgh:. , 1st ed..
     [Google Scholar]
  17. 17. 
    Scott. Gov. Model Care Polypharmacy Work. Group 2015. Polypharmacy guidance Guidance, Scott. Gov Edinburgh:. , 2nd ed.. https://www.sehd.scot.nhs.uk/publications/DC20150415polypharmacy.pdf
    [Google Scholar]
  18. 18. 
    Hanlon JT, Schmader KE. 2013. The medication appropriateness index at 20: where it started, where it has been, and where it may be going. Drugs Aging 3011893–900
     [Google Scholar]
  19. 19. 
    Burt J, Elmore N, Campbell SM, Rodgers S, Avery AJ, Payne RA 2018. Developing a measure of polypharmacy appropriateness in primary care: systematic review and expert consensus study. BMC Med 1691
     [Google Scholar]
  20. 20. 
    Avery A, Bell G. 2019. Rationalising medications through deprescribing. BMJ 3641570
     [Google Scholar]
  21. 21. 
    World Health Organ 2006. Quality of care: a process for making strategic choices in health systems Rep., World Health Organ. Geneva:
     [Google Scholar]
  22. 22. 
    Laupacis A, Sackett D, Roberts R 1988. An assessment of clinically useful measures of the consequences of treatment. N. Engl. J. Med. 318261728–33
     [Google Scholar]
  23. 23. 
    Cook R, Sackett D. 1995. The number needed to treat: a clinically useful measure of treatment effect. BMJ 3106977452–54
     [Google Scholar]
  24. 24. 
    Rawlins MD, Thompson JW. 1977. Pathogenesis of adverse drug reactions. Textbook of Adverse Drug Reactions DM Davies 10–17 Oxford, UK: Oxford Univ. Press
     [Google Scholar]
  25. 25. 
    Dumbreck S, Flynn A, Nairn M et al. 2015. Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines. BMJ 350h949
     [Google Scholar]
  26. 26. 
    Lindblad C, Hanlon J, Gross C et al. 2006. Clinically important drug-disease interactions and their prevalence in older adults. Clin. Ther. 2881133–43
     [Google Scholar]
  27. 27. 
    Taber DJ et al. 2014. Clinical and economic outcomes associated with medication errors in kidney transplantation. Clin. J. Am. Soc. Nephrol. 95960–66
     [Google Scholar]
  28. 28. 
    Hayward KL et al. 2016. Prevalence of medication discrepancies in patients with cirrhosis: a pilot study. BMC Gastroenterol 16114
     [Google Scholar]
  29. 29. 
    Chang Y-P, Huang S-K, Tao P et al. 2012. A population-based study on the association between acute renal failure (ARF) and the duration of polypharmacy. BMC Nephrol 13196
     [Google Scholar]
  30. 30. 
    Sutaria A, Lui L, Ahmed Z 2016. Multiple medication (polypharmacy) and chronic kidney disease in patients aged 60 and older: a pharmacoepidemiologic perspective. Ther. Adv. Cardiovasc. Dis. 104242–50
     [Google Scholar]
  31. 31. 
    Pirmohamed M, James S, Meakin S, Green C, Scott AK et al. 2004. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329745615–19
     [Google Scholar]
  32. 32. 
    Clin. Excell. Comm 2018. Medication safety and quality: high-risk medicines Rep., Clin. Excell. Comm Sydney: http://www.cec.health.nsw.gov.au/patient-safety-programs/medication-safety/high-risk-medicines
    [Google Scholar]
  33. 33. 
    Health Qual. Saf. Comm. New Zealand 2014. High-risk medicines must be treated with respect—new campaign News Release, Oct. 16. https://www.hqsc.govt.nz/news-and-events/news/1814/
    [Google Scholar]
  34. 34. 
    Natl. Pat. Saf. Agency 2011. High risk drugs list Natl. Pat. Saf. Agency London: https://www.mpft.nhs.uk/services/pharmacy/high-risk-drugs
    [Google Scholar]
  35. 35. 
