We investigated drug reduction suggestions by pharmacists based on a multidisciplinary polypharmacy conference in an acute care hospital for the elderly and the adoption rate of such suggestions. The target patients were 587 admitted to the Orthopedics and Regional Comprehensive Care Ward, Tokyo Metropolitan Institute for Geriatrics and Gerontology. The number of medications taken at the time of discharge from the hospital was significantly lower in the cases in which the pharmacist suggested medication reduction compared to those at the conference, respectively (P < 0.05). In addition, 83.4% of the proposals from pharmacists were adopted. The common reasons given for the proposal were “improvement of symptoms” (92.4%) and “adherence-related” (84.8%). High adoption rates were observed for anti-inflammatory analgesics (91.7%) and gastrointestinal drugs (83.2%). The group that adopted drug reduction suggestions exhibited 1.1 fewer medications and a reduction of 0.4 in the daily dose count at discharge compared to the time of the conference (P < 0.001). Logistic regression analysis revealed that being a woman, DASC-21 ≤ 29, being on 11 or more medications upon admission, and having a period of 12 or more days from the conference to discharge were factors independently associated with adoption. Drug reduction proposals from pharmacists are more likely to gain physician acceptance if they rely on patient-verified information about symptom changes and medication compliance. These findings suggest that drug reduction interventions are effective for patients without cognitive decline, who have a high number of medications at admission, and can afford a follow-up period.

In this study, we aimed to improve the quality of medication support for older patients. We qualitatively examined the factors that form and sustain the state of inconsistency between the prescribed medication and patients’ intentions to take it. The electronic medical record text data of patients hospitalized during the 6-month study period were qualitatively analyzed using Mayring’s qualitative content analysis. Concept saturation was observed in all 30 cases, and 10 categories were generated from 138 text intercepts. Patient-related factors included inability to resolve questions owing to “reticence to others,” “low interest in medication” owing to long-term use, and “adherence to medication” owing to the perception that a prescribed medication is necessary for oneself and fear of physical illness. This may have led to a shift from “understanding and taking” the medication to “taking as prescribed.” Environmental factors included “change in medication,” such as a change in name or addition of a medication owing to a change to a generic or combination drug, and “lack of pharmacist involvement” when there was no change in the regular medication. In conclusion, regardless of changes in their regular prescriptions, it is crucial for pharmacists to ensure that patients fully understand and adhere to their treatment regimens.

Background: Polypharmacy increases the risk of adverse drug reactions due to the combinatorial effects of multiple drugs. This problem is associated with an aging population and increasing demand for drug therapies. We aimed to develop a “medication questionnaire” to prevent polypharmacy.

Methods: We created a “prototype medication questionnaire” after collecting insights from six national centers in Japan. We disseminated this questionnaire to pharmacists from September 1 to November 30, 2021, to collect information on drugs used by inpatients. We compiled the responses to create a broadly applicable “medication questionnaire.”

Results: Of 1,467 patients aged 50.7 ± 27.6 years taking 7.3 ± 4.8 medications, 43.8% (643/1,467) were using 1.6 ± 1.6 potentially inappropriate medications (PIMs). Geriatric syndrome and adverse drug events were present in 67.0% (588/878) of patients and included lightheadedness/falls (29.6%, 260/878) and anorexia (27.1%, 238/878). Adverse effects were higher among older adults (76.0%, 447/588, p < 0.01). We improved the “medication questionnaire” by changing the self-answer format; it is now available for open access (https://www.ncgg.go.jp/hospital/news/20230829-1.html).

Conclusions: We confirmed the possibility of readily identifying polypharmacy-associated problems, including geriatric syndrome and adverse drug events, and developed a “medication questionnaire” to prevent polypharmacy. When used in conjunction with the publicly available list of PIMs, we can identify drugs that should be considered for dose reduction and facilitate the optimization of prescribed regimens. We intend to use the results of this study as a reference to resolve polypharmacy-related issues and perform safe and appropriate pharmaceutical interventions.