medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/2079-701X-2021-14-150-157medsovet-6443Research ArticleПРАКТИКАPRACTICEЭволюция полипрагмазии: соответствующая и проблемная полипрагмазия, выбор правильной стратегии и тактикиThe evolution of polypharmacy: appropriate and problematic polypharmacy, choosing the right strategy and tacticshttps://orcid.org/0000-0001-8228-1114ЛеоноваМ. В.LeonovaM. V.

Леонова Марина Васильевна, чл.-корр. РАЕН, д.м.н., профессор, клинический фармаколог

400005, Волгоград, ул. Коммунистическая, д. 50

Marina V. Leonova, Corr. Member RANS, Dr. Sci. (Med.), Professor, Clinical Pharmacologist

50, Kommunisticheskaya St., Volgograd, 400005

anti23@mail.ruМежрегиональная общественная организация «Ассоциация клинических фармакологов»РоссияInterregional Public Organization “Association of Clinical Pharmacologists”Russian Federation202118102021014150157Copyright © Леонова М.В., 20212021Леонова М.В.Leonova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/6443

Эволюция полипрагмазии, которая в течение многих лет заключалась в количественном измерении одновременно назначаемых лекарственных средств (ЛС), привела к появлению качественного описания: соответствующая полипрагмазия, которая может быть полезной для некоторых пациентов, и проблемная полипрагмазия, приносящая вред. Концепция соответствующей полипрагмазии предполагает назначение нескольких ЛС на основании лучших доказательств, клинического состояния пациентов, потенциальных межлекарственных взаимодействий. С возрастом увеличивается распространенность гериатрических синдромов, коморбидности/мультиморбидности, ограничение продолжительности жизни, что уменьшает положительное соотношение пользы/риска для большинства ЛС. Проблемная полипрагмазия имеет повышенный риск нежелательных реакций, межлекарственных взаимодействий, снижения комплаентности пациентов к лечению. Для улучшения полипрагмазии применяются различные методологии, оптимизирующие использование ЛС для максимальной пользы и наименьшего вреда. К таким вмешательствам относятся профессиональное консультирование пациентов, использование дополнительных инструментов (включая критерии Бирса, STOPP/START, индекс MAI и др.), электронные системы принятия решений, образовательные программы. Эффективность вмешательств по уменьшению полипрагмазии оценивалась в нескольких Кокрейновских метаанализах (2012, 2014, 2018), в которых показано уменьшение ненадлежащего использования ЛС и риска нежелательных лекарственных реакций (НЛР), но не было влияния на смертность, в единичных исследованиях обнаружено уменьшение количества госпитализаций. Методология депрескрайбинга особенно актуальна в условиях проблемной полипрагмазии и рассматривается в качестве неотъемлемого компонента континиума практики правильного назначения лекарств (Good Prescribing Practice), продвигается как стратегия уменьшения полипрагмазии и улучшения результатов для пациентов. Среди других вмешательств депрескрайбинг имеет наибольшее количество доказательств полезности для предотвращения связанных с приемом лекарств осложнений, улучшения клинических исходов и снижения затрат. Международной группой по сокращению ненадлежащего использования лекарств и полипрагмазии (IGRIMUP) в 2018 г. разработано 10 рекомендаций по снижению полипрагмазии и сокращению потенциально несоответствующих ЛС. Таким образом, концепция соответствующей полипрагмазии является рациональным подходом к оптимизации полипрагмазии, ее следует продвигать вместо пороговых числовых значений.

