TY - JOUR
T1 - Accumulation of Good Intentions
T2 - How Individual Practice Guidelines Lead to Polypharmacy in the Treatment of Patients with Polytrauma
AU - Brown-Taylor, Lindsey
AU - JARAMILLO, CARLOS
AU - Eapen, Blessen C.
AU - Kretzmer, Tracy
AU - Gavin, Lindsey P.
AU - Cooper, Tyler
AU - Pugh, Mary J.
N1 - Funding Information:
Disclosures: Dr. Pugh reports grants from VA Health Services Research and Development (IHX002608A) during the conduct of this study.
Publisher Copyright:
© 2020 American Academy of Physical Medicine and Rehabilitation
PY - 2021/10
Y1 - 2021/10
N2 - Polytrauma clinical triad (PCT) is the comorbid occurrence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain after trauma. No clinical practice guidelines for postacute care of patients with PCT currently exist; instead, clinical practice guidelines have been published for the three conditions (TBI, PTSD, and pain) as distinct clinical entities. Using multiple, individual practice guidelines for a patient with PCT may lead to unintended prescription of multiple and potentially adversely interacting medications (ie, polypharmacy). Polypharmacy, especially that which includes central nervous system-acting medications, may lead to overdose, suicidality, and chronic symptomatology. Current individual guidelines for each condition of PCT do not address how to coordinate care for the polytraumatic diagnosis. The purpose of this Practice Management piece is to describe the unintended consequences of polypharmacy in patients with PCT and to discuss mitigation approaches including rational prescribing, nonpharmacologic alternatives, and interdisciplinary coordination.
AB - Polytrauma clinical triad (PCT) is the comorbid occurrence of traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain after trauma. No clinical practice guidelines for postacute care of patients with PCT currently exist; instead, clinical practice guidelines have been published for the three conditions (TBI, PTSD, and pain) as distinct clinical entities. Using multiple, individual practice guidelines for a patient with PCT may lead to unintended prescription of multiple and potentially adversely interacting medications (ie, polypharmacy). Polypharmacy, especially that which includes central nervous system-acting medications, may lead to overdose, suicidality, and chronic symptomatology. Current individual guidelines for each condition of PCT do not address how to coordinate care for the polytraumatic diagnosis. The purpose of this Practice Management piece is to describe the unintended consequences of polypharmacy in patients with PCT and to discuss mitigation approaches including rational prescribing, nonpharmacologic alternatives, and interdisciplinary coordination.
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U2 - 10.1002/pmrj.12526
DO - 10.1002/pmrj.12526
M3 - Article
C2 - 33247558
AN - SCOPUS:85101770343
SN - 1934-1482
VL - 13
SP - 1169
EP - 1175
JO - PM and R
JF - PM and R
IS - 10
ER -