Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many.
Appropriate Polypharmacy and Medicine Safety: When Many is not Too Many.
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DOI：
10.1007/s40264-015-0378-5
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发表时间：
2016-02
期刊：
影响因子：
4.2
通讯作者：
Hughes CM
中科院分区：
文献类型：
--
作者：
Cadogan CA;Ryan C;Hughes CM
在中老年人群中，使用多种药物(多药联用)的现象越来越普遍。确保处方“太多”和“太多”之间的正确平衡是一个巨大的挑战。临床医生的任务是确保患者接受基于最佳可用证据的最适当的药物组合，并根据患者的临床需求优化用药(适当的多药联用)。从历史上看，由于相关的药物安全风险，如药物相互作用和不良药物事件，多药联用一直被视为负面的。最近，多药联用已被确定为处方不足的风险因素，即患者得不到必要的药物，这也可能对患者的安全和福祉构成风险。长期以来，与多药房这个术语相关的负面含义可能会成为处方不足的一个驱动因素，即临床医生不愿为已经接受过多药物治疗的患者开出必要的药物。现在人们认识到，在患有几种慢性病的患者中，开“许多”药物是完全合适的，如果考虑到患者的临床情况，与多药联用有关的不良药物事件的风险可能会大大降低。在这篇文章中，我们概述了目前关于多药房的观点，并提出了采用“适当的多药房”这一术语来区分开“多”药和“过多”药物的情况。我们还概述了这样做的内在挑战，并为未来的临床实践和研究提供建议。
The use of multiple medicines (polypharmacy) is increasingly common in middle-aged and older populations. Ensuring the correct balance between the prescribing of ‘many’ drugs and ‘too many’ drugs is a significant challenge. Clinicians are tasked with ensuring that patients receive the most appropriate combinations of medications based on the best available evidence, and that medication use is optimised according to patients’ clinical needs (appropriate polypharmacy). Historically, polypharmacy has been viewed negatively because of the associated medication safety risks, such as drug interactions and adverse drug events. More recently, polypharmacy has been identified as a risk factor for under-prescribing, such that patients do not receive necessary medications and this can also pose risks to patients’ safety and well-being. The negative connotations that have long been associated with the term polypharmacy could potentially be acting as a driving factor for under-prescribing, whereby clinicians are reluctant to prescribe necessary medicines for patients who are already receiving ‘many’ medicines. It is now recognised that the prescribing of ‘many’ medicines can be entirely appropriate in patients with several chronic conditions and that the risks of adverse drug events that have been associated with polypharmacy may be greatly reduced when patients’ clinical context is taken into consideration. In this article, we outline the current perspectives on polypharmacy and make the case for adopting the term ‘appropriate polypharmacy’ in differentiating between the prescribing of ‘many’ drugs and ‘too many’ drugs. We also outline the inherent challenges in doing so and provide recommendations for future clinical practice and research.