The evolution of polypharmacy, which for many years consisted of quantifying concurrently prescribed drugs, has led to an qualitative description: “appropriate polypharmacy”, which may be beneficial for some patients, and “problematic polypharmacy”, which is harmful. The concept of “appropriate polypharmacy” is to prescribe multiple drugs based on the best evidence, taking into account the patient’s clinical condition and potential drug-drug interactions. With age, the prevalence of geriatric syndromes, comorbidity/multimorbidity, and limitation of life expectancy increase, which reduces the positive benefit/risk ratio for most drugs. The problem with polypharmacy is associated with an increased risk of adverse reactions, drug-drug interactions, and decreased patient compliance. To improve polypharmacy, various methodologies are used to optimize drug use for maximum benefit and least harm. Such interventions include professional patient counseling, the use of additional tools (including Bierce’s criteria, STOPP/START, MAI index, etc.), electronic decision-making systems, educational programs. The effectiveness of interventions to reduce polypharmacy has been evaluated in several Cochrane meta-analyzes (2012, 2014, 2018) and showed a decrease in drug misuse and the risk of ADR, but there was no effect on mortality, and few studies found a decrease in the number of hospitalizations. The deprescribing methodology is especially relevant in the context of problematic polypharmacy and is considered an integral component of the continuum of good prescribing practice, promoted as a strategy to reduce polypharmacy and improve patient outcomes. Among other interventions, deprescribing has the most evidence for its utility in preventing drugrelated complications, improving clinical outcomes, and reducing costs. The International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP) in 2018 developed 10 recommendations to reduce polypharmacy and potentially inappropriate drugs. Thus, the concept of “appropriate polypharmacy” is a rational approach to optimizing polypharmacy; it should be promoted to replace existing thresholds.

полипрагмазиясоответствующая полипрагмазияпроблемная полипрагмазиямультиморбидностьвмешательствадепрескрайбингpolypharmacyappropriate polypharmacyproblematic polypharmacymultimorbidityinterventionsdeprescribingReferencesWilladsen T.G., Bebe A., Køster-Rasmussen R., Jarbøl D.E., Guassora A.D., Waldorff F.B. et al. The Role of Diseases, Risk Factors and Symptoms in the Definition of Multimorbidity – a Systematic Review. Scand J Prim Health Care. 2016;34(2):112–121. https://doi.org/10.3109/02813432.2016.1153242.Willadsen T.G., Bebe A., Køster-Rasmussen R., Jarbøl D.E., Guassora A.D., Waldorff F.B. et al. The Role of Diseases, Risk Factors and Symptoms in the Definition of Multimorbidity – a Systematic Review. Scand J Prim Health Care. 2016;34(2):112–121. https://doi.org/10.3109/02813432.2016.1153242.Pazan F., Wehling M. Polypharmacy in Older Adults: A Narrative Review of Definitions, Epidemiology and Consequences. Eur Geriatr Med. 2021;12(3):443–452. https://doi.org/10.1007/s41999-021-00479-3.Pazan F., Wehling M. Polypharmacy in Older Adults: A Narrative Review of Definitions, Epidemiology and Consequences. Eur Geriatr Med. 2021;12(3):443–452. https://doi.org/10.1007/s41999-021-00479-3.Duerden M., Avery T., Payne R. Polypharmacy and Medicines Optimisation: Making It Safe and Sound. London: The King’s Fund; 2013. 56 р.Duerden M., Avery T., Payne R. Polypharmacy and Medicines Optimisation: Making It Safe and Sound. London: The King’s Fund; 2013. 56 р.Masnoon N., Shakib S., Kalisch-Ellett L., Caughey G.E. What Is Polypharmacy? A Systematic Review of Definitions. BMC Geriatr. 