    Inst. Safe Med. Pract. Canada 2018. ISMP high-alert medications. Institute for Safe Medication Practices Canada https://www.ismp.org/assessments/high-alert-medications
    [Google Scholar]
  36. 36. 
    Geri-EM 2013. High-risk medications. Geri-EM https://geri-em.com/medication-management/high-risk-medications
    [Google Scholar]
  37. 37. 
    SA Health 2019. High risk medicines. Government of South Australia https://www.sahealth.sa.gov.au/wps/wcm/connect/public%20content/sa%20health%20internet/clinical%20resources/clinical%20topics/medicines%20and%20drugs/high%20risk%20medicines/high%20risk%20medicines
    [Google Scholar]
  38. 38. 
    Dreischulte T, Donnan P, Grant A, Hapca A, McCowan C, Guthrie B 2016. Safer prescribing—a trial of education, informatics, and financial incentives. N. Engl. J. Med. 374111053–64
     [Google Scholar]
  39. 39. 
    Howard R, Avery A, Slavenburg S, Royal S, Pipe G et al. 2007. Which drugs cause preventable admissions to hospital? A systematic review. Br. J. Clin. Pharmacol. 632136–47
     [Google Scholar]
  40. 40. 
    Am. Geriatr. Soc. Beers Criteria Update Expert Panel 2015. American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in adults. J. Am. Geriatr. Soc 632227–46
     [Google Scholar]
  41. 41. 
    O'Mahony D, O'Sullivan D, Bryne S et al. 2015. STOPP/ START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 442213–18
     [Google Scholar]
  42. 42. 
    Maust DT, Kim HM, Seyfried LS, Chiang C, Kavanagh J et al. 2015. Antipsychotics, other psychotropics, and the risk of death in patients with dementia: number needed to harm. JAMA Psychiatry 725438–45
     [Google Scholar]
  43. 43. 
    Banerjee S. 2009. The use of antipsychotic medication for people with dementia: time for action. London: Dep. Health
  44. 44. 
    Ment. Welf. Comm. Scotl 2014. Dignity and respect: dementia continuing care visits Visit Rep., Ment. Welf. Comm. Scotl. Edinburgh:
     [Google Scholar]
  45. 45. 
    Nazareth K, Burkhard K. 2016. Hypnotics & anxiolytics practice guide Pract. Guide, All Wales Med. Strateg. Group. Cardiff: http://www.wales.nhs.uk/sites3/Documents/582/Guide_Hypnotics%20%26%20Anxiolytics%20Practice%20Guide_version02.pdf
    [Google Scholar]
  46. 46. 
    Campbell AJ, Robertson MC, Gardner MM et al. 1999. Psychotropic medication withdrawal and a home-based exercise program to prevent falls: a randomized, controlled trial. J. Am. Geriatr. Soc. 47850–53
     [Google Scholar]
  47. 47. 
    BNF 2018. Antidepressants London: Pharmaceutical Press
     [Google Scholar]
  48. 48. 
    Risacher SL, McDonald BC, Tallman EF, West JD, Farlow MR et al. 2016. Association between anticholinergic medication use and cognition, brain metabolism, and brain atrophy in cognitively normal older adults. JAMA Neurol 736721–32
     [Google Scholar]
  49. 49. 
    Sumukadas D, McMurdo M, Mangoni A, Guthrie B 2013. Temporal trends in anticholinergic medication prescription in older people: repeated cross-sectional analysis of population prescribing data. Age Ageing 434515–21
     [Google Scholar]
  50. 50. 
    Durán C, Azermai M, Vander Stichele R 2013. Systematic review of anticholinergic risk scales in older adults. Eur. J. Clin. Pharmacol. 6971485–96
     [Google Scholar]
  51. 51. 
