Writing a Comprehensive Literature Review on Polypharmacy

Crafting a literature review on polypharmacy can be an arduous task, demanding meticulous

research, critical analysis, and proficient academic writing skills. Polypharmacy, the concurrent use of
multiple medications by a patient, poses significant challenges in healthcare, necessitating thorough
examination and understanding from various perspectives.

Delving into the vast array of scholarly articles, research papers, and academic journals on
polypharmacy requires patience and dedication. It involves sifting through copious amounts of
literature to identify relevant studies, theories, and findings pertinent to the topic. Furthermore,
synthesizing the information gathered into a coherent narrative demands adept critical thinking and
analytical prowess.

One of the primary difficulties encountered in writing a literature review on polypharmacy lies in the
complexity and multifaceted nature of the subject matter. Polypharmacy encompasses diverse
aspects, including its prevalence, associated risks, clinical implications, management strategies, and
societal impacts. Thus, navigating through this intricate landscape necessitates a comprehensive
understanding of pharmacology, clinical medicine, public health, and related disciplines.

Moreover, ensuring the credibility and validity of the sources cited in the literature review is
paramount. Assessing the reliability of research studies, evaluating the methodology employed, and
discerning biases are crucial aspects of academic rigor. This rigorous scrutiny adds another layer of
complexity to the writing process, requiring meticulous attention to detail and critical appraisal of the
literature.

Given the challenges inherent in crafting a literature review on polypharmacy, seeking assistance
from professional writing services can be a prudent choice. ⇒ StudyHub.vip ⇔ offers specialized
academic writing services tailored to meet the unique requirements of literature reviews on complex
topics like polypharmacy. With a team of experienced writers well-versed in healthcare research and
academic writing conventions, ⇒ StudyHub.vip ⇔ ensures the delivery of high-quality, well-
researched literature reviews that adhere to academic standards and guidelines.

By entrusting your literature review on polypharmacy to ⇒ StudyHub.vip ⇔, you can alleviate the
burden of extensive research and writing, allowing you to focus on other aspects of your academic
or professional endeavors. With a commitment to excellence and customer satisfaction, ⇒
StudyHub.vip ⇔ strives to provide unparalleled support to individuals grappling with the challenges
of academic writing.

In conclusion, writing a literature review on polypharmacy is a demanding task that requires