2017;17(1):230. https://doi.org/10.1186/s12877-017-0621-2.Masnoon N., Shakib S., Kalisch-Ellett L., Caughey G.E. What Is Polypharmacy? A Systematic Review of Definitions. BMC Geriatr. 2017;17(1):230. https://doi.org/10.1186/s12877-017-0621-2.Cadogan C.A., Ryan C., Hughes C.M. Appropriate Polypharmacy and Medicine Safety: When Many Is not Too Many. Drug Saf. 2016;39(2):109–116. https://doi.org/10.1007/s40264-015-0378-5.Cadogan C.A., Ryan C., Hughes C.M. Appropriate Polypharmacy and Medicine Safety: When Many Is not Too Many. Drug Saf. 2016;39(2):109–116. https://doi.org/10.1007/s40264-015-0378-5.Khezrian M., McNeil C. J., Murray A.D., Myint P.K. An Overview of Prevalence, Determinants and Health Outcomes of Polypharmacy. Ther Adv Drug Saf. 2020;11:2042098620933741. https://doi.org/10.1177/2042098620933741.Khezrian M., McNeil C. J., Murray A.D., Myint P.K. An Overview of Prevalence, Determinants and Health Outcomes of Polypharmacy. Ther Adv Drug Saf. 2020;11:2042098620933741. https://doi.org/10.1177/2042098620933741.Clyne B., Fitzgerald C., Quinlan A., Hardy C., Galvin R., Fahey T., Smith S.M. Interventions to Address Potentially Inappropriate Prescribing in Community-Dwelling Older Adults: A Systematic Review of Randomized Controlled Trials. J Am Geriatr Soc. 2016;64(6):1210–1222. https://doi.org/10.1111/jgs.14133.Clyne B., Fitzgerald C., Quinlan A., Hardy C., Galvin R., Fahey T., Smith S.M. Interventions to Address Potentially Inappropriate Prescribing in Community-Dwelling Older Adults: A Systematic Review of Randomized Controlled Trials. J Am Geriatr Soc. 2016;64(6):1210–1222. https://doi.org/10.1111/jgs.14133.Beers M.H., Ouslander J.G., Rollingher I., Reuben D.B., Brooks J., Beck J.C. Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home Residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991;151(9): 1825–1832. https://doi.org/10.1001/archinte.1991.00400090107019.Beers M.H., Ouslander J.G., Rollingher I., Reuben D.B., Brooks J., Beck J.C. Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home Residents. UCLA Division of Geriatric Medicine. Arch Intern Med. 1991;151(9): 1825–1832. https://doi.org/10.1001/archinte.1991.00400090107019.Павличенко С.Н., Леонова М.В., Упницкий А.А. Особенности фармакотерапии у пожилых пациентов с мультиморбидностью: критерии Бирса. Лечебное дело. 2017;(2):18–26. Режим доступа: http://www.atmosphere-ph.ru/modules.php?name=Magazines&sop=viewarticle&magid=7&issueid=412&artid=4958.Pavlichenko S.N., Leonova M.V., Upnitskiy A.A. Pharmacotherapy in Elderly Patients with multimorbidity: Beers Criteria. Lechebnoe delo = Medical Business. 2017;(2):18–26. (In Russ.) Available at: http://www.atmosphereph.ru/modules.php?name=Magazines&sop=viewarticle&magid=7&issueid=412&artid=4958.O’Mahony D., O’Sullivan D., Byrne S., O’Connor M.N., Ryan C., Gallagher P. STOPP/START Criteria for Potentially Inappropriate Prescribing in Older People: Version 2. Age Ageing. 2015;44(2):213–218. https://doi.org/10.1093/ageing/afu145.O’Mahony D., O’Sullivan D., Byrne S., O’Connor M.N., Ryan C., Gallagher P. STOPP/START Criteria for Potentially Inappropriate Prescribing in Older People: Version 2. Age Ageing. 