    Nishtala P, Salahudeen M, Hilmer S 2016. Anticholinergics: theoretical and clinical overview. Expert Opin. Drug Saf. 156753–68
     [Google Scholar]
  52. 52. 
    Bishara D, Harwood D, Sauer J, Taylor D 2016. Anticholinergic effect on cognition (AEC) of drugs commonly used in older people. Int. J. Geriatr. Psychiatry 326650–56
     [Google Scholar]
  53. 53. 
    Chew M, Mulsant B, Pollock B, Lehman M, Greenspan A et al. 2008. Anticholinergic activity of 107 medications commonly used by older adults. J. Am. Geriatr. Soc. 5671333–41
     [Google Scholar]
  54. 54. 
    Ehrt U, Broich K, Larsen J, Ballard C, Aarsland D 2009. Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study. J. Neurol. Neurosurg. Psychiatry 812160–65
     [Google Scholar]
  55. 55. 
    Rudolph J. 2008. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch. Intern. Med. 1685508–13
     [Google Scholar]
  56. 56. 
    Sittironnarit G, Ames D, Bush A, Faux N, Flicker L et al. 2011. Effects of anticholinergic drugs on cognitive function in older Australians: results from the AIBL study. Dement. Geriatr. Cogn. Disord. 313173–78
     [Google Scholar]
  57. 57. 
    Eff. Prescr. Ther 2018. Quality prescribing for chronic pain Scott. Gov., Edinburgh: https://www.therapeutics.scot.nhs.uk/pain/
    [Google Scholar]
  58. 58. 
    Pub. Health Engl 2014. Advice for prescribers on the risk of the misuse of pregabalin and gabapentin Fact Sheet, Pub. Health Engl London: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/385791/PHE-NHS_England_pregabalin_and_gabapentin_advice_Dec_2014.pdf
    [Google Scholar]
  59. 59. 
    Wills S. 2005. Drugs of Abuse London: Pharmaceutical Press. , 2nd ed..
     [Google Scholar]
  60. 60. 
    Fac. Pain Med 2019. Crime survey for England and Wales Rep., Royal Coll Anaesth., London: https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-aware/clinical-use-of-opioids/crime-survey-findings
    [Google Scholar]
  61. 61. 
    Eff. Prescr. Ther 2019. Opioid prescribing for chronic pain in primary care Rep., Scott. Gov Edinburgh:
     [Google Scholar]
  62. 62. 
    Eff. Prescr. Ther 2019. Gabapentoid prescribing for chronic pain in primary care—resource for clinicians and boards v1.0 Quick Ref. Guide, Scott. Gov Edinburgh: https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/11/Gabapentinoid-Quick-Reference-Guide-23112018-Final-v1.0.pdf
    [Google Scholar]
  63. 63. 
    Qaseem A, Wilt T, Kansagara D, Horwitch C, Barry M, Forciea M 2018. Haemoglobin A1c targets for glycemic control with pharmacologic therapy for nonpregnant adults with type 2 diabetes mellitus: a guidance statement update from the American College of Physicians. Ann. Intern. Med. 1688569–76
     [Google Scholar]
  64. 64. 
    Healthc. Improv. Scotl 2017. SIGN 116: management of diabetes—a national clinical guideline Natl. Clin. Guidel., Scott. Intercoll. Guidel. Netw. Edinburgh: https://www.sign.ac.uk/assets/sign116.pdf
    [Google Scholar]
  65. 65. 
    O'Loughlin JL, Robitaille Y, Boivin JF, Suissa S 1993. Incidence of and risk factors for falls and injurious falls among the community dwelling elderly. Am. J. Epidemiol. 137342–54
     [Google Scholar]
  66. 66. 
    Tinetti ME, Speechley M, Ginter SF 1988. Risk factors for falls among the elderly persons living in the community. N. Engl. J. Med. 3191701–7
     [Google Scholar]
  67. 67. 
