From the Guidelines
Reducing pill burden is crucial to minimize the risk of falls, mortality, and other adverse outcomes, as evidenced by a study of 5213 participants in England, which found a 21% higher rate of falls in people taking 4 or more medications compared to those taking fewer 1. When considering the management of polypharmacy, it is essential to assess and interview the patient, reconcile medications, and systematically identify drug therapy problems, as highlighted in the study published in the Mayo Clinic Proceedings 1. Key points to consider when reducing pill burden include:
- Simplifying the regimen for ambulatory patients and in long-term care to reduce hospitalizations or negative incidents 1
- Avoiding drug therapy problems and risk of rehospitalizations by choosing pharmacotherapy carefully, such as tapering benzodiazepines, opioids, and others 1
- Being aware of the increased risk of mortality as the number of medications rises, with a meta-analysis suggesting a progressive increase in risk from 1 to 4 medications (adjusted odds ratio [aOR] 1.24 [1.10 to 1.39]) up to aOR 1.96 [1.42 to 2.71] for those taking >9 medications 1 By reducing pill burden, patients can experience improved medication adherence, reduced risk of medication errors, and decreased side effects, ultimately leading to better health outcomes and improved quality of life.
From the Research
Reducing Pill Burden
Reducing pill burden is essential for improving medication adherence and health outcomes. The following points highlight the importance of reducing pill burden:
- Fixed-dose combination therapy reduces pill burden and may improve medication adherence and health outcomes 2
- A higher pill burden is directly and significantly associated with decreased adherence and persistence with antihypertensive therapies in real-practice settings 2
- Reducing pill burden can lead to a significant improvement in adherence to pharmacological therapy of type 2 diabetes compared to a loose-dose combination 3
- Fixed-dose combinations can simplify the treatment regimen by reducing pill burden compared with the same combination delivered as separate pills, leading to improved adherence 4
Benefits of Reducing Pill Burden
The benefits of reducing pill burden include:
- Improved medication adherence 2, 3, 4
- Increased persistence with treatment 2, 3
- Better disease management, particularly among patients with complex medication demands or poor medication adherence 3
- Potential for improved clinical outcomes 2, 3
Strategies for Reducing Pill Burden
Strategies for reducing pill burden include: