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http://dx.doi.org/10.24304/kjcp.2018.28.1.1

Reviews on the Current Status and Appropriate Management of Polypharmacy in South Korea  

Park, Hae-Young (College of Pharmacy, Kyungpook National University)
Sohn, Hyun Soon (College of Pharmacy, CHA University)
Kwon, Jin-Won (College of Pharmacy, Kyungpook National University)
Publication Information
Korean Journal of Clinical Pharmacy / v.28, no.1, 2018 , pp. 1-9 More about this Journal
Abstract
Polypharmacy is increasing owing to an increase in the elderly population and multimorbidities associated with the increased risk of administration of potentially inappropriate medications (PIMs). The negative effects of polypharmacy on various health conditions and aspects, such as fall, fracture, mortality, cognitive function, and dementia, have been reported. The management of excess and inappropriate polypharmacy through proper interventions and local or national guidelines has been highlighted. The purpose of polypharmacy management is to appropriately prescribe medicines that are essential to treat diseases in patients and to avoid inappropriate polypharmacy, such as interactive or duplicate medicines under prescription and PIMs for specific diseases. Community pharmacists in Australia, the EU, USA, and Japan are collaborating with prescribers to review medications to ensure that the patients can be prescribed appropriate medications. The service cost is reimbursed by public or private insurers. A study in the United States has shown that even with medication review costs, the overall medication cost has reduced. In Korea, various projects such as Drug Utilization Review service and safe use of medicines have been conducted; however, no national guidelines or management measures have been established. It is necessary to implement a national long-term plan on polypharmacy management. Furthermore, a phased implementation plan is required. Shortly, active medication review services and education programs for healthcare professionals with the support of the government should be considered in Korea with reference to other countries in order to raise awareness of seriousness and risks of inappropriate polypharmacy.
Keywords
Polypharmacy; the elderly; potentially inappropriate medication;
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1 World Health Organization: Ageing and Health Technical Report Vol. 5: A Glossary of Terms for Community Health Care and Services for Older Persons. In.; 2004.
2 Mortazavi SS, Shati M, Keshtkar A, et al. Defining polypharmacy in the elderly: a systematic review protocol. BMJ Open 2016;6(3):e010989.   DOI
3 Herr M, Robine JM, Pinot J, et al. Polypharmacy and frailty: prevalence, relationship, and impact on mortality in a French sample of 2350 old people. Pharmacoepidemiol Drug Saf 2015;24(6):637-46.   DOI
4 Jyrkka J, Enlund H, Lavikainen P, et al. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf 2011;20(5):514-22.   DOI
5 Nobili A, Pasina L, Tettamanti M, et al. Potentially severe drug interactions in elderly outpatients: results of an observational study of an administrative prescription database. J Clin Pharm Ther 2009; 34(4):377-86.   DOI
6 Wang R, Chen L, Fan L, et al. Incidence and Effects of Polypharmacy on Clinical Outcome among Patients Aged 80+: A Five-Year Follow-Up Study. PLoS One 2015; 10(11):e0142123.   DOI
7 Fried TR, O'Leary J, Towle V, et al. Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. J Am Geriatr Soc 2014; 62(12):2261-72.   DOI
8 Park HY, Park JW, Song HJ, et al. The Association between Polypharmacy and Dementia: A Nested Case-Control Study Based on a 12-Year Longitudinal Cohort Database in South Korea. PLoS One 2017;12(1):e0169463.   DOI
9 Masnoon N, Shakib S, Kalisch-Ellett L, et al. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017; 17(1):230.
10 Park HY, Park JW, Sohn HS, et al. Association of Parkinsonism or Parkinson Disease with Polypharmacy in the Year Preceding Diagnosis: A Nested Case-Control Study in South Korea. Drug Saf 2017.
