Endpoints in strategies to reduce polypharmacy

Polypharmacy is closely associated with potentially inappropriate prescriptions that can have negative effects on patients. It is present in approximately 58% of those over 65 years of age and can occur in 70% of nursing home residents 1. Along with the pharmacokinetic changes induced by ageing, polypharmacy plays an important role in the occurrence of adverse drug events 2 and is associated with multiple clinical problems, such as poor adherence to treatment, drug interactions, development of geriatric syndromes and increased care costs 3.

Recently, Johansson et al. published a meta‐analysis on the impact of strategies to reduce polypharmacy in clinically important outcomes (hospitalization and death), and found that there is no evidence of their effectiveness 4. The included strategies were divided into interventions focusing on pharmacists, other multidisciplinary teams, or medical personnel.

It is interesting to note that, of the 25 trials included in the review, the highest proportion of studies (three‐quarters of the studies) showing some positive impact on all‐cause mortality were those with physician‐led interventions 4. Some of these achieved a significant decrease in the utilization of medical services, the number of drugs per patient and the number of drugs initiated during the intervention 4.

Our research group has conducted various medical education interventions aimed at rationalizing the use of drugs. We gained a good response from the medical community and achieved variable adherence to the recommendations. The success of these activities resulted in a reduction in the number of drugs prescribed and the number of patients with inappropriate prescriptions, avoided the possible occurrence of adverse drug reactions and even generated significant savings in drug costs 5, 6.

We consider the strengthening of the various medical education activities aimed at improving and ensuring appropriate drug use to be of great importance, in order to provide adequate, rational and cost‐effective therapies. The meta‐analysis of Johansson et al. 4 is a motivation not only to generate new studies seeking to change prescribing patterns and reduce the total number of drugs taken, but also to determine the final impact of these adjustments.

Competing Interests

All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.

Gaviria‐Mendoza, A. , Machado‐Alba, J. E. , Castaño‐Montoya, J. P. , Machado‐Duque, M. E. , and Giraldo‐Giraldo, C. (2017) Endpoints in strategies to reduce polypharmacy. Br J Clin Pharmacol, 83: 432–433. doi: 10.1111/bcp.13122.