    NICE (Natl. Inst. Health Care Excell.) 2013. Falls in older people: assessing risk and prevention NICE Clin. Guidel., Natl. Inst. Health Care Excell. London: http://www.nice.org.uk/Guidance/CG161
    [Google Scholar]
  68. 68. 
    World Health Organ 2015. World report on ageing and health Rep., World Health Organ. Luxembourg:
     [Google Scholar]
  69. 69. 
    Deanrea S, Lucenteforte E, Bravi F, Foschi R, La Vecchia C et al. 2010. Risk factors for falls in community-dwelling older people. Epidemiology 21658–68
     [Google Scholar]
  70. 70. 
    Darowski A, Chambers SCF, Chambers DJ 2009. Antidepressants and falls. Drugs Aging 265381–94
     [Google Scholar]
  71. 71. 
    Darowski A, Whiting R. 2011. Cardiovascular drugs and falls. Rev. Clin. Gerontol. 212170–79
     [Google Scholar]
  72. 72. 
    Laflamme L, Monárrez-Espino J, Johnell K et al. 2015. Type, number or both? A population-based matched case-control study on the risk of fall injuries among older people and number of medications beyond fall-inducing drugs. PLOS ONE 103e0123390
     [Google Scholar]
  73. 73. 
    Ryan-Atwood TE, Hutchinson-Kern M, Ilomäki J et al. 2017. Medication use and fall-related hospital admissions from long-term care facilities: a hospital-based case-control study. Drugs Aging 348625–33
     [Google Scholar]
  74. 74. 
    Van der Velde N, van den Meiracker AH, Pols HA et al. 2007. Withdrawal of fall-risk-increasing drugs in older persons: effect on tilt-table test outcomes. J. Am. Geriatr. Soc. 55734–39
     [Google Scholar]
  75. 75. 
    Seppala LJ, Wermelink A, de Vries M, Ploegmakers KJ, van de Glind EMM 2018. Fall-risk-increasing drugs: a systematic review and meta-analysis: II. psychotropics. J. Am. Med. Dir. Assoc. 194371 e311–371.e317
    [Google Scholar]
  76. 76. 
    Seppala LJ, van de Glind EMM, Daams JG, Ploegmakers KJ, de Vries M 2018. Fall-risk-increasing drugs: a systematic review and meta-analysis: III. others. J. Am. Med. Dir. Assoc. 194372.e371–372.e378
     [Google Scholar]
  77. 77. 
    de Vries M, Seppala LJ, Daams JG, van de Glind EMM, Masud T 2018. Fall-risk-increasing drugs: a systematic review and meta-analysis: I. cardiovascular drugs. J. Am. Med. Dir. Assoc. 194371.e371–79
     [Google Scholar]
  78. 78. 
    Freeland KN, Thompson AN, Zhao Y, Leal JE, Mauldin PD, Moran WP 2012. Medication use and associated risk of falling in a geriatric outpatient population. Ann. Pharmacother. 4691188–92
     [Google Scholar]
  79. 79. 
    Dutta R. 2014. Falls in older people. Guidel. Pract. 17652–59
     [Google Scholar]
  80. 80. 
    Elliott R. 2009. Non-adherence to medicines: not solved but solvable. J. Health Serv. Res. Policy 14158–61
     [Google Scholar]
  81. 81. 
    PGEU (Pharm. Group Eur. Union) 2008. Targeting adherence: improving patient outcomes in Europe through community pharmacists’ intervention Policy Statement, Pharm. Group Eur Union, Brussels: https://healthwatch.eu/artikelen/PGEU_Targeting%20Adherence_2008.pdf
    [Google Scholar]
  82. 82. 
    Eur. Comm 2019. European innovation partnership on active and healthy ageing. European Commission https://ec.europa.eu/eip/ageing/home_en
    [Google Scholar]
  83. 83. 
    Health Lit. Place 2019. Teach back. Health Literacy Place http://www.healthliteracyplace.org.uk/tools-and-techniques/techniques/teach-back
    [Google Scholar]
  84. 84. 
