Polypharmacy and quality of life

Due to chronic diseases and polypharmacy, the medication-related burden for patients is steadily increasing and consequently leading to worse clinical results and an overall decrease in the quality of patients’ lives. This multidimensional burden includes concerns regarding the use of medicines, financial difficulties, unwanted side effects and other problems that harm the patient’s everyday life. Alleviating the medication-related burden is one of the key focal points on the way to improve the patient’s health and quality of life.

Prescribing medicines is one of the most common services the healthcare system provides, and monitoring the patient's experience with medicines is an increasing priority¹. The demographic aging of the population in most developed countries of the world is faster than in recent years, increasing the likelihood of the development and occurrence of chronic diseases, which are a major cause of morbidity and death, most often requiring the use of multiple medications and leading to polypharmacy^{1, 2}. Although diseases can be treated in many ways, medication is still the most common form of treatment³.

Polypharmacy is thus a global phenomenon, accelerated by the increase in human longevity and the prevalence of chronic diseases such as cardiovascular disease, type 2 diabetes, arthritis and osteoporosis. The use of more drugs in patients is also increasing at the expense of a broader range of specializations and disease-specific clinical guidelines^{4, 5}. 

Prescribing and specialist recommendations are often uncoordinated, which quickly leads to polypharmacy in a patient with multiple diagnoses who is prescribed a new drug at each specialist review. Krska et al. write that although clinical guidelines and the involvement of multiple specialists result in better disease control, they also lead to increased prescribing, which is already burdensome for the patient without additional factors⁶. 

Observational studies have shown that, in addition to the burden of drug therapy, polypharmacy is associated with several other clinical outcomes, such as drug-drug interactions, non-cooperation with treatment, inappropriate prescribing, adverse drug reactions (ADRs), increased hospitalization and mortality^{5, 7}. It is also important to add that for some individuals, just one medication or even one unit of medication per day can be a burden - especially if the difficulties the patient faces to achieve the desired outcome outweigh the benefits of the drug treatment^{1, 8, 9}.

Although medicines are beneficial, relieving symptoms, preventing exacerbations and even prolonging life, coordinating the use of medicines in the presence of coexisting long-term conditions is challenging and poorly understood. Chronic conditions often require a complex regimen of managing both the impact of the disease and health interventions, which place considerable demands on the individual in terms of effort, time and, ultimately, finances¹. 

Despite advances in medical care and pharmaceuticals, patients feel the burden of treatment. This burden may lead to reduced participation in drug therapy, negative clinical outcomes or failure to achieve the treatment goal. All of this has a consequent detrimental effect on the patient's health. Patient participation in treatment is important because many therapies are only effective when they are implemented correctly and consistently. In addition to the above, the burden also affects the patient's overall well-being and satisfaction, social functioning and quality of life^{1, 4, 3, 5, 6}. 

Patients perceive medicines as unwanted but unavoidable, so a routine of taking medicines is the key to coping successfully. According to various qualitative studies, patients in general tend to feel reluctant to use medicines and want to use as few as possible^{10, 11}. For this reason, they often assess the benefits and risks of medication, with ADRs being a central factor tipping the balance in one direction or the other. As the use of medication is mostly associated with the presence of a disease or a deteriorating health condition, patients who do not accept their disease are usually also reluctant to accept treatment for it^{10, 11}.

The burden of medication poses a major challenge for patients suffering from chronic diseases and facing polypharmacy. Despite advances in medical care and pharmaceutical science, the burden of multiple medications remains a significant factor that negatively affects patients' engagement in treatment, clinical outcomes and overall quality of life. Close collaboration between patients, doctors, pharmacists and other healthcare professionals is essential to successfully manage this burden. The aim should be to reduce the burden of drug therapy and improve the patient's health and quality of life, taking into account the individual's needs, preferences and abilities. 

Doctors, pharmacists and other healthcare professionals are involved in the treatment process alongside the patient. It's important for everyone to know about treatment options and medicine interactions. Mediately PRO offers features to both check and resolve drug interactions.

Sources:

1. Katusiime B, Corlett S, Reeve J, Krska J: Measuring medicine-related experiences from the patient perspective: a systematic review. Patient Related Outcome Measures 2016; 7: 157–171.
2. Gabrijelčič Blenkuš M, Robnik M: Starostniki: Od epidemiologije do specifičnih lastnosti populacije – nekateri spregledani (javno) zdravstveni problemi starejših. Farm Vestn 2017; 68: 97-105.
3. Sav A, King MA, Whitty JA, Kendall E, McMillan SS, Kelly F, Hunter B, Wheeler AJ: Burden of treatment for chronic illness: a concept analysis and review of the literature. Health Expect. 2015; 18(3): 312-24.
4. Krska J, Katusiime B, Corlett SA: Validation of an instrument to measure patients’ experiences of medicine use: the Living with Medicines Questionnaire. Patient Prefer Adherence. 2017; 11: 671-679.
5. May C, Montori VM, Mair FS: We need minimally disruptive medicine. BMJ. 2009; 339: b2803.
6. Krska J, Morecroft CW, Poole H, Rowe PH: Issues potentially affecting quality of life arising from long-term medicines use: a qualitative study. Int J Clin Pharm. 2013; 35(6): 1161-1169.
7. Krska J, Katusiime B, Corlett SA: Patient Experiences of the Burden of Using Medicines for Long-Term Conditions and Factors Affecting Burden: A Cross-Sectional Survey. Health & Social Care in the Community 2018; 26(6): 946–59.
8. Krska J, Morecroft CW, Rowe PH, Poole H: Measuring the impact of long-term medicines use from the patient perspective. Int J Clin Pharm. 2014; 36(4): 675-8.
9. Reeve J, Dickenson M, Harris J, Ranson E, Dohnhammer U, Cooper L, Krska J, Byng R, Britten N: Solutions to problematic polypharmacy: learning from the expertise of patients. Br J Gen Pract. 2015; 65(635): 319–320.
10. Pound P, Britten N, Morgan M, Yardley L, Pope C, Daker-White G, Campbell R: Resisting medicines: a synthesis of qualitative studies of medicine taking. Soc Sci Med. 2005; 61(1): 133-55.
11. Moen J, Bohm A, Tillenius T, Antonov K, Nilsson JL, Ring L: "I don't know how many of these [medicines] are necessary.." - a focus group study among elderly users of multiple medicines. Patient Educ Couns. 2009; 74(2): 135-41.