Risk Management of Polypharmacy in Older Adult with Non-Communicable Diseases in An Outpatient Clinic by the ARMOR Tool

Abstract

Background: Older adults with chronic non-communicable diseases are prone to problems with polypharmacy. The ARMOR tool has been reported to be able to use in assessing and managing risks of polypharmacy in elderly patients. However, the tool has not been implemented in primary hospitals affiliated to the Department of Health, Ministry of Public Health.

Objectives: To study the effect of risk management model of polypharmacy in elderly patients with chronic non-communicable diseases in out-patient clinic using the ARMOR tool.

Methods: This quasi-experimental research study was conducted in 50 out-patients aged ≥ 60 years with chronic non-communicable diseases who attended outpatient clinic at Health Promoting Hospital, Regional Health Promotion Center 2, Phitsanulok and took ≥ 5 medications. The risk management model was developed using the ARMOR tool before clinical implementation. The result of risk management was evaluated and sufficient medication adherence was deemed by Medication Adherence Scale in Thais (MAST^©) score ≥34.

Results: The drug associated risks were found in 23 patients corresponding to 46%. The most frequent risk was the occurrence of adverse drug reactions (83%). To manage those risks, either discontinuation of the causative drugs, dosage adjustment or both were implemented in 48%, 48% and 4% of patients, respectively. As a result, the drug associated risk was manageable by 91% and 86% of patients had sufficient medication adherence.

Conclusion: The risk management model developed using ARMOR tool can minimize the risk from polypharmacy in elderly patients with chronic non-communicable diseases in the primary hospital out-patient setting.