Professor of internal medicine at Bern University Hospital, Nicholas Rodondi, states that over 60% of patients aged 65 and above admitted to hospitals have polypharmacy – the medical term for multiple drug prescriptions.
Some studies have found that approximately 30% of hospital admissions and 20% non-essential healthcare costs in the elderly are due to unnecessary, duplicative or simply inappropriate medicine prescriptions.
President of the Swiss Medical Association, Jürg Schlup, states that they have found themselves in a situation where lives last longer every decade. He added that thanks to improvements in the medical management of chronic diseases, people also stay healthier. However, this is where we are faced with the danger of over-medicalization.
Rodondi and a team of experts from 6 EU countries earlier this year responded to the European Commission Horizon 2020 research framework’s call to investigate the issue of over-prescription of medicine in the elderly. They received €6.6 million to develop a software programme that will produce personalised medical suggestions for elderly patients.
The Optimising Therapy to Prevent Avoidable Hospital Admissions in the Multimorbid elderly (OPERAM) study is the first health-related Horizon 2020 project led by Switzerland. It will centre on 1,900 patients aged 75 and above from all countries taking part.
Software is being developed by the researchers to determine medicine that may be inappropriate for elderly patients, either because they interact negatively with other drugs, there is no particular indication for them or because the wrong dosage has been prescribed.
The work could also bring to light important medicines missing from an elderly patient’s healthcare plan.
Rodondi explained that they designed a trial to test whether a blend of interventions could not only reduce polypharmacy, but also enhance clinical outcomes in the elderly – by increasing patient quality of life and reducing the amount of hospitalisations, for example.
Rodondi and his team hope that as well as improving patient lives, the OPERAM project will save each country taking part millions each year in healthcare costs.
How much medicine each day?
According to Rodondi, in Switzerland, over-prescription results in many older patients taking as many as 10 different kinds of medicine each day.
But how is this possible? Is it not obvious when a procedure or medicine is unnecessary? Actually, there are many common causes of polypharmacy, and the OPERAM study aims to tackle each one of them.
Care coordination is one problem: treatments from general practitioners may not automatically be harmonized with prescriptions issued during hospitalisation or those from specialists.
There are times when the cause of over-prescription of medicine comes from the patients themselves; a lot of us feel more comfortable leaving the doctor’s office with a prescription, instead of leaving empty-handed. A common example is the prescription of antibiotics for non-bacterial infections such as a flu virus. People are happy with the doctor when they receive antibiotics, but then other problems arise such as side-effects or antibiotic resistance.
One reason for over-medicalisation is that there is still a lot that doctors do not know about elderly patients suffering from more than one illness, and about how different interventions affect them. Even worse, these patients are frequently excluded from clinical trials, due to worries that several conditions could misrepresent the accuracy of trial results.
Rodondi states that lack of enough data is made worse by the fact that unlike other countries like Denmark, Switzerland does not possess a central healthcare data repository.