MedCity Influencers

It’s Past Time to Prevent Polypharmacy in U.S. Healthcare

The dangers of polypharmacy and its increasingly wide reach across the American population make it imperative that we enhance the accuracy and efficiency of medication reconciliation processes.

When making medical decisions, it’s crucial that clinicians have unencumbered access to the complete and accurate medication histories of their patients. Put simply, treatment decisions made in the absence of this information or based on outdated or otherwise incorrect data can lead to a variety of adverse and, often, potentially fatal consequences. 

However, traditional processes of medication reconciliation in the United States, through which providers obtain and verify the accuracy of their patients’ medication histories, are often incredibly time-consuming and inundated with procedural inefficiencies and unnecessary complexity. It’s also difficult to obtain a current—and accurate—list of medications prescribed across care sites, especially from out-of-network providers—and patients and families struggle to fill in the gaps. As a result, medication regimens often differ from provider to patient.  

In older adults, medication regimens can balloon in size as individuals seek care from multiple providers and are more likely to experience hospitalizations and transitions of care that lead to treatment decisions are frequently made alongside an increased risk of polypharmacy, or the use of multiple medications simultaneously to treat a single condition. Today, polypharmacy is not only a major public health concern, but also a significant contributor to rising healthcare costs, with more than $177 billion in added expense resulting from polypharmacy each year—mostly due to drug-related hospitalizations.

As things currently stand, there is no perfect solution to the medication reconciliation processes and preventing polypharmacy in the United States. But recent advances that were derived from the collaborative efforts of healthcare clinicians, informaticians, data scientists and policy makers in Connecticut provide a blueprint for clinicians across the nation to utilize new tools that make medication regimens safer, all for. more informed treatment decisions and ultimately improve quality of life for millions of patients.  

Increasingly apparent dangers of polypharmacy

The prevalence of polypharmacy has been steadily increasing in the United States for decades. For example, the number of older Americans on a medication regimen of at least five drugs more than tripled from 1994 to 2014, rising from 13.8% to 42.4%.

Since then, this upward trend has continued despite our deepening understanding of the myriad negative consequences associated with polypharmacy, including its well-established association with a significantly greater risk of hospitalization or death. More specifically, patients taking more than five prescription medications simultaneously face a 50% chance of having an adverse drug reaction, and polypharmacy in general has been found to be the fifth leading cause of death in the United States, accounting for roughly 30% of all hospital admissions each year. 

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And while polypharmacy is more commonly associated with older individuals and seniors, who are more likely to be prescribed multiple medications and are uniquely vulnerable to adverse drug reactions and other complications, polypharmacy and its associated risks are in no way exclusive to a single demographic. In fact, a recent study from the University of Maryland found that more and more children and adolescents throughout the country are taking multiple psychiatric drugs at once, revealing a 9.5% increase in polypharmacy from 2015 to 2020 among Medicaid patients ages 17 or younger. 

The dangers of polypharmacy and its increasingly wide reach across the American population make it imperative that we enhance the accuracy and efficiency of medication reconciliation processes. Yet reversing this trend has historically posed a significant challenge for healthcare. While no one disagrees that polypharmacy needs to be addressed, because of the complexities surrounding polypharmacy—including how to ensure pharmacists have access to the most up-to-date information regarding a patient’s medication history, no matter where they receive care—it has often been overlooked as a priority action item for states. Polypharmacy is also a term that describes the problem but is not action oriented. To change medication regimens, clinicians need accurate information and training on how to appropriately deprescribe medications.

But it’s past time to commit to building tools and workflows that address polypharmacy and support medication reconciliation. In Connecticut, recent advancements toward a more novel and effective solution could serve as the beginning of a roadmap for dramatically increasing medication safety across the country. 

Paving a new path forward for medication reconciliation

In theory, the process of medication reconciliation is the first and most effective line of defense against potentially harmful or even fatal instances of polypharmacy and other medication errors, such as misused inappropriate treatments that have adverse effects on health. Moreover, the need for immediate, unencumbered access to medication history often becomes even more dire in an emergency scenario. 

