Poly-pharmacy and adherence to treatments, a public health problem

The increase in life expectancy in Spain, currently in 82 years, leads to an increasing intake of medication by elderly patients. By means of an integrated management, a more adequate service to the poly medicated patient can be offered and contribute to adherence to the treatment.

Medications by themselves always deserve special attention. However, in poly medicated patients there are conditions that must be known, understood and integrated into the pharmacotherapeutic process in any of its phases or areas. The total number of medications prescribed and the age of the patients already indicates that we must make a greater effort so that the medication they take generates the expected results.

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We often read headlines such as "The 10 keys to managing poly-pharmacy", with similar claims or recommendations. All of them focused on immediate technical aspects. However, from our experience we miss the conditions that facilitate a change.

In short, poly-medicated patient management and adherence is not an easy job. If so, it would be solved for a long time. Although the word management does not please everyone, if we want to act in an appropriate way, integrated management is the only possible solution, although it seems very elementary.

These are some of the conditioning factors of good poly-medicated patient management:

·       The sanitary field. It is the space where all medical activities take place.

·       The interrelations between the different professionals and resources. It translates into how to cooperate and communicate, where mutual trust is essential.

·       The professional performance Based on competences: knowledge, skills and attitudes. It is recommended the use of documentary supports, health education sessions, active communication and incentives.

·       The process management These require a specific itinerary based on standardized guidelines and procedures.

·       The involvement of patients. They must have an active role in their healing and adherence to treatment, confident and committed to the procedure.

·       The resources of the system. The organizational model must be structured in processes, set specific goals and continuously evaluate the results, interconnected information systems, the use of communication technologies, training linked to action, stratification of patients and use of prediction tools.

If we stay in the analysis phase of what is happening, we will not solve anything. On the other hand, if we go one step further and manage in an integrated manner, we can offer results and learn from each other's experience. If we use predictive tools, we can anticipate problems and prevent them early.