Polypharmacy: More drugs, More prescribers, More risk
While the exact definition of the number of concurrent medications may vary – typically greater than three to five – polypharmacy applies to situations where more medications than are clinically indicated are being prescribed, usually resulting in unnecessary drug use. Healthesystems has reported on the risks of polypharmacy for several years, and more information about this topic can be found in the RxInformer archives.
Workers’ compensation claimants are often prescribed complicated medication regimens that can lead to situations of polypharmacy. When three or more medications are prescribed to an injured worker at the same time, often an attempt is being made to treat the side effects of other drugs. And when a complex drug therapy regimen involving opioids is involved, patients and payers are at even more risk for unintended consequences.
In workers’ comp, the drug mix for treating pain can change over time, often because prescribers add new drugs to combat the side effects of opioid therapy. It also frequently includes the overlapping of various drug types for treating pain, including the use of multiple opioids.
Polypharmacy has largely negative connotations of inappropriate or irrational therapy on the part of prescribers. There are some situations in which polypharmacy is appropriate or necessary but the increased risk is not always accompanied by increased effectiveness.
The unique nature of workers’ compensation removes cost as a consideration for patients to submit to diagnostic studies, accept treatments and fill prescriptions for medication, since most injured workers incur no out of pocket cost for treatment. When cost is not a concern for patients and prescribers, it becomes an even greater concern for payers, not only for the costs of the initial polypharmacy, but also for the additional treatments to address resulting adverse effects.
If early detection and clinical intervention do not occur, polypharmacy and its associated financial and human costs can quickly spin out of control.
Clinical intervention is imperative and can include drug regimen reviews and various forms of outreach to physicians. Intervention can lead to:
- Decreased number of drugs used
- Improved patient outcomes
- Increased safety
- Reduced costs