11 Kim HA, Shin JY, Kim MH, et al. Prevalence and predictors of polypharmacy among Korean elderly. PLoS One 2014; 9(6):e98043.   DOI
12 Nam YS, Han JS, Kim JY, et al. Prescription of potentially inappropriate medication in Korean older adults based on 2012 Beers Criteria: a cross-sectional population based study. BMC Geriatr 2016; 16:118.   DOI
13 Park HY, Ryu HN, Shim MK, et al. Prescribed drugs and polypharmacy in healthcare service users in South Korea: an analysis based on National Health Insurance Claims data. Int J Clin Pharmacol Ther 2016; 54(5):369-77.   DOI
14 McCracken R, McCormack J, McGregor MJ, et al. Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada. BMJ Open 2017; 7(8):e017430.
15 Sinnige J, Braspenning JC, Schellevis FG, et al. Inter-practice variation in polypharmacy prevalence amongst older patients in primary care. Pharmacoepidemiol Drug Saf 2016;25(9):1033-41.   DOI
16 Saum KU, Schottker B, Meid AD, et al. Is Polypharmacy Associated with Frailty in Older People? Results From the ESTHER Cohort Study. J Am Geriatr Soc 2017; 65(2):e27-e32.   DOI
17 Moriarty F, Hardy C, Bennett K, et al. Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study. BMJ Open 2015; 5(9):e008656.   DOI
18 Beer C, Hyde Z, Almeida OP, et al. Quality use of medicines and health outcomes among a cohort of community dwelling older men: an observational study. Br J Clin Pharmacol 2011; 71(4):592-9.   DOI
19 Franchi C, Cartabia M, Risso P, et al. Geographical differences in the prevalence of chronic polypharmacy in older people: eleven years of the EPIFARM-Elderly Project. Eur J Clin Pharmacol 2013;69(7):1477-83.   DOI
20 Niikawa H, Okamura T, Ito K, et al. Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community. Geriatr Gerontol Int 2017;17(9):1286-93.   DOI
21 Nishtala PS, Salahudeen MS. Temporal Trends in Polypharmacy and Hyperpolypharmacy in Older New Zealanders over a 9-Year Period: 2005-2013. Gerontology 2015;61(3):195-202.   DOI
22 Lu WH, Wen YW, Chen LK, et al. Effect of polypharmacy, potentially inappropriate medications and anticholinergic burden on clinical outcomes: a retrospective cohort study. CMAJ 2015;187(4):E130-7.   DOI
23 Charlesworth CJ, Smit E, Lee DS, et al. Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988-2010. J Gerontol A Biol Sci Med Sci 2015;70(8):989-95.   DOI
24 Richardson K, Ananou A, Lafortune L, et al. Variation over time in the association between polypharmacy and mortality in the older population. Drugs Aging 2011;28(7):547-60.   DOI
25 Jang IY, Lee YS, Jeon MK, et al. Potentially Inappropriate Medications in Elderly Outpatients by the 2012 Version of Beers Criteria: A Single Tertiary Medical Center Experience in South Korea. J Korean Geriatr Soc 2013;17:126-33.   DOI
26 Kojima T, Akishita M, Nakamura T, et al. Polypharmacy as a risk for fall occurrence in geriatric outpatients. Geriatr Gerontol Int 2012;12(3):425-30.   DOI
27 Zia A, Kamaruzzaman SB, Tan MP. The consumption of two or more fall risk-increasing drugs rather than polypharmacy is associated with falls. Geriatr Gerontol Int 2017;17(3):463-70.   DOI
28 Thorell K, Ranstad K, Midlov P, et al. Is use of fall risk-increasing drugs in an elderly population associated with an increased risk of hip fracture, after adjustment for multimorbidity level: a cohort study. BMC Geriatr 2014;14:131.   DOI
29 Laflamme L, Monarrez-Espino J, Johnell K, et al. 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 fallinducing drugs. PLoS One 2015;10(3):e0123390.
