Poly What?

Polypharmacy, defined by researchers as “the use of more medications than are medically necessary,” is becoming a significant concern for the elderly, and more specifically, the hospitalized elderly.  According to a recent article in Kaiser Health News, the consequences of prescribing unnecessary medications to elderly patients range from medical complications to heavy financial burdens on the healthcare system.  Despite these foreseeable challenges, the prevalence of over-prescribing is quite high. 

A 2005 study evaluated the hospital discharge of 384 elderly patients, and researchers discovered that 58.6% of the patients took one or more unnecessarily prescribed drugs.  Further, the Department of Health and Human Services (HHS), in their National Action Plan for Adverse Drug Event Prevention, cited a 2006 study that revealed 57-59% of adults 65 years of age and older reported taking five to nine medications, and 17-19% reported taking 10 or more medications.  Taking so many medications increases medical costs and affects a patient’s health. 

HHS reports that adverse drug events (ADEs), injuries that result from the medical intervention of a drug, account for a third of hospital adverse events and two million hospital stays annually.  Further, while older adults make up 35% of all hospital stays, more than half of those visits are drug-related complications, and they add around three days to the average stay.  Financially, ADEs are estimated to incur $5.6 million (1993 USD) in excess hospital costs and $3.5 billion (2006 USD) in health care costs.  Overall, Medicare beneficiaries suffer the highest risk of acquiring an ADE during a hospital stay as Medicare reimburses 75% of inpatient ADEs. 

The numbers and percentages make it apparent that polypharmacy creates a large burden on patients and the healthcare system.  Since a great majority of the population at risk for an ADE is made up of Medicare beneficiaries, this problem is of particular concern for those who intend to see Medicare thrive in the future.  The financial uncertainty of Medicare is rooted in the fact that Medicare’s population is growing substantially while the population charged with funding the Medicare program is not growing at nearly the same rate.  Accordinly, there is very little room for superfluous spending on drugs.  HHS reports that in 2012 alone, spending on the Medicare Part D program was $66.9 billion, and that number is projected to increase to $165.1 billion by 2022.  Alleviating the financial burdens of polypharmacy will help prevent Medicare’s potential solvency.

The question remains then how hospitals intend to root out the causes of ADEs and polypharmacy in general.  One cause that has received some attention lately is the lack of coordination and communication between health care professionals that treat elderly patients.  When a patient is admitted into the hospital, a physician may prescribe medications for the illness presented and any side effects that may arise.  The problem arises when hospital doctors do not account for how long the patient will need the medication.  As a result, medication prescriptions accumulate over a very short period of time, leaving those elderly patients susceptible to ADEs, which often leads to another trip to the hospital.  Nationally, older adults are two to three times more likely to visit the doctor’s office or emergency department and seven times more likely to have an ADE that requires a hospital admission.

What does this mean for providers who care for the elderly?  It means that more focus must be paid toward updating and maintaining awareness of the medications prescribed for patients before, during, and after a hospital stay.  For example, the UCLA Medical Center in Santa Monica has found a workable remedy to polypharmacy by hiring a clinical pharmacist to help patients and doctors decide what medications the patients genuinely need compared to those they can survive without.  The clinical pharmacist spends most of his days updating the medication charts of elderly patients, answering questions about which medications are best for such patients; and explaining to the patients themselves what medications they should be taking, how often they should be taking them, and what each change in dosage or frequency actually means.  The medical center reported that in the six-month stretch after they brought on the clinical pharmacist to the geriatric unit, readmissions for drug problems decreased from 22 to three.  It’s not hard to see that having a clinical pharmacist on the team can only benefit patients and hospitals long term.  Especially taking into consideration recent federal legislation and the general trends towards value based incentive payments, polypharmacy is certainly an area open to some cleaning.

Maria Marek is in her second year at the DePaul College of Law in Chicago.  She hopes to achieve a certificate in Health Law in conjunction with her J.D. upon graduation in 2018.  Maria is actively involved in the Mary and Michael Jaharis Health Law Institute, and is especially interested in health policy and regulations.