2015;44(2):213–218. https://doi.org/10.1093/ageing/afu145.Hill‐Taylor B., Sketris I., Hayden J., Byrne S., O’Sullivan D., Christie R. Application of the STOPP/START Criteria: A Systematic Review of the Prevalence of Potentially Inappropriate Prescribing in Older Adults, and Evidence of Clinical, Humanistic and Economic Impact. J Clin Pharm Ther. 2013;38(5):360–372. https://doi.org/10.1111/jcpt.12059.Hill‐Taylor B., Sketris I., Hayden J., Byrne S., O’Sullivan D., Christie R. Application of the STOPP/START Criteria: A Systematic Review of the Prevalence of Potentially Inappropriate Prescribing in Older Adults, and Evidence of Clinical, Humanistic and Economic Impact. J Clin Pharm Ther. 2013;38(5):360–372. https://doi.org/10.1111/jcpt.12059.Hill-Taylor B., Walsh K.A., Stewart S., Hayden J., Byrne S., Sketris I.S. Effectiveness of the STOPP/START (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) Criteria: Systematic Review and Meta-Analysis of Randomized Controlled Studies. J Clin Pharm Ther. 2016;41(2):158–169. https://doi.org/10.1111/jcpt.12372.Hill-Taylor B., Walsh K.A., Stewart S., Hayden J., Byrne S., Sketris I.S. Effectiveness of the STOPP/START (Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions/Screening Tool to Alert doctors to the Right Treatment) Criteria: Systematic Review and Meta-Analysis of Randomized Controlled Studies. J Clin Pharm Ther. 2016;41(2):158–169. https://doi.org/10.1111/jcpt.12372.O’Mahony D. STOPP/START Criteria for potentially Inappropriate Medications/Potential Prescribing Omissions in Older People: Origin and Progress. Expert Rev Clin Pharmacol. 2020;13(1):15–22. https://doi.org/10.1080/17512433.2020.1697676.O’Mahony D. STOPP/START Criteria for potentially Inappropriate Medications/Potential Prescribing Omissions in Older People: Origin and Progress. Expert Rev Clin Pharmacol. 2020;13(1):15–22. https://doi.org/10.1080/17512433.2020.1697676.Samsa G.P., Hanlon J.T., Schmader K.E., Weinberger M., Clipp E.C., Uttech K.M. et al. A Summated Score for the Medication Appropriateness Index: Development and Assessment of Clinimetric Properties Including Content Validity. J Clin Epidemiol. 1994;47(8):891–896. https://doi.org/10.1016/0895-4356(94)90192-9.Samsa G.P., Hanlon J.T., Schmader K.E., Weinberger M., Clipp E.C., Uttech K.M. et al. A Summated Score for the Medication Appropriateness Index: Development and Assessment of Clinimetric Properties Including Content Validity. J Clin Epidemiol. 1994;47(8):891–896. https://doi.org/10.1016/0895-4356(94)90192-9.Mangin D., Bahat G., Golomb B.A., Mallery L.H., Moorhouse P., Onder G. et al. International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action. Drugs Aging. 2018;35(7):575–587. https://doi.org/10.1007/s40266-018-0554-2.Mangin D., Bahat G., Golomb B.A., Mallery L.H., Moorhouse P., Onder G. et al. International Group for Reducing Inappropriate Medication Use & Polypharmacy (IGRIMUP): Position Statement and 10 Recommendations for Action. Drugs Aging. 2018;35(7):575–587. https://doi.org/10.1007/s40266-018-0554-2.Garfinkel D., Zur-Gil S., Ben-Israel J. The War Against Polypharmacy: A New Cost-Effective Geriatric-Palliative Approach for Improving Drug Therapy in Disabled Elderly People. Isr Med Assoc J. 2007;9(6):430–434. Available at: https://pubmed.ncbi.nlm.nih.gov/17642388/.Garfinkel D., Zur-Gil S., Ben-Israel J. The War Against Polypharmacy: A New Cost-Effective Geriatric-Palliative Approach for Improving Drug Therapy in Disabled Elderly People. Isr Med Assoc J. 2007;9(6):430–434. Available at: https://pubmed.ncbi.nlm.nih.gov/17642388/.Garfinkel D., Ilhan B., Bahat G. Routine Deprescribing of Chronic Medications to Combat Polypharmacy. Ther Adv Drug Saf. 2015;6(6):212–233. https://doi.org/10.1177/2042098615613984.Garfinkel D., Ilhan B., Bahat G. Routine Deprescribing of Chronic Medications to Combat Polypharmacy. Ther Adv Drug Saf. 2015;6(6):212–233. https://doi.org/10.1177/2042098615613984.Scott I.A., Pillans P.I., Barras M., Morris C. Using EMR-Enabled Computerized Decision Support Systems to Reduce Prescribing of Potentially Inappropriate Medications: A Narrative Review. Ther Adv Drug Saf. 2018;9(9):559–573. https://doi.org/10.1177/2042098618784809.Scott I.A., Pillans P.I., Barras M., Morris C. Using EMR-Enabled Computerized Decision Support Systems to Reduce Prescribing of Potentially Inappropriate Medications: A Narrative Review. Ther Adv Drug Saf. 2018;9(9):559–573. https://doi.org/10.1177/2042098618784809.Vélez-Díaz-Pallarés M., Pérez-Menéndez-Conde C., Bermejo-Vicedo T. Systematic Review of Computerized Prescriber Order Entry and Clinical Decision Support. Am J Health Syst Pharm. 