Pharmacist presence in clinic reduces polypharmacy in multiple myeloma patients
The rate of polypharmacy is high among patients with multiple myeloma, according to a study. However, comanagement with a pharmacist reduces the number of all medications, particularly those that are not related to myeloma.
A retrospective chart review was performed in an urban academic cancer centre using electronic records of 44 patients in the traditional physician-managed clinic and 57 patients in the collaborative physician-pharmacist clinic.
On average, patients in the collaborative clinic used fewer medications (9 vs 7; p=0.045). The median number of medications for the treatment of myeloma was higher (2 vs 4; p<0.001), but the number of nonmyeloma-related medications was lower (7 vs 3; p<0.0001) in the collaborative clinic.
Although both clinics demonstrated high rates of polypharmacy (93 percent vs 84 percent; p=0.22), the collaborative clinic had a substantially lower rate of polypharmacy of nonmyeloma medications (71 percent vs 33 percent; p=0.0003), including both minor (five to nine medications: 48 percent vs 28 percent; p=0.06) and major (≥10 medications: 23 percent vs 5 percent; p=0.02) polypharmacy.
On the other hand, patients in the collaborative clinic had significantly higher minor polypharmacy of myeloma-related medications (32 percent vs 2 percent; p=0.0002).
In multivariate analysis, patients in the collaborative clinic had a reduced risk of having a higher number of medications (relative risk [RR], 0.79, 95 percent confidence interval [CI], 0.67–0.93; p=0.004), a lower risk of having any polypharmacy of nonmyeloma-related medications (RR, 0.41, 95 percent CI, 0.25–0.67; p<0.001) and a lower risk of receiving potentially inappropriate medication (RR, 0.62, 95 percent CI, 0.41–0.95; p=0.029).