expertise, diligence, and precision. With its specialized academic writing services, ⇒ StudyHub.vip
⇔ offers a reliable solution for individuals seeking assistance in navigating the complexities of this
critical healthcare topic. Trust ⇒ StudyHub.vip ⇔ to deliver a comprehensive and meticulously
crafted literature review that meets your academic or professional needs.
If the drug is contraindicated, the prescriber gives a valid reason 6. Least associated with
polypharmacy were lithium, divalproex, and carbamazepine, while most associated included
antidepressants and atypical antipsychotics. Pattern of pharmacotherapy by episode types for
patients with bipolar disorders and its concordance with treatment guidelines. General indicators
Box 4 Final indicators as agreed by expert panel Implicit indicators of polypharmacy appropriateness
For this specific drug: 1. It also considered drug-drug or drug-disease interactions. However, if
treatment regimens and medical history are not carefully reviewed by healthcare professionals and
payors, a patient may inadvertently take multiple medications that may negatively interact with each
other or that all treat the same condition. The fact that the rate of DRPs has not been studied in the
country reveals a serious gap in knowledge, which could have potential cost-saving implications. If
these people can be engaged with, the above benefits may be realised. They are similar to the Beers
criteria in terms of being formed as a list of drugs that healthcare professionals should stop and,
respectively, start prescribing in adults, based on specific situations. Ritanserin as an adjunct to
lithium and haloperidol for the treatment of medication-naive patients with acute mania: a double
blind and placebo controlled trial. There is also the STOPP (Screening Tool of Older Person’s
Prescription) Criteria that identifies inappropriate medication use. Whilst our proposed measure,
when operationalised, may highlight patients where there are clinical concerns about medication
regimen, it cannot offer a holistic assessment of the appropriateness of the regimen, where the
patients’ perspectives must be central to any decisions about care. However, even these criteria are
not generally accepted as a “golden standard”. Before diagnosis, RA patients do not have more
comorbidities than controls ( 7 ). Consensus classifications for each indicator were established using
a series of rules, outlined in Table 1. Drug selection is consistent with established clinical practice 4.
With this approach, it cannot be excluded, that the number of medications does not only correlate
with the number of comorbidities, but purely depends on the increased age. This knowledge gap
could have cost-saving implications. Surprisingly few existing published trials using that design
specify precisely or systematically what drugs comprise TAU, in either number or intensity of
therapy, limiting the extent to which inferences can be made about the relative impact of a unique
agent added to an existing complex regimen without knowledge of the appropriateness or adequacy
of baseline TAU. We address these issues and propose practical recommendations for management
of treatment for elderly patients with cancer. The authors of the study concluded that majority of
drugs prescribed for these patients were for the prevention of cardiovascular conditions and that
these medications were the most expensive. A short overview of these three instruments is presented
below. However, the transferability of our findings to all patients taking more than four medications
is unknown. Panel members were sent a personalised link to complete the first stage of ratings using
the survey software, Qualtrics ( ). Aims of Identified Interventions Across the reviewed literature,
some attention is paid to prevention of polypharmacy. Clinicians may sometimes implement new
agents as augmentations without necessarily discarding existing medications, in the hopes of either
additive or synergistic effects, or perhaps fear of clinical deterioration if existing medications were
deprescribed. Polypharmacy has seen increased interest, due to the increased consumption of
medicines leading to clinical issues ( 1 ). This is certainly the impression generated by most
observational studies linking lower remission rates with the use of more extensive medication
regimens for bipolar disorder (eg, Chae et al 48 ), although it contrasts with findings from the
Swedish registry study 11 showing higher rates of treatment failure (eg, relapse, rehospitalization)
among monotherapy than polypharmacy recipients. When a person takes many medicines, there's a
larger risk for side-effects and interactions. Frequency of medication errors in primary care patients
with polypharmacy.
Impact of comorbidity on physical function in patients with rheumatoid arthritis. Removal of
duplicates resulted in 365 records, which were fully screened, blinded, following inclusion and
exclusion criteria. A method for assessing drug therapy appropriateness. Based on the reported
experiences, we recommend that healthcare professionals upscale communicative efforts and
involvement of patients’ social network on an individualised basis to facilitate shared decision-
making and treatment adherence in many patients with multimorbidity and polypharmacy. It aimed
at describing one, the cost and two, the number of drugs prescribed for diabetic patients residing in
the nursing homes owned by a primary care unit in the United Kingdom. Trends in the
psychopharmacological treatment of bipolar disorder: a nationwide register-based study. Changes in
prescribing for bipolar disorder between 2009 and 2016: national-level data linkage study in
Scotland. On the contrary, they are criticized for not listing a relevant number of drug-related
problems ( Verdoorn et al., 2015 ) and a limited clinical value ( Parekh et al., 2019 ). Some authors
suggest that they should be used in a complementary fashion to improve detection of adverse drug
reactions ( Brown et al., 2016 ). Actually, some decision support systems use both these sets of
criteria in parallel ( Monteiro et al., 20192019 ). Moreover, practical use of these criteria might be
difficult. These 3 search engines yielded a total of 493 results. The following searches through
PsycINFO yielded 49 additional results and through Embase, 142 additional results. Pooled analysis
of studies showed that around 30% of patients will experience a side-effect related to the
inappropriate drug. Frequently, the therapy of patients is changed increasing the risk of
polypharmacy. Whilst our proposed measure, when operationalised, may highlight patients where
there are clinical concerns about medication regimen, it cannot offer a holistic assessment of the
appropriateness of the regimen, where the patients’ perspectives must be central to any decisions
about care. It should be emphasized that this model is not based on any specific explicit criteria-
based tools. Hence, it is possible that complex polypharmacy might sometimes arise from the fact
that available treatments are frequently not always efficacious as monotherapy, underscoring the
need for development of novel therapeutics. Freeman, MD, Editor in Chief, has received research
funding from JayMac and Sage; has been a member of the advisory boards for Otsuka, Alkermes,