2018;75(23):1909–1921. https://doi.org/10.2146/ajhp170870.Vélez-Díaz-Pallarés M., Pérez-Menéndez-Conde C., Bermejo-Vicedo T. Systematic Review of Computerized Prescriber Order Entry and Clinical Decision Support. Am J Health Syst Pharm. 2018;75(23):1909–1921. https://doi.org/10.2146/ajhp170870.Wolfstadt J.I., Gurwitz J.H., Field T.S., Lee M., Kalkar S., Wu W., Rochon P.A. The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review. J Gen Intern Med. 2008;23(4):451–458. https://doi.org/10.1007/s11606-008-0504-5.Wolfstadt J.I., Gurwitz J.H., Field T.S., Lee M., Kalkar S., Wu W., Rochon P.A. The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review. J Gen Intern Med. 2008;23(4):451–458. https://doi.org/10.1007/s11606-008-0504-5.Woodward M. Deprescribing: Achieving Better Health Outcomes for Older People Through Reducing Medications. J Pharm Pract Res. 2003;33:323–328. https://doi.org/10.1002/jppr2003334323.Woodward M. Deprescribing: Achieving Better Health Outcomes for Older People Through Reducing Medications. J Pharm Pract Res. 2003;33:323–328. https://doi.org/10.1002/jppr2003334323.Page A.T., Potter K., Clifford R., Etherton-Beer C. Deprescribing in Older People. Maturitas. 2016;91:115–134. https://doi.org/10.1016/j.maturitas.2016.06.006.Page A.T., Potter K., Clifford R., Etherton-Beer C. Deprescribing in Older People. Maturitas. 2016;91:115–134. https://doi.org/10.1016/j.maturitas.2016.06.006.Scott I.A., Hilmer S.N., Reeve E., Potter K., Le Couteur D., Rigby D. et al. Reducing Inappropriate Polypharmacy: The Process of Deprescribing. JAMA Intern Med. 2015;175(5):827–834. https://doi.org/10.1001/jamainternmed.2015.0324.Scott I.A., Hilmer S.N., Reeve E., Potter K., Le Couteur D., Rigby D. et al. Reducing Inappropriate Polypharmacy: The Process of Deprescribing. JAMA Intern Med. 2015;175(5):827–834. https://doi.org/10.1001/jamainternmed.2015.0324.Ulley J., Harrop D., Ali A., Alton S., Davis S.F. Deprescribing Interventions and Their Impact on Medication Adherence in Community-Dwelling Older Adults with Polypharmacy: A Systematic Review. BMC Geriatrics. 2019;19(1):15. https://doi.org/10.1186/s12877-019-1031-4.Ulley J., Harrop D., Ali A., Alton S., Davis S.F. Deprescribing Interventions and Their Impact on Medication Adherence in Community-Dwelling Older Adults with Polypharmacy: A Systematic Review. BMC Geriatrics. 2019;19(1):15. https://doi.org/10.1186/s12877-019-1031-4.Page A.T., Clifford R.M., Potter K., Schwartz D., Etherton-Beer C.D. The Feasibility and the Effect of Deprescribing in Older Adults on Mortality and Health: A Systematic Review. Br J Clin Pharmacol. 2016;82(3):583–623. https://doi.org/10.1111/bcp.12975.Page A.T., Clifford R.M., Potter K., Schwartz D., Etherton-Beer C.D. The Feasibility and the Effect of Deprescribing in Older Adults on Mortality and Health: A Systematic Review. Br J Clin Pharmacol. 2016;82(3):583–623. https://doi.org/10.1111/bcp.12975.Kua C.H., Mak V.S. L., Huey Lee S.W. Health Outcomes of Deprescribing Interventions among Older Residents in Nursing Homes: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2019;20(3):362.e11-372. e11. https://doi.org/10.1016/j.jamda.2018.10.026.Kua C.H., Mak V.S. L., Huey Lee S.W. Health Outcomes of Deprescribing Interventions among Older Residents in Nursing Homes: A Systematic Review and Meta-Analysis. J Am Med Dir Assoc. 