Who is The Polypharmacist?

The Polypharmacist, Demetra Antimisiaris,  is above all person concerned about our collective situational awareness regarding every day, real world, medication use.

But professionally, The Polypharmacist is a 30 year veteran medication manager who started after pharmacy school as a consultant pharmacist, taking care of nursing home residents and older adults with complex medical and medication needs.

The big surprise today is that Polypharmacy is no longer just a concern of older persons. Polypharmacy has become a part of everyone's life, including children, parents, employers, employees, athletes, students, and many more.  This was not the case 20+ years ago and has much to do with the 15 minute office visit and algorithmic are superimposed on complicated health system payments. 

Robust, overall, dedicated medication management, is not reimbursed adequately in the healthcare system, leaving the responsibility on each of our shoulders. Even in countries where medication management is fiscally supported, because of gaps between highly technical nature of medication design,  and real world use, the need for skills, communication, knowledge and empowerment for optimized medication use persists.  

It is difficult to say what model of polypharmacy management is ideal because studies on the topic are few and far in between.  The only medical study evidence we have is that which is funded to study. (remember that it's important and we will discuss in our web collaborations)   

Rarely if ever is the study of optimization of medication use funded.  No study, no evidence, thus, not part of  evidence based practice. Some of us would argue that absence of evidence is not evidence of absence as the saying goes. 

The Polypharmacist has observed the need for people to come together and speak a common language of medication use.  The hope is that this website will help facilitate that goal and empower each person to feel more confident in using  and talking about medications.

The Polypharmacist doesn't want to just lecture people on how to think about medications use. It has been my experience that everyone I have ever talked to teaches me something new , and I want us to teach each other.

My first year after graduation from pharmacy school, as a PharmD (clinical pharmacist), I did a residency at the VA Medical Center Sepulveda-West LA-UCLA in Geriatric Pharmacy.  At that time, the program's culture was strongly focused on Polypharmacy and optimization of medication use in older persons.  The physician (Geriatrician) that developed the "Beers Criteria", Mark Beers happened was trained at the same program a few years after my time there. We were trained by caring giants in Geriatrics, who were experts in every aspect of the care of older persons and trained many of todays leaders.

My role as a nursing home consultant has been the greatest training and honor one could wish for. Caring for the generations who cared for us has been rewarding. They taught me that riches, notoriety and many things in life are really not important. They taught me the importance of quality of life, family, friends and community. The also taught me the limits of pushing medication use and the critical importance of the risk vs benefit approach.

 The Polypharmacist's Pearl: "if you want a drug to reveal its toxicity, give it to a frail older person"   The reason is- they are medically complex, take lots of other medications and have diminished physiological reserve.

The other important lesson from long term care (care of nursing home residents) is that most of what I know, I have learned from the underpaid and underappreciated day to day caregivers in long term care.  If you want to know what's really going on with a resident, ask the CNAs (certified nursing assistants). This lesson has served me well in all polypharmacy consults...you need lots of perspectives in addition to the person taking the medication, especially the day to day stake holders.

Then, you have to convey succinctly the right information that the episodic care giver (stake holder, such as physician, therapist, distant family) needs. 

The Polypharmacist is a long time member of the American Society for Consultant Pharmacist and awardee of the 2019 Archambault Award, the highest honor conferred by the society.  It is embarrassing to be spotlighted but am full of gratitude to my colleagues for the recognition. 

About mid career, I moved my primary work from private sector nursing home care to join academia and lead a program unique among medical schools, dedicated to polypharmacy.  (Still work as a consultant pharmacist...you can't teach what you don't do!).  

This unusual dedicated polypharmacy program was made possible by a private philanthropist.  I would later learn that funding for the study of polypharmacy is not common.

Leading the polypharmacy program was an interesting challenge. There was little education in health sciences about polypharmacy and overall medication management, because until recently, polypharmacy was the domain of Geriatrics, and in undergraduate health science education, curricula don't typically focus on specialty populations, their main focus is understandably, training students to pass their board exams.

So, I set out to create education, for post graduates, caregivers, and community stake holders. Simultaneously, I had an active polypharmacy referral clinic, taught basic science pharmacology and worked with a variety of health care professions on medication use education and clinic management.

  The most exciting academic work, and  a large part of my interest, was and is, the development of methods to qualitatively and quantitively understand how polypharmacy can impact clinical outcomes and assessments (like pulmonary function tests and now working on the influence of medications on covid-19 infection and outcomes).   These methods and research are rooted in a core element of successful medication management: individualized medication risk modeling.

 After working on  academic scholarship such as publishing peer reviewed biomedical texts, articles and research, towards the end of my academic career,  it became very clear that the solution to polypharmacy does not lie strictly within the walls of biomedical science.  In fact, it was biomedical science that wasn't getting ahead of the problem.  The reason was, the underpinnings of the problem is more than just biomedical science. It is driven by factors in the domain of public health, and health systems.  

Now that I am nearing retirement from full time academia,  the polypharmacy program exists in the school of public health, as well as medicine.  Future innovation in polypharmacy will come through the study of health literacy, health systems and data science in collaboration with biomedical science. 

The variety of stake holders, roles and insights I experienced in multidisciplinary academia (our university had no pharmacy school), provided me with an unusual view into variable stake holder "blind spots" in polypharmacy and medication  use.  This inspires me to use those experiences for meaningful purposes going forth. 

 Once a colleague taught me that traditionally Universities exist to innovate (vs colleges where the focus is on teaching).  This resonated with me personally, because a meaningful life is one where you can make a difference.  

The purpose of this website is to convene interested people to dialogue and "color outside the lines" to find solutions to optimized medication use and polypharmacy.  I firmly believe that the solution to optimal medication use and polypharmacy management lie beyond the boundaries of traditional biomedical science, and the academy.  The solution is in the hands of us, the people who use medications. 

On a personal note, I have some very memorable examples of medication misadventure and medication induced morbidity and mortality,  that occurred  with my loved ones (parents, grandparents) and despite the biomedical expertise around them (myself, close kin who were physicians, etc).  The only successful outcome out of four incidents,  was when the person at the center recognized the threat and acted on their own behalf with real world, every day medication management.  

This is why I believe empowerment of all people, especially consumers (that's all of us!), is the key to optimal medication use. 

When one "retires" from formal work, the benefits of open collaboration arise.  One might wonder why would I work on this despite the lure of enjoying retirement?  Several reasons- loyalty to the philanthropist who started the University program, I like to finish what I start,  have years of experience to share, and the value of real world collaboration is a very enticing lure. 

I am looking forward to working with you, my new collaborators, for co creation of answers and empowerment for all  to experience optimal medication use!