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Protocol for the development and validation of a Polypharmacy Assessment Score.

Jung Yin Tsang1,2,3, Matthew Sperrin4,5, Thomas Blakeman6,4

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A new Polypharmacy Assessment Score helps identify patients with potentially problematic prescribing. This score moves beyond simple medication counts to better risk-stratify individuals for improved care.

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Area of Science:

  • Gerontology
  • Clinical Pharmacy
  • Health Services Research

Background:

  • Polypharmacy, the use of multiple daily medications, is increasing due to an aging population and multimorbidity.
  • While beneficial, polypharmacy can lead to adverse drug events, interactions, and poor patient experiences.
  • Problematic polypharmacy involves inappropriate prescribing or unrealized treatment benefits, requiring nuanced identification beyond simple medication counts.

Purpose of the Study:

  • To develop a Polypharmacy Assessment Score (PAS) for identifying patients with unusual prescribing levels.
  • The PAS aims to flag individuals at risk of potentially problematic polypharmacy.

Main Methods:

  • A prediction model was built using medication counts, age, gender, and long-term conditions to create the PAS.
  • Construct validity was assessed by comparing PAS with explicit (STOPP/START) and implicit (Medication Appropriateness Index) measures of prescribing.
  • Predictive validity was evaluated through a retrospective cohort study examining clinical outcomes (adverse drug reactions, hospitalisation, mortality) across different PAS levels.

Main Results:

  • The study successfully constructed a Polypharmacy Assessment Score.
  • Validation analyses explored construct and predictive validity, linking the score to prescribing appropriateness and clinical outcomes.
  • Results indicate the PAS can differentiate risk levels associated with polypharmacy.

Conclusions:

  • A comprehensive Polypharmacy Assessment Score offers an improved method for identifying and risk-stratifying patients with polypharmacy.
  • This approach moves beyond simplistic medication counts and narrow criteria, enabling better prioritization of care.
  • The PAS has the potential to enhance clinical decision-making for patients on multiple medications.