ArticleAge and ageing2024
Stakeholder perceptions of and attitudes towards problematic polypharmacy and prescribing cascades: a qualitative study.
Article in Age and ageing, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
13 citing papers in PubMed.
- Creating Awareness of preScribing Cascades and Managing Adverse Drug Effects (CASC-ADE) Tool: Appraisal by Future End Users.Drugs & aging · 2026Article
- How direct healthcare professional communications are operationalised by general practitioners and community pharmacists in Ireland: a national cross sectional study.International journal of clinical pharmacy · 2026Article
- Prevalence and impact of prescribing cascades in community-dwelling adults: Longitudinal analysis of the Irish longitudinal study on ageing (TILDA).British journal of clinical pharmacology · 2026Article
- Investigating Potential Prescribing Cascades Resulting in Prochlorperazine Prescription: An Exploratory Analysis of Antihypertensives and NSAIDs.Drugs & aging · 2026Article
- Prescribing Cascade as a Therapeutic Error: A Danger for Geriatric Patients with Multimorbidity.Geriatrics (Basel, Switzerland) · 2026Article
- Adverse Drug Reactions and Drug Interactions in Multimorbid Patients: A Review of Current Evidence.Cureus · 2025Review
- Patterns of Analgesic Prescribing and High-Risk Prescribing in Primary Care in Ireland 2014-2022-A Repeated Cross-Sectional Study.European journal of pain (London, England) · 2025Article
- Factors Influencing Hospital Physicians' Recognition of Prescribing Cascades: A Qualitative Interview Study.Drugs & aging · 2025Article
- Prevalence of potentially inappropriate prescribing in community-dwelling older adults: an application of STOPP/START version 3 to The Irish Longitudinal Study on Ageing (TILDA).European geriatric medicine · 2025Article
- Real-World Complexity of Prescribing Cascades.Basic & clinical pharmacology & toxicology · 2025Review
- Pharmacy-led interventions to reverse and prevent prescribing cascades in primary care: a proof-of-concept study.International journal of clinical pharmacy · 2025Article
- Article
- Yonder: Prescribing cascades, teacher wait time, online services for mental health conditions, and community deep vein thrombosis pathways.The British journal of general practice : the journal of the Royal College of General Practitioners · 2024Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionProblematic polypharmacy is the prescribing of five or more medications potentially inappropriately. Unintentional prescribing cascades represent an under-researched aspect of problematic polypharmacy and occur when an adverse drug reaction (ADR) is misinterpreted as a new symptom resulting in the initiation of a new medication. The aim of this study was to elicit key stakeholders' perceptions of and attitudes towards problematic polypharmacy, with a focus on prescribing cascades.
methodsqualitative one-to-one semi-structured interviews were conducted with predefined key stakeholder groups. Inductive thematic analysis was employed.
resultsThirty-one stakeholders were interviewed: six patients, two carers, seven general practitioners, eight pharmacists, four hospital doctors, two professional organisation representatives and two policymakers. Three main themes were identified: (i) ADRs and prescribing cascades-a necessary evil. Healthcare professionals (HCPs) expressed concern that experiencing an ADR would negatively impact patients' confidence in their doctor. However, patients viewed ADRs pragmatically as an unpredictable risk. (ii) Balancing the risk/benefit tipping point. The complexity of prescribing decisions in the context of polypharmacy made balancing this tipping point challenging. Consequently, HCPs avoided medication changes. (iii) The minefield of medication reconciliation. Stakeholders, including patients and carers, viewed medication reconciliation as a perilous activity due to systemic communication deficits.
conclusionStakeholders believed that at a certain depth of polypharmacy, the risk that a new symptom is being caused by an existing medication becomes incalculable. Therefore, in the absence of harm, medication changes were avoided. However, medication reconciliation post hospital discharge compelled prescribing decisions and was seen as a high-risk activity by stakeholders.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.