For instance, one of the biggest risks adults over the age of 60—who typically take more than one medication due to chronic disease—face related to polypharmacy is oversedation and falls. This contributes to higher rates of household injuries and motor vehicle accidents. Among rheumatology patients, emerging evidence suggests polypharmacy “contributes to adverse outcomes and alters treatment response.” And in older adults with two or more chronic conditions, polypharmacy is associated with higher risk of adverse drug events.  Patients taking four or more medications are at increased risk of falling.

In practice, however, medication reconciliation is often rendered inefficient and ultimately ineffective by a lack of strategic coordination to close critical gaps in healthcare professionals’ access to information. This includes poor or nonexistent collaboration between community pharmacies to integrate dispensing data, siloed electronic health records, and the overall absence of universal standards surrounding the management of prescription data throughout the U.S. healthcare system. 

Understanding the increasingly urgent need to address these challenges, in 2018, the Connecticut General Assembly passed Special Act 18-6, requiring the establishment of a Medication Reconciliation and Polypharmacy Workgroup. Within a year, the group delivered multiple recommendations for policy improvements and the promotion of interoperability and the standardization of prescription medication data. The workgroup evolved into a committee of the Office of Health Strategy. The committee helped establish the creation of a “Best-Possible Medication History – BPMH” as the end-goal, recognizing that medication reconciliation will never result in a 100% accurate medication regimen.  The committee’s efforts formed the foundation of and ultimately led to the development and recent launch of a new Medication Management Tool

By breaking down many of the information silos that existed within the state’s healthcare system and infrastructure, and bringing together the many critical stakeholders who influence a patient’s medication care, the tool has given providers across Connecticut the ability to more efficiently store, access, and dispatch critical medication data to the point of care. It has also significantly reduced polypharmacy and enhanced deduplication processes. In fact, during its latest 12-month phase, duplicated prescriptions dropped considerably among more than 3 million patients across the state, with medication lines reduced from 187.6 million to 21.5 million. [Editor’s Note: This Medication Management Tool was launched by Connie, a Health Information Exchange in the state of Connecticut, where Jean Searles, one of the authors of this article is Executive Director.]

Above all, while further work is needed, the efforts of Connecticut’s clinicians, legislators, nonprofit organizations, and industry collaborators demonstrate that improving medication reconciliation in the United States is not a lost cause. Key to success: a shared awareness, determination, and strategic coordination among diverse stakeholders across the healthcare industry. 

Will it take years of hard work to ensure a foolproof medication reconciliation process is available to all providers throughout the nation? Almost certainly. However, the idea that millions of Americans today need to be concerned about the safety of the drug combinations that are prescribed to help them is unacceptable. We should collectively be willing to do whatever it takes to reign in polypharmacy and its negative impacts once and for all.

Photo: Stas_V, Getty Images

Jenn Searls, MHA is the Executive Director at Connie, the state of Connecticut’s official health information exchange. Prior to joining Connie, Ms. Searls was the Chief Operating Officer at SOHO Health where she led the effort to scale the former Saint Francis Healthcare Partners to a regional clinically integrated network for the 1,700 providers and five hospitals affiliated with Trinity Health of New England. There, she was responsible for the build of a new population health infrastructure in its transition to value-based care. Previous to that, she was the Chief Information Officer at ProHealth Physicians, where she orchestrated the successful transition from paper records to an electronic medical record and served as co-lead for a multi-disciplinary team who guided the organization and all of its practices to the achievement of Level 3 recognition as a Patient Centered Medical Home (at the time, the largest single PCMH submission in NCQA history).

Dr. Sean Jeffery, PharmD, BCGP, FASCP, AGSF, is Director of Pharmacy Services at Integrated Care Partners, a physician-led, clinically integrated network responsible for Hartford Healthcare’s value-based practice transformation. Dr. Jeffery is responsible for managing Medicare Part D Star pharmacy quality measures, population health management, and supporting an integrated care-management team and employed medical group. Dr. Jeffery is also a Professor of Pharmacy Practice at the University of Connecticut School of Pharmacy and is currently the 2nd Vice President of the Connecticut Pharmacist Association. Prior to joining Integrated Care Partners, Dr. Jeffery served as a consultant pharmacist for the VA Connecticut Geriatrics Consult service from 1998 - 2015. During this time Dr. Jeffery also established a Post Graduate Year-2 Geriatrics Pharmacy Residency Program and served as Director from 2002 - 2015.