Polypharmacy: Too Many Cooks Spoil the Broth
This week’s article is about polypharmacy, which is roughly defined as the use of multiple medications to treat one or more conditions. Polypharmacy is not always a bad thing, but if not managed appropriately it can easily end up harming a patient physically and financially. The risks of polypharmacy include drug interactions, overuse of drugs that are similar, wasted money on unneeded refills, and complications of long-term use of medications that are meant to be short-term and limited (i.e. muscle relaxers, pain medications, anti-anxiety meds, etc.) One study from the United Kingdom showed that in 2018 there were 8.6 million admissions of adverse drug events in Europe, meaning there was some injury caused by prescription medication. Of those, they estimated that as much as 50% of the events were preventable. The primary cause was patients over the age of 65 and on 5 or more medications.
Polypharmacy can have a variety of causes, especially when you look at different age groups. For the elderly, chronic conditions tend to be more prevalent, so a person may be on multiple meds for hypertension, diabetes, arthritis, cholesterol, etc. Younger patients tend to have fewer chronic conditions, and their type of polypharmacy may be more related to treating acute ailments. In today’s medical climate, patients often have many different sources of prescriptions including primary care providers, urgent care, emergency rooms, and specialists. While this access to care is convenient, it is easy for a patient to receive an onslaught of medications from multiple providers who may not have a good idea of what you are being prescribed by someone else.
It is important to know that there is no central database for prescription medications. Providers don’t have access to your medication list unless they are in a shared system. For example, our electronic health record system at 45 Urgent Care is not accessible from anyone outside the clinic. We completely rely on you to let us know what you are currently taking in order to safely prescribe medications to you. I recommend that you always carry an up-to-date list of your medications, what they are used for, and any allergies you have. You may be wondering why we ask why you are taking medication. Yes, we know what the medications are intended for, but there are often off-label uses that your prescriber may be using that particular medication for, which is good for us to know. Another reason we ask is that sometimes patients keep taking a medication for a long time after they are needed simply because no one told them not to.
In addition to having a list, it is also recommended that you keep your PCP updated on any medication changes you have from other providers. As your PCP is your main health manager, they should be well-informed about what medications you are taking. Another thing you can do is reduce the number of prescribers you encounter. There is an old saying that too many cooks spoil the broth, and it is a philosophy that I use in my decision making as an urgent care provider. I may refill medications that you get from your PCP if needed, but I generally don’t change dosages of those medications. Periodically you should meet with your PCP to determine the need for current medications. As I mentioned earlier, you may have been given medication with multiple refills as a convenience, but if it is not necessary to keep taking it you are both spending money you don’t need to and potentially doing harm to your health.
Here are 45 Urgent Care we are committed to treating your acute needs and educating you on preventative medicine. If you have any questions about the medications you are on, we would be happy to meet with you and discuss them.