30 Lai SW, Lin CH, Liao KF, et al. Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan. Geriatr Gerontol Int 2012;12(3):491-8.   DOI
31 Aronson JK. In defence of polypharmacy. Br J Clin Pharmacol 2004; 57(2):119-20.   DOI
32 Aronson JK. Polypharmacy, appropriate and inappropriate. Br J Gen Pract 2006;56(528):484-45.
33 Cole A, Wright H: The importance of 'appropriate' polypharmacy and the value of medicines. European Journal of Hospital Pharmacy 2017; 24(1):70-2.
34 Kuijpers MA, van Marum RJ, Egberts AC, et al. Relationship between polypharmacy and underprescribing. Br J Clin Pharmacol 2008; 65(1):130-3.   DOI
35 Patterson SM, Cadogan CA, Kerse N, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 2014;10:CD008165.
36 Oboh L, Qadir MS. Deprescribing and managing polypharmacy in frail older people: a patient-centred approach in the real world. European Journal of Hospital Pharmacy 2017;24(1):58-62.   DOI
37 Cullinan S, Raae Hansen C, Byrne S, et al. Challenges of deprescribing in the multimorbid patient. European Journal of Hospital Pharmacy 2017; 24(1):43-6.   DOI
38 Levy HB. Polypharmacy Reduction Strategies: Tips on Incorporating American Geriatrics Society Beers and Screening Tool of Older People's Prescriptions Criteria. Clin Geriatr Med 2017;33(2):177-187.   DOI
39 Barnett N, Jubraj B. A themed journal issue on deprescribing. European Journal of Hospital Pharmacy 2017;24(1):1-2.   DOI
40 Scott I, Anderson K, Freeman C. Review of structured guides for deprescribing. European Journal of Hospital Pharmacy 2017;24(1):51-7.   DOI
41 Bulajeva A, Labberton L, Leikola S, et al. Medication review practices in European countries. Res Social Adm Pharm 2014;10(5):731-40.   DOI
42 Kwon KH. A study on the pharmacy manpower project "Vision 2013"; A research report for the Ministry of Health and Welfare. In.; 2013.
43 Dhillon AK, Hattingh HL, Stafford A, et al. General practitioners' perceptions on home medicines reviews: a qualitative analysis. BMC Fam Pract 2015;16:16.   DOI
44 Mair A, Fernandez-Llimos F. Polypharmacy management programmes: the SIMPATHY Project. European Journal of Hospital Pharmacy 2017;24(1):5-6.   DOI
45 Australian Government Department of Health. Medication management reviews. Online at. Available from http://www.health.gov.au/internet/main/publishing.nsf/Content/medication_management_reviews.htm. Accessed September 28 2017.
46 Chen TF. Pharmacist-Led Home Medicines Review and Residential Medication Management Review: The Australian Model. Drugs Aging 2016;33(3):199-204.   DOI
47 Gilbert AL, Roughead EE, Beilby J, et al. Collaborative medication management services: improving patient care. Med J Aust 2002; 177(4):189-92.
48 Emblen G, Miller E. Home medicines review. The how and why for GPs. Aust Fam Physician 2004;33(1-2):49-51.
49 Dolovich L, Consiglio G, MacKeigan L, et al. Uptake of the MedsCheck annual medication review service in Ontario community pharmacies between 2007 and 2013. Canadian Pharmacists Journal 2016;149(5):293-302.
50 Barnett MJ, Frank J, Wehring H, et al. Analysis of pharmacist-provided medication therapy management (MTM) services in community pharmacies over 7 years. J Manag Care Pharm 2009;15(1):18-31.
51 Matlin OS, Kymes SM, Averbukh A, et al. Community pharmacy automatic refill program improves adherence to maintenance therapy and reduces wasted medication. Am J Manag Care 2015;21(11):785-91.
52 The Ministry of Health and Welfare. Drug Utilization Review; DUR system. Available from http://www.mohw.go.kr/front_new/policy/index.jsp?PAR_MENU_ID=06&MENU_ID=062904&PAGE=4. Accessed November 11, 2017.