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Risk Factors for Polypharmacy in the COVID-19 Era

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We've been discussing polypharmacy at length in recent blogs, touching on everything from definitions to statistics to deprescribing guidelines. But one topic we haven't discussed yet that is critical to understanding how polypharmacy is affecting patients today and what can be done to improve its management is risk factors for polypharmacy — and more specifically those in the COVID-19 era we now find ourselves in.

Let's look at four risk factors for polypharmacy and how the pandemic is affecting them.

1. Increase number of medications

A surefire way to make polypharmacy management more difficult and increase the risks associated with polypharmacy is to introduce more medications to a regimen, including over-the-counter drugs and vitamins/supplements. COVID-19 has done just that for numerous patients.

Here are just a few ways that has happened:

  • The stress of the pandemic is taking a significant mental health toll on people, which is translating to noteworthy increases in antidepressant, anti-anxiety, and anti-insomnia medications, reported Express Scripts. In a news release, Dr. Glen Stettin, senior vice president and chief innovation officer at the company, said, "Americans have grown increasingly anxious as they've seen this global pandemic upend their lives within a very short time. We're all concerned about our health, our families and our livelihoods, and are struggling with uncertainty."
  • Acetaminophen purchases saw a significant spike due to a belief that the medication might be a good way to fight COVID-19. It's also likely that consumers have increased their consumption of such medications to treat ailments such as headaches brought on by stress and backaches brought up by extended time spent indoors sitting in chairs and on couches.
  • As The New York Times reported, antacids like Tums, Pepcid and its generic version, famotidine, are facing shortages. Contributing factors highlighted in the piece include increased stress attributable to the coronavirus itself, remote learning challenges, and the current political environment.
  • Consumers have made substantial changes to their usage of dietary supplements during the public health emergency, including increasing supplement intake, taking the same supplements more regularly, and increasing dose(s).

2. Usage of multiple pharmacies

When patients fill medications at more than one pharmacy, this ups the potential for several risks, including medication duplication, drug-drug interactions, and complex medication management.

As a U.S. Pharmacist article states, "Pharmacists provide more efficient medication therapy management (MTM) services when they have a complete picture of the patient's health status." This can become significantly more challenging when multiple pharmacists at multiple pharmacies do not have access to medication information filled at all pharmacies.

The COVID-19 pandemic motivated many people to begin using mail-order pharmacies to reduce the need to leave their homes and travel to physical pharmacies to pick up prescriptions. As a Kaiser Family Foundation (KFF) report notes, "Data from the first seven months of 2020 shows that use of mail order increased by up to 20% over 2019 levels in the early weeks of the pandemic." This is a trend that likely continued in the months that followed, and we can comfortably assume that many people will continue to use mail-order pharmacies going forward.

While mail-order prescriptions have helped patients limit their exposure to the novel coronavirus, it has also introduced another "pharmacy" into the equation for many patients. And medications delivered by mail brings its own risks.

3. Increase chronic conditions

Polypharmacy is commonplace for patients with chronic conditions. The likelihood of polypharmacy — and the overall number of medications — increases as the number of chronic conditions or severity of these conditions increases.

The pandemic has likely contributed to both of these risk factors for polypharmacy. As an HFMA article notes, a survey of primary care clinicians had 37% reporting that they had found chronic conditions getting "noticeably worse," with 56% of those surveyed reporting an increase in negative health burdens due to delayed or inaccessible care. Research has shown that the pandemic has affected exercise routines, contributed to missed routine checkup/lab testing, and impacted daily healthcare — all of which can contribute to the development of chronic diseases.

4. Physician turnover

One of the more frequently cited risk factors for polypharmacy is multiple medical conditions being managed by physicians from multiple specialties. As we noted in a previous blog, "Without realizing it, each provider may take a condition- or disease-centric approach to prescribing. And patients may not understand, for instance, that the cardiologist needs to know about the pills that the pulmonologist and orthopedist prescribed."

What can further complicate this risk factor is the changing of patients' physicians. Altering doctors can lead to miscommunication between the parties. New doctors are also unfamiliar with patients and may not have easy access to a patient's medical and medication history.

The pandemic has disrupted and is continuing to disrupt the physician community in numerous ways. One of the most significant ways can be summarized by this quote from a paper produced by AMN Healthcare, B.E. Smith, and Merritt Hawkins: "… for the first time in memory, a significant number of physicians are facing employment uncertainty — losing their jobs, experiencing pay cuts or, in the case of independent practice owners, facing practice closure."

A recent physician survey conducted by Jackson Physician Search found that "54% of physicians surveyed said COVID-19 has changed their employment plans. Of those, 50% are considering leaving for a new healthcare employer, 21% said they may hang up their white coat for early retirement, and 15% are thinking about leaving the practice of medicine entirely." This led the physician recruiting firm to ask, "… is the healthcare industry on the verge of a physician turnover epidemic?"

In December, Physicians Foundation reported that about 8% of physician practices were forced to close because of the pandemic, while an additional 4% of practices are expected to shut down their offices within the following 12 months.

Another form of physician turnover for patients may also be contributing to polypharmacy management risks. While many patients have taken advantage of telehealth offerings during the public health emergency, this often required meeting with new physicians if existing physicians lacked virtual care delivery capabilities, sometimes by choice.

And then there are those patients who have added one or more physicians during the past year to help with management of new or worsening conditions, such as the aforementioned mental health challenges and chronic diseases.

Pandemic as a Polypharmacy Risk Factor

Considering that the public health emergency has likely affected all risk factors for polypharmacy and made prescribing, medication management, and medication adherence more difficult, a strong argument can be made that the COVID-19 pandemic is its own risk factor. Clinicians will want to be mindful of how the pandemic is contributing to new or increasing challenges associated with polypharmacy management and take steps to help reduce the inherent patient safety risks that come with frequent changes to medication regimens — particularly for those patients taking numerous medications and supplements.

One of the most effective ways for clinicians to better ensure medication management safety is the ability to access a comprehensive, up-to-date view of medications prescribed to a patient and patient pickup and refill history, dosage changes, and other critical medication usage information. Cureatr's Meds 360° platform does all of this and more. To learn about this powerful solution and how it can help your organization reduce polypharmacy risks, schedule a demo today.

 

Understanding and Addressing Polypharmacy: A Detailed Guide

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