Should We Redefine Medication Adherence in this Age of Polypharmacy?
Written by Rushabh Lagdiwala PharmD’22
Published on December 13, 2017
Is understanding how to take your prescribed medication as simple as reading the instructions on the bottle? For a large group, such as the elderly, multiple variables lead them to deviate from properly adhering to dosage instructions. They are in need of assistance in order to achieve optimal effects of the medications prescribed and live a healthy life. However, the first step in finding a resolution is to make sure that the entire health community has standard parameters for analyzing information. Barriers such as different definitions of polypharmacy and varying medication adherence reporting techniques can be further reviewed in an effort to increase the knowledge of medication adherence and properly treat the expanding elderly community.
The aging community finds it difficult to keep up with polypharmacy as they become older. However, the first step in solving this issue is to understand what polypharmacy is. According to Zelko and colleagues, there has been a difficulty amongst the health policy community in coming up with a consensus of the exact definition of polypharmacy, making it difficult to collect valuable data in resolving the issue. When collecting data from multiple sources, they found that some researchers believed polypharmacy as consuming three or more drugs for the same ailment, while other researchers believed it to be consuming five or more drugs. Varying perspectives of what polypharmacy exactly is makes it difficult to analyze data and understand the possible downsides of polypharmacy for the elderly community. Through communication, specific parameters can be set for what polypharmacy exactly is, thus allowing for a standard benchmark to be created when analyzing patient results.
Obscurity in the exact definition of polypharmacy has also led to failures in medication adherence reporting techniques. Over fifty-eight different types of measures were identified throughout the systematic review by Garfield et. al. and only few were reliable and given enough time to complete. Additionally, from a majority of these measures, only a small number of them were able to distinguish between the various non-adherence types and various methods of improving adherence interventions. With conflicted interpretations of polypharmacy, it was even more difficult to determine which measures were reliable. An example of a reliable measure, based on Garfield and his research team that allowed for non-adherence types to be measured, were surveys being sent to patients taking medications and allowing them to answer as to what level they adhere to the medication instructions that were provided. However, it was difficult for patients to also come up with specific estimates as to how many doses they missed causing them to only be able to give general estimates to their adherence. This exemplified how even the most reliable measures were filled with flaws. With so many unreliable measures stemming from an ambiguous definition of polypharmacy, the lack of standardized medication review methods have not only led to the failure in the studies, but also a lack of results to analyze and identify possible resolutions in improving adherence.
Barriers such as the understanding of polypharmacy and suitable approaches to revising medication adherence should be resolved before successful research can be done in improving the health of the elderly community. By creating standardized approaches in understanding what exactly polypharmacy is and by conducting experiments in line with these standards, the data produced will be stronger. This will not only help explain the trend amongst the elderly and medication adherence, but also will give researchers an idea of how to define and improve medication adherence in this population.
Categories: Health Policy, Public Health, Medication Adherence, Mayes College of Healthcare Business and Policy, Department of Health Policy and Public Health, Students, Department of Pharmaceutical and Healthcare Business