POLYPHARMACY, POTENTIAL INAPPROPRIATE MEDICATION AND DEPRESCRIBING IN NIGERIA: HOW FAR HAVE WE GONE?
Abstract
Patients safety is very vital in pharmacotherapy. To achieve this, medications safety has to be established and rational prescribing promoted. As a developing country with a growing aged population, the adverse effects of polypharmacy and potential inappropriate medications (PIMs) cannot be contained in Nigeria especially its impact on hospital expenditure as 90% of this expense is through out-of-pocket spending. Polypharmacy is a growing public health issue. WHO postulated an increment in the population of the elderly population from 8% to 16% in 2050 in Nigeria. This will invariably increase the rate of multi-morbidity in the elderly, certainly a rise in poplypharmacy. Polypharmacy and the use of PIMs tend to increase the adverse drug reactions in elderly. The use of PIMs also leads to frequent hospital visits, healthcare expenditure, increase fall and hospitalization. On the other hand, deprescribing intervention is introduced into the healthcare to tackle the effects of polypharmacy and help patients to partake in the advantages it offers. Deprescribing as an intervention to polypharmacy, is essential in controlling polypharmacy and removing PIMs, thus improving patients' outcome. Also, ascertaining the knowledge and acceptability of deprescribing which is still a nascent concept, will help to improve the clinical outcomes, reduce adverse drug reactions, decrease hospitalization especially as Nigeria is faced with poor and inadequate healthcare system. This review summarizes the extent of polypharmacy and PIMs , most commonly implicated PIM prescribed in Nigeria, Factors influencing polypharmacy, knowledge and acceptability of deprescribing in Nigeria through established studies carried out in the country. Thus establishing what is known, knowledge gap and recommending areas of further studies. Further studies on Polypharmacy, PIM and deprescribing is recommended in the southeast of Nigeria, younger patients, other disease states such as hypertension, diabetes mellitus, osteoarthritis which have been under-researched in this area and the correlation between female gender and polypharmacy.
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