Frazier Polypharmacy Program

The Frazier Polypharmacy Program (FPP) is a program dedicated to research, education and outreach regarding the growing challenge of Polypharmacy.

What is Polypharmacy?

Polypharmacy is conventionally defined at the use of 5 medications simultaneously. The basis for that definition is a study from the 1980’s demonstrating that as number of medications increase 1-5 there is a proportionate increase in risk of adverse drug events (ADEs). More than 5 medications are associated with an exponential (disproportionately higher) risk of ADEs. Polypharmacy is typically considered a syndrome of harm. 

However, it is important to keep in mind that there are evidence-based approaches to successfully manage chronic and other diseases which require polypharmacy. In that sense, targeted, well managed, thoughtful polypharmacy can be intentional and therapeutic.

The goal is to balance the risk with the benefit of medication use.  Assessment and understanding of risk and benefit are highly individual and contextual and include lots of factors: such as access to care, ability of patients (or caregivers) to manage complex medication use, monitoring and access to monitoring, time to benefit, the validity of the studies which guide care decisions, incentives in the healthcare system or over the counter market, and many more.

Because medication use is so complex, it is difficult to optimize, even when trying one’s best. Jonathan Watanabe PhD and colleagues studied non-optimized medication use and reported that non-optimized medication use costs $528.4 billion (2016) dollars and 275, 689 deaths per year. These figures are for well-intended therapeutic medication use where lack of optimized use led to potentially avoidable emergency department visits, hospitalizations, long term care stays and physicians’ office visits.

If the US Centers for Disease Control counted non-optimized medication use as one of the top 10 causes of death in the US, it would have ranked 3rd behind cancer and cardiovascular disease and ahead of diabetes and Alzheimer’s disease. 

The UofL FPP is dedicated to a wholistic approach to polypharmacy to help move society closer to successful integration of clinical skills to manage polypharmacy with the real-world factors that sometimes negate the best intentions of clinicians and patients or their caregivers.

UofL FPP History

The FPP was started in the UofL Department of Family and Geriatric Medicine (DFGM) in 2007.  The FPP was then called the “Polypharmacy Initiative”. It was launched through the support of a local citizen and philanthropist (Mrs. Jean Frazier) whose long-standing concern about polypharmacy aligned with the work led by then DFGM chair, Dr. James G. O’Brien MD. The pilot eventually became an endowed program called the University of Louisville Frazier Polypharmacy Program.

The UofL FPP continues to grow as the thematic component of the UofL School of Public Health and Information Sciences With the UofL SPHIS, the UofL FPP has expanded polypharmacy research and education to include and beyond clinical skills. Some of the areas of expansion include work in pharmacoepidemiology, system science (e.g. how systems of healthcare impact components of polypharmacy), population studies (e.g. using large data sets to explore how medications interact with people), implementation science (e.g. what processes in care can improve polypharmacy), COVID-19 research (e.g. how therapeutics and comorbidity medications interact with covid-19 infected persons), and health policy (e.g. evidence for societal approaches to medications and medication management).

References

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