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Conceptualizing multiple drug use in patients with comorbidity and multimorbidity : proposal for standard definitions beyond the term polypharmacy

Kadam, Umesh T.; Roberts, Isobel; White, Simon; Bednall, Ruth; Khunti, Kamlesh; Nilsson, Peter M. LU and Lawson, Claire A. (2019) In Journal of Clinical Epidemiology 106. p.98-107
Abstract

With older and aging populations, patients experience multiple chronic diseases at the same time. Individual chronic disease guidelines often recommend pharmacological therapies as a key intervention, resulting in patients being prescribed multiple regular medications for their different diseases. Although the term “polypharmacy” has been applied to the use of multiple medications, there is no consistent definition, and this term is now being used all inclusively. To improve both scientific rigor and optimal patient care, it is crucial that a standard terminology is used, which reclassifies the term “polypharmacy” into distinct phenotypes relating to the index chronic disease, additional conditions to the index (comorbidity), or the... (More)

With older and aging populations, patients experience multiple chronic diseases at the same time. Individual chronic disease guidelines often recommend pharmacological therapies as a key intervention, resulting in patients being prescribed multiple regular medications for their different diseases. Although the term “polypharmacy” has been applied to the use of multiple medications, there is no consistent definition, and this term is now being used all inclusively. To improve both scientific rigor and optimal patient care, it is crucial that a standard terminology is used, which reclassifies the term “polypharmacy” into distinct phenotypes relating to the index chronic disease, additional conditions to the index (comorbidity), or the experience of multiple chronic conditions at the same time (multimorbidity). Using three exemplar index conditions; heart failure, type 2 diabetes, and breast cancer, we propose the reclassification of the term “polypharmacy” into three distinct phenotypes. First, index drug or multi-index drug therapy, where each index condition creates multiple drug use for that condition; second, codrug therapy, where addition of other comorbid conditions increases the multiple drug use and may influence the management of the index disease and third, multidrug therapy, where adult population with multimorbidity may be on many drugs. This article reviews guidelines for the individual exemplars to develop the basis for the new terms and then develops the pharmacoepidemiology of multiple drug use further by reviewing the evidence on the relationship between the phenotypic classification and important outcomes. The importance of standardizing “polypharmacy” terminology for the scientific agenda and clinical practice is that it relates to an index condition or disease safety outcomes including drug interactions, adverse side effects in hospital admissions, and related “polypill” concept.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Breast cancer, Comorbidity, Diabetes, Heart failure, Multimorbidity, Polypharmacy
in
Journal of Clinical Epidemiology
volume
106
pages
10 pages
publisher
Elsevier
external identifiers
  • scopus:85056774449
ISSN
0895-4356
DOI
10.1016/j.jclinepi.2018.10.014
language
English
LU publication?
yes
id
8f79aea5-7d80-47bb-b21a-0903318f7571
date added to LUP
2018-11-26 10:55:36
date last changed
2018-11-26 10:55:36
@article{8f79aea5-7d80-47bb-b21a-0903318f7571,
  abstract     = {<p>With older and aging populations, patients experience multiple chronic diseases at the same time. Individual chronic disease guidelines often recommend pharmacological therapies as a key intervention, resulting in patients being prescribed multiple regular medications for their different diseases. Although the term “polypharmacy” has been applied to the use of multiple medications, there is no consistent definition, and this term is now being used all inclusively. To improve both scientific rigor and optimal patient care, it is crucial that a standard terminology is used, which reclassifies the term “polypharmacy” into distinct phenotypes relating to the index chronic disease, additional conditions to the index (comorbidity), or the experience of multiple chronic conditions at the same time (multimorbidity). Using three exemplar index conditions; heart failure, type 2 diabetes, and breast cancer, we propose the reclassification of the term “polypharmacy” into three distinct phenotypes. First, index drug or multi-index drug therapy, where each index condition creates multiple drug use for that condition; second, codrug therapy, where addition of other comorbid conditions increases the multiple drug use and may influence the management of the index disease and third, multidrug therapy, where adult population with multimorbidity may be on many drugs. This article reviews guidelines for the individual exemplars to develop the basis for the new terms and then develops the pharmacoepidemiology of multiple drug use further by reviewing the evidence on the relationship between the phenotypic classification and important outcomes. The importance of standardizing “polypharmacy” terminology for the scientific agenda and clinical practice is that it relates to an index condition or disease safety outcomes including drug interactions, adverse side effects in hospital admissions, and related “polypill” concept.</p>},
  author       = {Kadam, Umesh T. and Roberts, Isobel and White, Simon and Bednall, Ruth and Khunti, Kamlesh and Nilsson, Peter M. and Lawson, Claire A.},
  issn         = {0895-4356},
  keyword      = {Breast cancer,Comorbidity,Diabetes,Heart failure,Multimorbidity,Polypharmacy},
  language     = {eng},
  pages        = {98--107},
  publisher    = {Elsevier},
  series       = {Journal of Clinical Epidemiology},
  title        = {Conceptualizing multiple drug use in patients with comorbidity and multimorbidity : proposal for standard definitions beyond the term polypharmacy},
  url          = {http://dx.doi.org/10.1016/j.jclinepi.2018.10.014},
  volume       = {106},
  year         = {2019},
}