and Sunovion; and has been a member of the Independent Data Safety and Monitoring Committee
for Janssen. Ethics approval The study did not require ethical approval. Implicit criteria-based
approaches are usually employed by more complex strategies, such as comprehensive geriatric
assessment (CGA). The pattern of pharmacological treatment of bipolar patients discharged from
psychiatric units in Poland. In a synthesis of qualitative studies of medication-taking in general,
certain medications, such as those for mental health conditions, were reported as being particularly
stigmatised, likely due to the stigma attached to mental illness. 43 Our syntheses expand on this by
suggesting that taking multiple medications, regardless of underlying conditions, can be perceived as
embarrassing by patients. Data synthesis We used meta-aggregation to synthesise the data. 24 In this
process, findings as expressed by researchers are summarised to produce generalisations that provide
a basis for identifying recommendations for action. 25 All findings are linked to a specific category
and then to a specific synthesis, providing transparency in reporting. Would be very happy to have
further sessions as it will improve patient safety in the longer term.”. These results suggest that
patients and the way they are taking their medication might be the prevalent factors in causing
adverse events. Patients were recruited from primary care and community settings. Development and
validation of a new Prescription Quality Index: Prescription quality. BMC Psychiatry.
2012;12(1):153. PubMed CrossRef Show Abstract. When a person takes many medicines, there's a
larger risk for side-effects and interactions. No member of the CME Institute staff reported any
relevant personal financial relationships. PIMs were determined using the 2015 Beers Criteria.
Campbell View author publications You can also search for this author in.
Coincidentally (although as skeptics, we do not believe in coincidence), the initial statistical team
was changed when data were sold to the French pharmaceutical company applying for the marketing
authorization in France. These included patient adherence, the complexity of the medication regimen
and the availability of non-pharmacological alternatives. Given the fact that hospital admissions
affect the subsequent medication burden after discharge, this should further incentivize healthcare
establishments to implement criteria for minimizing the risk associated, particularly in elderly
patients, who could have a high medication burden already. Copies of full-text papers considered as
potentially relevant after the first screening were then fully analysed independently by two
researchers (out of the three: BJ-P, MK-M, and PL). Potentially inappropriate medication (PIM),
identified by Beer's and STOPP (Screening Tools of Older Person's potentially inappropriate
medications) ( 12 ) criteria, refer to drugs that have a high likelihood of causing ADRs. If you stay on
our website, it means that you agree to our. Are drugs taken for symptom relief but the symptoms
are stable? 4. Specific aims of relevant interventions include one or several out of the below-listed
ones: 1. Based on the reported experiences, we recommend that healthcare professionals upscale
communicative efforts and involvement of patients’ social network on an individualised basis to
facilitate shared decision-making and treatment adherence in many patients with multimorbidity and
polypharmacy. The drug, as currently prescribed, is not likely to be sub-therapeutic or toxic, based
on the dose, route and dosing interval for the age, renal and hepatic status of the patient 8. We used
exploded MeSH terms (e.g. inappropriate prescribing) and combinations of relevant keywords and
their variants (e.g. medication, drug therapy, drug utilisation, drug utilisation review, prescribing).
Disease-specific treatment may prevent additional prescription of analgesics, thus avoiding
unnecessary polypharmacy and further supporting the strategy of T2T ( 27 ). Firstly, it identifies
cost-cutting measures that can be explored in the care of patients with diabetes in nursing homes
such as the withdrawal of the expensive liquid preparations used to prevent cardiovascular disease
when they are deemed to be of no clinical benefit. These classes are also supported in the Beers
Criteria, with the exception of the H2 receptor antagonists which were removed from the Beers
Criteria in 2019 because there was weak evidence to support avoiding its use in the elderly. Whereas,
some newer tsDMARDs and bDMARDs are used on a daily basis, others are applied only every
other week or month. 3.4% of RA-patients had more than 4 medications on a weekly basis, although
a majority of patients consider “forgetfulness” as an explanation for non-compliance in weekly
dosing ( 24 ). Polypharmacy was significantly associated with comorbidities and the use of
corticosteroids, MTX and bDMARDs ( 22 ). You can download the paper by clicking the button
above. After screening titles and abstracts, we included 69 studies, of which 10 met the eligibility
criteria after full-text screening. Analysis of PIMs and prevention of DRPs is a potential opportunity
to strengthen pharmacist-physician cooperation for the benefit of elderly patients. The patients aged
18 -55 years who have been diagnosed with psychiatric illnesses as per ICD-10 classifications and
receiving or prescribed with atypical antipsychotic drugs were selected. Although adherent patients
utilized 55% more ambulatory visits and 44% more emergency services compared to nonadherent
individuals, overall, there was a 27% decrease in hospitalizations for all reasons. BJ-P, PK, MK-M
and PL performed the search of the literature. From the 13 included studies, we extracted a plethora
of experiences of being a patient with polypharmacy and formed five interrelated syntheses related
to the differing medication information needs, the difficulties of achieving adherence, the
complexity of decision-making, the relationship between healthcare professionals and patients, and
the impact on patients’ self-perception. Accepting the perspective of practical approach and
pragmatic guidance to polypharmacy management, the objective of this scoping review was to map
available interventions and more complex strategies, and discuss their implementability. Older
patients' perception of deprescribing in resource-limited settings: a cross-sectional study in an
Ethiopia university hospital. There is also the STOPP (Screening Tool of Older Person’s Prescription)
Criteria that identifies inappropriate medication use. Prescribers were often not consulted before
interviewees changed regimens. Following our stage two panel meeting, we developed and applied
additional decision rules to produce a non-duplicative and coherent indicator list; whilst this was
done in consultation with the panel, we acknowledge that other research teams may have made
different decisions about which indicators to retain. According to one publication included in our
review, GPs should scrutinize senior people’s medications on each consultation whenever a patient
meets the criteria of polypharmacy ( Dunning, 2017 ). Available online at: (europa.eu) (accessed
November 12, 2021).