2019;20(3):362.e11-372. e11. https://doi.org/10.1016/j.jamda.2018.10.026.Thillainadesan J., Gnjidic D., Green S., Hilmer S.N. Impact of Deprescribing Interventions in Older Hospitalised Patients on Prescribing and Clinical Outcomes: A Systematic Review of Randomised Trials. Drugs Aging. 2018;35(4):303–319. https://doi.org/10.1007/s40266-018-0536-4.Thillainadesan J., Gnjidic D., Green S., Hilmer S.N. Impact of Deprescribing Interventions in Older Hospitalised Patients on Prescribing and Clinical Outcomes: A Systematic Review of Randomised Trials. Drugs Aging. 2018;35(4):303–319. https://doi.org/10.1007/s40266-018-0536-4.Patterson S.M., Hughes C., Kerse N., Cardwell C.R., Bradley M.C. Interventions to Improve the Appropriate Use of Polypharmacy for Older People. Cochrane Database Syst Rev. 2012;(5):CD008165. https://doi.org/10.1002/14651858.CD008165.pub2.Patterson S.M., Hughes C., Kerse N., Cardwell C.R., Bradley M.C. Interventions to Improve the Appropriate Use of Polypharmacy for Older People. Cochrane Database Syst Rev. 2012;(5):CD008165. https://doi.org/10.1002/14651858.CD008165.pub2.Patterson S.M., Cadogan C.A., Kerse N., Cardwell C.R., Bradley M.C., Ryan C., Hughes C. Interventions to Improve the Appropriate Use of Polypharmacy for Older People. Cochrane Database Syst Rev. 2014;(10):CD008165. https://doi.org/10.1002/14651858.CD008165.pub3.Patterson S.M., Cadogan C.A., Kerse N., Cardwell C.R., Bradley M.C., Ryan C., Hughes C. Interventions to Improve the Appropriate Use of Polypharmacy for Older People. Cochrane Database Syst Rev. 2014;(10):CD008165. https://doi.org/10.1002/14651858.CD008165.pub3.Johansson T., Abuzahra M.E., Keller S., Mann E., Faller B., Sommerauer C. et al. Impact of Strategies to Reduce Polypharmacy on Clinically Relevant Endpoints: A Systematic Review and Meta-Analysis. Br J Clin Pharmacol. 2016;82(2):532–548. https://doi.org/10.1111/bcp.12959.Johansson T., Abuzahra M.E., Keller S., Mann E., Faller B., Sommerauer C. et al. Impact of Strategies to Reduce Polypharmacy on Clinically Relevant Endpoints: A Systematic Review and Meta-Analysis. Br J Clin Pharmacol. 2016;82(2):532–548. https://doi.org/10.1111/bcp.12959.Rankin A., Cadogan C.A., Patterson S.M., Kerse N., Cardwell C.R., Bradley M.C. et al. Interventions to Improve the Appropriate Use of Polypharmacy for Older People. Cochrane Database Syst Rev. 2018;9(9):CD008165. https://doi.org/10.1002/14651858.CD008165.pub4.Rankin A., Cadogan C.A., Patterson S.M., Kerse N., Cardwell C.R., Bradley M.C. et al. Interventions to Improve the Appropriate Use of Polypharmacy for Older People. Cochrane Database Syst Rev. 2018;9(9):CD008165. https://doi.org/10.1002/14651858.CD008165.pub4.Earl T.R., Katapodis N.D., Schneiderman S.R., Shoemaker-Hunt S.J. Using Deprescribing Practices and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions Criteria to Reduce Harm and Preventable Adverse Drug Events in Older Adults. J Patient Saf. 2020;16(3S Suppl 1):S23–S35. https://doi.org/10.1097/PTS.0000000000000747.Earl T.R., Katapodis N.D., Schneiderman S.R., Shoemaker-Hunt S.J. Using Deprescribing Practices and the Screening Tool of Older Persons’ Potentially Inappropriate Prescriptions Criteria to Reduce Harm and Preventable Adverse Drug Events in Older Adults. J Patient Saf. 2020;16(3S Suppl 1):S23–S35. https://doi.org/10.1097/PTS.0000000000000747.Mair A., Fernandez-Llimos F. Polypharmacy Management Programmes: the SIMPATHY Project. Eur J Hosp Pharm. 2017;24(1):5–6. https://doi.org/10.1136/ejhpharm-2016-001044.Mair A., Fernandez-Llimos F. Polypharmacy Management Programmes: the SIMPATHY Project. Eur J Hosp Pharm. 2017;24(1):5–6. https://doi.org/10.1136/ejhpharm-2016-001044.

The authors declare that there are no conflicts of interest present.