    Saum KU, Schottker B, Meid AD, Holleczek B, Haefeli WE et al. 2017. Is polypharmacy associated with frailty in older people? Results from the ESTHER cohort study. J. Am. Geriatr. Soc. 652e27–32
     [Google Scholar]
  85. 85. 
    König M, Spira D, Demuth I, Steinhagen-Thiessen E, Norman K 2018. Polypharmacy as a risk factor for clinically relevant sarcopenia: results from Berlin ageing study. J. Gerontol. 73117–22
     [Google Scholar]
  86. 86. 
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K 2013. Frailty in elderly people. Lancet 381752–62
     [Google Scholar]
  87. 87. 
    Clegg A, Bates C, Young J, Ryan R, Nichols L et al. 2016. Development and validation of an electronic frailty index using routine primary care electronic health record data. Age Ageing 453353–60
     [Google Scholar]
  88. 88. 
    Benetos A, Labat C, Rossignol P, Fay R, Rolland Y et al. 2015. Treatment with multiple blood pressure medications, achieved blood pressure, and mortality in older nursing home residents. JAMA Intern. Med. 1756989–95
     [Google Scholar]
  89. 89. 
    Hansen ML, Sorensen R, Clausen MT, Fog-Petersen ML, Raunso J et al. 2010. Risk of bleeding with single, dual, or triple therapy with warfarin, aspirin, and clopidogrel in patients with atrial fibrillation. Arch. Intern. Med. 170161433–41
     [Google Scholar]
  90. 90. 
    Boyd C, Fortin M 2010. Future of multimorbidity research: how should understanding of multimorbidity inform health systems designs. ? Public Health Rev 32451–74
     [Google Scholar]
  91. 91. 
    van den Bussche H, Schön G, Kolonko T, Hansen H, Wegscheider K et al. 2011. Patterns of ambulatory medical care utilisation in elderly patients with special reference to chronic disease and multimorbidity—results from a claims data based observational study in Germany. BMC Geriatr 1154
     [Google Scholar]
  92. 92. 
    Panagioti M, Stokes J, Esmail A, Coventry P, Cheraghi-Sohi S et al. 2015. Multimorbidity and patient safety incidents in primary care: a systematic review and meta-analysis. PLOS ONE 108e0135947
     [Google Scholar]
  93. 93. 
    Shah BM, Hajjar ER. 2012. Polypharmacy, adverse drug reactions, and geriatric syndromes. Clin. Geriatr. Med. 282173–86
     [Google Scholar]
  94. 94. 
    Davies EA, O'Mahony MS. 2015. Adverse drug reactions in special populations—the elderly. Br. J. Clin. Pharmacol. 804796–807
     [Google Scholar]
  95. 95. 
    Hubbard RE, O'Mahony MS, Woodhouse KW 2013. Medication prescribing in frail older people. Eur. J. Clin. Pharmacol. 693319–26
     [Google Scholar]
  96. 96. 
    Molokhia M, Majeed A. 2017. Current and future perspectives on the management of polypharmacy. BMC Fam. Pract. 1870
     [Google Scholar]
  97. 97. 
    Pronovost PJ, Ravitz AD, Stoll RA, Kennedy SB 2015. Transforming patient safety: a sector-wide systems approach WISH Rep., Pat. Saf. Forum, Qatar Found Doha: https://www.wish.org.qa/wp-content/uploads/2018/01/WISH_PatientSafety_Forum_08.01.15_WEB-1.pdf
    [Google Scholar]
  98. 98. 
    Peters DH. 2014. The application of systems thinking in health: Why use systems thinking. ? Health Res. Policy Syst. 1251
     [Google Scholar]
  99. 99. 
    Stewart D, Mair A, Wilson M, Kardas P, Lewek P et al. 2016. Guidance to manage inappropriate polypharmacy in older people: systematic review and future developments. Expert Opin. Drug Saf. 162203–13
     [Google Scholar]
  100. 100. 
