Understanding polypharmacy - prescribing cascades and anticholinergic burden
Supervisors:
Professor David McAllister, School of Health & Wellbeing (University of Glasgow)
Dr Peter Hanlon, School of Health & Wellbeing (University of Glasgow)
Dr Daniel Morales, School of Medicine (University of Dundee)
Summary:
Polypharmacy is common in multimorbidity; multiple conditions lead to multiple ‘indications’ for treatment and more chance of being treated with multiple drugs.
Polypharmacy can be bad for individuals; drug-drug and drug-disease interactions increase the risk of side effects. Even where there are no side effects treatment regimes can themselves be burdensome. Managing the complexity of polypharmacy is also challenging for healthcare professionals and health services.
This PhD will focus on two aspects of polypharmacy – prescribing cascades and anticholinergic burden. In prescribing cascades, a drug is started to treat a side effect from another drug. Anticholinergic burden is an example of a problem where multiple different drug classes all affect a common pathway, potentially amplifying side effects.
The PhD student will develop expertise in polypharmacy, epidemiology and statistics as they study these phenomena using complementary data sources:- real-world data and individual-level clinical trial data. Real world data is rich in people with multimorbidity and polypharmacy. Trial data is less representative, but has rich documentation on changes in drug treatment. More importantly, including both types of data allows us to understand whether and how trial data can be used to inform decision-making about polypharmacy.