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Monitoring polypharmacy at the population level entails complex decisions: results of a survey of experts in geriatrics and pharmacotherapy

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Abstract

Aim

The use of multiple medications is rising steadily among older individuals, but little is known about the impact of polypharmacy at a population level, both over time and across countries. Surveillance of polypharmacy is required to overcome these gaps. There currently exists no standard population indicator of polypharmacy. The objective of this survey was to query expert opinion on establishing a gold standard method for polypharmacy surveillance at the population level.

Methodology

We invited 71 experts in geriatrics, pharmacoepidemiology, pharmacology and surveillance to respond to an Internet-based survey. Participants were asked to rate their degree of agreement on statements related to the definition of polypharmacy, the goals of polypharmacy surveillance and knowledge transfer issues. Consensus was reached when 70 % of participants either strongly or moderately agreed with the statements. Qualitative content analysis was performed on optional comments provided by the participants.

Results

Thirty individuals (42 %) completed the survey. Consensus was reached on most items. However, there was no agreement on a quantitative indicator of polypharmacy. Participants resolved that the indicator include a quality component, and that levels of polypharmacy be created. Defining exposure also proved problematic: cumulative (e.g. total annual number) and/or simultaneous (concomitant) prescriptions could be considered.

Conclusions

A gold standard indicator of polypharmacy should include both quantity and quality. There is a need to better inform the relevant outcomes of polypharmacy, to identify the most appropriate threshold(s) and quality measure(s) of interest to decision makers.

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Acknowledgments

The authors are deeply grateful to all participants for their involvement in the survey. They wish to fully acknowledge the input of the following participants who have consented for their names to be published: David Buckeridge, Julie Couture, Guillaume Dolley, Danielle Doyon, Pierre-André Dubé, Anick Dupras, Pierre Durand, Valérie Émond, Mirella Faubert, Catherine Girouard, Line Guénette, Edeltraut Kröger, Marie-Laure Laroche, Claude Lemay, Yves Levesque, Louise Mallet, Jocelyne Moisan, Michelle Normandeau, Marc Simard, Caroline Sirois, Mélanie St-Onge, Cara Tannenbaum, Jean-Pierre Trépanier, Mélanie Turgeon, René Verreault, Machelle Wilchesky.

The authors also thank Melanie Tessier for her help with the survey and Mirella Faubert for input in designing the survey statements.

Author information

Authors and Affiliations

  1. Université du Québec à Rimouski, 1595 Boulevard Alphonse-Desjardins, Lévis, QC, G6V 0A6, Canada

    Caroline Sirois, Marie-Eve Gagnon & Daniel Milhomme

  2. Centre d’excellence sur le vieillissement de Québec, Centre de recherche du CHU de Québec, Québec, Canada

    Caroline Sirois

  3. Institut national de santé publique du Québec, Québec, Canada

    Caroline Sirois & Valérie Émond

  4. Institut universitaire de gériatrie de Montréal, Québec, Canada

    Cara Tannenbaum

  5. Faculté de pharmacie de l’Université de Montréal, Montréal, Canada

    Cara Tannenbaum

Authors
  1. Caroline Sirois
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  2. Cara Tannenbaum
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  3. Marie-Eve Gagnon
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  4. Daniel Milhomme
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  5. Valérie Émond
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Corresponding author

Correspondence to Caroline Sirois.

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Funding

This work was supported by a start-up Grant from the Université du Québec à Rimouski (365025), and by a Canadian Institute of Health Research (CIHR) knowledge synthesis Grant (201404KRS-328964). Marie-Eve Gagnon was the recipient of a CIHR undergraduate summer student health research award.

Conflict of interest

The authors report no other conflicts of interest.

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Sirois, C., Tannenbaum, C., Gagnon, ME. et al. Monitoring polypharmacy at the population level entails complex decisions: results of a survey of experts in geriatrics and pharmacotherapy. Drugs Ther Perspect 32, 257–264 (2016). https://doi.org/10.1007/s40267-016-0299-0

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  • DOI: https://doi.org/10.1007/s40267-016-0299-0

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