    McIntosh J, Alonso A, Codina A 2016. D4.1 report on case studies Rep., SIMPATHY Consort., Scotl. http://www.simpathy.eu/sites/default/files/D4_1.pdf
    [Google Scholar]
  101. 101. 
    Mair A, Balaso A, McKenzie D, Gietona M, Weise B et al. 2015. D5.1: model change management process for managing appropriate controlling polypharmacy Rep., SIMPATHY Consort., Scotl. http://www.simpathy.eu/sites/default/files/D5_1.pdf
    [Google Scholar]
  102. 102. 
    Cameron KS, Quinn RE. 2006. Diagnosing and Changing Organizational Culture: Based on the Competing Values Framework San Francisco: John Wiley & Sons
     [Google Scholar]
  103. 103. 
    Deal T, Kennedy A. 2000. Corporate Cultures: The Rites and Rituals of Corporate Life New York: Perseus
     [Google Scholar]
  104. 104. 
    Mair A, Balaso A, McKenzie D, Gietona M, Weise B et al. 2016. D5.2: model strategic plan Rep., SIMPATHY Consort., Scotl. http://www.simpathy.eu/sites/default/files/D5_2.pdf
    [Google Scholar]
  105. 105. 
    Kotter Int 2019. Kotter's 8-step process for leading change. Kotter International https://www.kotterinc.com/8-steps-process-for-leading-change/
    [Google Scholar]
  106. 106. 
    Mair A, Hurding S, Michael N, Kinnear M, Wilson M 2016. Case study summary Scotland (UK) Case Study, SIMPATHY Consort., Scotl. http://www.simpathy.eu/resources/case-studies/case-study-scotland
    [Google Scholar]
  107. 107. 
    Stewart D, Gibson-Smith K, MacLure K, Mair A, Alonso A et al. 2017. A modified Delphi study to determine the level of consensus across the European Union on the structures, processes and desired outcomes of the management of polypharmacy in older people. PLOS ONE 1211e0188348
     [Google Scholar]
  108. 108. 
    McIntosh J, Alonso A, MacLure K, Stewart D, Kempen T, Mair A 2018. A case study of polypharmacy management in nine European countries: implications for change management and implementation. PLOS ONE 134e0195232
     [Google Scholar]
  109. 109. 
    Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F et al. 2012. The Global Rating Scale complements the AGREE II in advancing the quality of practice guidelines. J. Clin. Epidemiol. 655526–34
     [Google Scholar]
  110. 110. 
    Bergert FW, Braun M, Ehrenthal K, Fessler J, Gross J et al. 2014. Recommendations for treating adult and geriatric patients on multimedication. Int. J. Clin. Pharmacol. Ther. 52Suppl. 11–64
     [Google Scholar]
  111. 111. 
    Verenso 2011. Multidisciplinaire richtlijn diabetes Rep., Verenso, Utrecht. https://www.verenso.nl/_asset/_public/Richtlijnen_kwaliteit/richtlijnen/VER_Richtlijn_Diabetes_Deel2_2011_web.pdf
    [Google Scholar]
  112. 112. 
    Scott. Gov 2017. Scottish Government events in Brussels: 2017. SIMPATHY event—27 April Scottish Government https://www.gov.scot/publications/scottish-government-events-in-brussels-2017/
    [Google Scholar]
/content/journals/10.1146/annurev-pharmtox-010919-023508
Loading
Addressing the Challenge of Polypharmacy
Annual Review of Pharmacology and Toxicology 60, 661 (2020); https://doi.org/10.1146/annurev-pharmtox-010919-023508
/content/journals/10.1146/annurev-pharmtox-010919-023508
/content/journals/10.1146/annurev-pharmtox-010919-023508
Loading

Data & Media loading...

  • Article Type: Review Article

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error