The results from this study suggest that while participants feel comfortable communicating with their doctor, the content of these conversations may not include polypharmacy issues and medication reviews. Many participants were uncertain about details concerning their medications. In addition, participants did not demonstrate confidence about understanding the adversities associated with multiple medication use and the importance of completing medication reviews. Furthermore, most of the participants responded that they had not received or were unsure about receiving medication reviews. This result serves to emphasize that while participants feel their physician is open to communication, there may be a lack of communication occurring where medication reviews are concerned. When asked if they were able to describe a “drug-drug interaction” or the purpose of a medication review, the responses ranged from disagree to neutral. Participants were either unsure about these questions or about the topics these questions were in reference to. However, it was encouraging that more than 60% of the population was interested in learning about medication reviews and talking to their doctor about a medication review.
The correlation analysis provided insight into associations between measures. The association found between the number of providers for a participant and the number of medications they are taking suggests that seeing multiple doctors may increase the likelihood of taking multiple medications. While causal relationships cannot be inferred, this association may indicate that each doctor is prescribing a medication, thereby increasing the overall number of medications for a patient. This finding exemplifies the importance of effective patient-physician communication as well as communication among physicians caring for the same patient to reduce adverse drug-drug interactions.
Another interesting finding is the association between individuals who have someone helping them with their medication regimen and those who utilize tools for referencing their medications. Further research is needed to understand why this association is occurring. Possible reasons may be that the individual assisting the participant is using the medication tools (pillboxes, printed charts) to care for the participant or the assisting individual is teaching the participant to use them. Another reason could be that some participants are more likely to seek help from any and all available sources, whether they be a person or tool. Thus, future studies could delve deeper into the associations found in this exploratory study.
In Hawai‘i, the effects of a medication review by geriatricians in a nursing home were analyzed.11
The study involved a review of a patient's medication list, consulting Beers' Criteria online, and recommending medication changes to the patient's primary physicians.11
Results showed that 46.2% of the patients were on nine or more medications.11
The ethnicities of the patients were not specified. After a physician intervention, the average total of medications declined, demonstrating that the application of a system of medication guidelines and tools can significantly reduce polypharmacy.11
Interventions that have targeted reducing polypharmacy among the elderly population have placed emphasis on the role and responsibility of the physician. Hanlon, et al, performed a trial in Durham, North Carolina, of a clinical pharmacist intervention in elderly outpatients with polypharmacy to improve inappropriate prescribing.12
Clinical pharmacists met with the intervention group to evaluate medications, give general drug information, and make recommendations that were sent to the patient's physician.12
After one year, there was a 23% difference between groups in the reduction of inappropriate prescribing.12
Thus, pharmacists can also make a significant contribution to improving prescription appropriateness for elderly adults.12
There is a movement within healthcare to improve communication and availability of patient information at the point of care through Health Information Exchange (HIE) and other Health Information Technology (HIT). As more providers adopt electronic health records and exchange patient information, the quality of communication between patients and among their providers in regards to multiple medication use is likely to improve. Communication among a patient's physicians is important, and it can be facilitated by technologies that allow physicians to readily identify all the medications taken by a patient to reduce the occurrence of adverse drug-drug interactions. HIT tools may also help patients access information about their medications and remind them how and when to take them. Interventions testing such applications among high risk populations in Hawai‘i are also needed.
The data from this needs assessment indicates a need for an intervention that is focused on multiple medication use and medication review awareness and education. An intervention should address important findings from the study such as the results indicating that most participants did not have another individual, a medication schedule, or another tool to aid them in keeping track of their medications. An intervention should especially target those individuals who feel they have difficulty following their medication regimen, but are not utilizing any tools to help themselves. In addition, further analysis should be done to assess the relationship between the measures, and to test causality of having an adverse reaction to medications. Geriatric individuals are more susceptible to adverse effects due to polypharmacy simply due to physiology and co-morbidities associated with aging. An intervention is needed to address these health issues to ensure that elderly patients are better equipped to manage their multiple medication use.