PATIENTS WITH POLYPHARMACY - etouches · •Non-suitable dosage form ... Many actors involved with the care for patients with polypharmacy: ... ICT systems not sufficiently facilitating

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

11/6/2014 © 2012–2014 Healthcare Information and Management Systems Society (HIMSS) 2

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.


Polypharmacy (continued)

Polypharmacy is a risk factor for avoidable, unplanned hospitalizations.


Problems experiencedMedication related problems:

• Overuse

• Underus

• Interactions

• Double medication

• Incorrect dose

• Non-suitable dosage form


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.


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.


Problems experienced (continued)Several steps in the pharmaceutical care process:


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.


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).


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.


What is happening in practice?


THANK YOU FOR YOUR ATTENTION

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Any questions? Feel free to ask.

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PATIENTS WITH POLYPHARMACY - etouches · •Non-suitable dosage form ... Many actors involved with the care for patients with polypharmacy: ... ICT systems not sufficiently facilitating