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As the size of the older adult population (those older than 62) and the number of younger people with complex health conditions have increased in the United States, polypharmacy has become a growing problem.1 Polypharmacy has negative consequences for patients and the health care system (Table 1).2-17 For example, patients taking more than four medications have an increased risk of injurious falls, and the risk of falls increases significantly with each additional medication, regardless of medication type.18
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | Comments |
|---|---|---|
| Physicians should identify and prioritize medications to discontinue and discuss potential deprescribing with the patient.31-34 | C | Expert consensus and narrative review articles |
| When deprescribing, always develop a specific follow-up plan with the patient.31,33,38,41 | C | Expert opinion from review articles |
| Once a medication reconciliation and deprescribing plan has been put into place, it should be considered at each visit as time allows and comprehensively reviewed at health maintenance visits.19,20,29,32 | B | Cochrane review with inconsistent and limited evidence and expert consensus |
| Before starting any new medications, consider underlying causes to treat first, necessity of treatment, alternative nonpharmacologic treatments, and benefits vs. risks of treatment.13,26,29,32,40 | C | Survey study, narrative review, and expert consensus |
| When starting any new medication, consider it a trial rather than a permanent addition.13,26,32,40 | C | Survey study and narrative review articles |
| When refilling medications, consider the benefits vs. risks of continuation in the short term and long term.13,26,32,40 | C | Survey study and narrative review articles |
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.
BEST PRACTICES IN PHARMACOLOGY
Recommendations from the Choosing Wisely Campaign
| Recommendation | Sponsoring organization |
|---|---|
| Do not prescribe medications for patients currently on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be discontinued. | American Society of Health-System Pharmacists |
| Do not prescribe a medication without conducting a drug regimen review. | American Geriatrics Society |
Source: For more information on the Choosing Wisely...