• Without a medication use history, patients may end up with complications like failing kidneys, failing heart or coma, from simple errors like medication refill
Pharmaceutical Society of Kenya President Dr Louis Machogu says Kenya lacks national guidance on appropriate polypharmacy management.
“However, a large number of pharmacists have been trained on Medication Therapy Management to solve the problem,” he says.
"It is worth noting that medication errors are the third-leading cause of hospital-related death in the US after NCDs and cancer.”
Dr Machogu advises caregivers of chronic patients to insist on having a pharmacist as part of the care team, in order to have them take responsibility on making medication action plans and medication reviews.
“This is because these pharmacists are the medication use experts within the healthcare team,” he says.
In Kenya, a professional pharmacist must have an annual practice licence renewed by the Pharmacy and Poisons Board after satisfying professional development.
They also require clearance as members of good standing by their professional body, the Pharmaceutical Society of Kenya.
Dr Machogu says without a medication use history done by a professional pharmacist, patients may end up with complications like failing kidneys, failing heart or coma, from simple errors like medication refill.
To make medication review decisions, pharmacists currently rely on guidelines recommended by the World Health Organisation.
The guidelines provide a structured evaluation that can be used to prevent harm and improve outcomes by optimising the use of medicines for each individual patient.
Therefore, it is essential to reassure that the review is not viewed merely as a mechanism to reduce or stop medications.
WHO says medication reviews in polypharmacy should be performed in collaboration with the patient or their caregiver.
The perspective of the patient on managing and taking multiple medications should be assessed, as well as the patient’s goal of care.
The intentions of the patient would need to be aligned with the prescribers’ view of improving outcomes and treatment goals.
NEED TO DE-PRESCRIBE
The information and changes derived from the medication review should be made available to other health care professionals, especially as the patient moves across different care settings, to enable collaboration in appropriate polypharmacy management.
The organisation says research shows that pharmacist-led medication reviews reduce hospital admissions, especially for high-risk groups, such as older persons or patients with multiple medications.
“In addition, medication reviews may have an effect on the reduction of medication-related problems. For example, a study by Schnipper et al. found that medication reviews reduced the number of preventable adverse drug events 30 days after patient discharge,” it says in Medication Safety In Polypharmacy report.
WHO says considerations for “deprescribing” medicines should be as robust as that of prescribing.
Deprescribing is the process of tapering, stopping, discontinuing or withdrawing drugs with the goal of managing polypharmacy and improving outcomes.
The process encompasses minimisation of the medication load in terms of dosage, number of tablets taken and frequency of administration times.
WHO says it is important to undertake medication reviews with a holistic approach, as medications may need to be started or stopped, both to prevent harm and to prevent health deterioration.
One useful measure which helps prescribers to understand the probable clinical efficacy of a medicine is the Number Needed to Treat. The NNT can be defined as the average number of patients who require to be treated over a time period for one patient to benefit compared with a control; it can also be expressed as the reciprocal of the absolute risk reduction.
The ideal NNT, being one, signifies that every patient improves on the outcome with the treatment. The higher the NNT, the less effective the treatment is in terms of the trial outcome and timescale.
Similarly to NNT, another measure used in decision-making is the Number Needed to Harm (NNH). The NNH is the average number of people taking a medication over a time period in order for one adverse event to occur. This concept is not as widely used as the NNT. Combined with NNT, the overall benefit to risk ratio (NNT/NNH) should be considered for individual patients during the decision-making process.