She explains how one of her patients living in a long-term care facility was given a medication to treat osteoporosis, but the medicine was administered incorrectly by crushing it first, which led to burning of the patient’s esophagus. The patient stopped eating and almost died.

“Fortunately, we were able to save her and send her home, where she healed and gained her weight back,” Antimisiaris said. “This is an example of the critical importance of medication literacy from the patient to the entire health care team.”

Polypharmacy, the use of multiple medications together, often associated with medication use risk, is usually associated with older adults, but is increasingly becoming more common among younger adults and children. With approximately 20,000 prescription and more than 300,000 over-the-counter products available to consumers, understanding on how to use medications and how they interact together has never been more important. 

“There’s nowhere in the health care system that you can go if you’re taking 20 drugs and say, ‘Here’s what I’m taking. Is everything ok?’,” Antimisiaris said.

UofL’s distinctive program 

The UofL Jean Frazier Polypharmacy & Medication Management Program is unique among colleges and universities in its dedication to education, research and outreach on the growing challenge of polypharmacy.

Originally launched through the , the FPMMP was created in 2007 through the support of philanthropist Jean Frazier, whose long-standing concern about polypharmacy aligned with the work led by then DFGM chair,  James G. O’Brien.

Frazier’s interest in supporting a polypharmacy program was sparked after three people she knew well suffered from adverse medication issues within one year’s time – one of them, her mother.

“I started to wonder if there was anything I could do to help stop problems like this and I talked with Dr. O’Brien, who hired Dr. Antimisiaris, and that’s where it all started,” said Frazier.

Since 2007, Frazier said she is pleased with the progress in community awareness about polypharmacy through the efforts of the polypharmacy program.

“One of the things the program is doing that I am delighted with is a process of having people take an interest in their own health – understanding their illnesses and medications and knowing the side effects and interactions,” she said. “I think the program is beneficial and it is growing. It really is an asset for the community.”

Antimisiaris says 275,000 people die every year trying to use their medicines correctly, and adverse drug events account for more than 3.5 million doctor visits annually and 1 million emergency department visits.

“When you have one medicine from your cardiologist, one from your psychiatrist and three more you take over the counter, it’s a lot harder to monitor and predict the effects,” said Antimisiaris. “Usually, we don’t recognize it until they hit the emergency room doors. And by then, it’s often too late.” 

Making a global impact 

As a dedicated program focused on polypharmacy, UofL’s efforts are leading the way nationally and internationally in medication management expertise. In June 2023, the FPMMP worked with the Polish Ministry of Health and the Universities of Poznan and Warsaw to pilot a medication therapy management (MTM) project. Antimisiaris served as one of the ministry’s experts on MTM implementation and evaluation, providing advanced practice education.

Agnieszka Neumann Podczaska, Polish Ministry of Health’s Medication Management pilot project director, said the Frazier program partnership has been valuable for their program and for the field of polypharmacy.

“At Poznan University of Medical Sciences, the collaboration with Dr. Antimisiaris helped us to understand the need of providing research in all aspects of polypharmacy, not only the influence on clinical assessment but also on barriers to medication literacy and systems, or lack of systems, of polypharmacy management in clinic,” Podczaska said.

In addition, she said observing the program emphasized the importance of engagement with diverse experts in health systems of care delivery, policy, incentives, literacy, international perspectives and governance.

Antimisiaris said the FPMMP is extending its efforts across the European Union (EU) to help bring medication management to more populations. “We recognize they face the same problems we do with gaps in medication management caused by policy and systems of health care,” she said. “I think this is a credit to UofL and to Mrs. Frazier that we have the stakeholders and leaders in the EU looking to us.”

Collaboration within the UofL community

Closer to home, the FPMMP is looking to leverage public health expertise and education in medication literacy to develop innovative programming in the polypharmacy space. Population and societal approaches that empower people are especially important to address system gaps, said Antimisiaris.

For example, the School of Public Health and Information Sciences recently launched a new course open to undergraduate students called “Medication Use: History, Science and Humanity,” designed to raise awareness and skills of students who will be better equipped citizens and advocates, beyond those working in health care.

Creative inter-disciplinary approaches also led to a collaboration with colleagues in the to examine pharmacy accessibility in care deserts (pharmacy deserts) that was funded by UofL’s .

With an average of 50 new prescription products approved for market annually, most of which are high-technology and unfamiliar, and nearly 50% of the US population taking at least one prescription medication, the challenge of effective and safe medication use will continue.

“What has happened is that our systems, policies and individual medication literacy have not kept up with the growth of medication consumption worldwide,” Antimisiaris said.

What motivates Antimisiaris is seeking innovative solutions to transform the way society interacts with polypharmacy and medication management.

“What are the systems and individual-level solutions needed to keep us healthy and safe? These are the questions we will continue to study,” she said.

The University of Louisville has long tackled this issue through the Frazier Polypharmacy Program, led by Demetra Antimisiaris, PharmD, CGP, FASCP.

The program, dedicated to research, education and outreach, continues to grow as Antimisiaris broadens the focus of her study beyond the geriatric population.

“Historically, polypharmacy was exclusively a problem of aging, but now it is a part of life for all ages, including middle-aged adults and children. If a child has asthma, diabetes and ADHD, they could be receiving as many as seven or more medications, not including over-the-counter medication,” said Antimisiaris, who recently joined the UofL School of Public Health and Information Sciences Department of Health Management and Systems Sciences.

She points out that although science indicates that the use of five medications at the same time increases the odds of adverse events for older adults, it would take double that to produce similar adverse events for middle-aged adults. Still, there are considerations of polypharmacy exposure in younger people that may differ from the traditional concerns in older adults.

“We don’t fully understand the effect of medication burden on learning, cognition, mood or physical function – or even what long-term medication use may mean for a younger person’s physical or mental wellness into adulthood,” Antimisiaris said.

Antimisiaris also serves as assistant dean for Continuing ����ֱ�� and Professional Development and has a part-time appointment in the UofL School of Medicine’s Department of Neurology. One of the most significant contributions of the Frazier Polypharmacy Program to date has been creation of continuing education programs on polypharmacy.

Her research interests center on multi-stakeholder decision-making on medication use. Antimisiaris says polypharmacy can’t be studied as a science in the absence of understanding the human factors influencing medication use, and she focuses her studies on the interface of science with how people use information and understand medications.

Antimisiaris’ work to be honored 

The American Society of Consultant Pharmacists (ASCP) has recognized Antimisiaris’ contributions to the profession, and will confer her with the George F. Archambault Award, the organization’s highest honor during its annual meeting Nov. 7 in Texas.

“Dr. Antimisiaris’ entrepreneurial initiative, incredibly strong work ethic and talent as an excellent communicator and teacher have led her to prominence in both her chosen disciplines of clinical pharmacy, pharmacology and therapeutics, and in many other diverse circles,” said Chris Alderman, B Pharm, PhD, FSHP, BCPP, CGP, associate professor, Pharmacy Practice, University of South Australia, who nominated her for the award. “Earlier in her career, she led a novel academic initiative and authored new content addressing the issue of polypharmacy for nurses, physicians, pharmacists, social workers, basic scientists, therapists and even those outside of health care. At the time, there was little information on polypharmacy available, and Dr. Antimisiaris was forging a path in what has now come to be recognized as an area critical to the safe and effective use of medicines.”

ASCP Archambault Award honorees are selected by past recipients and based on their significant contributions to consultant or senior care pharmacy. Past recipients include Mark Beers, MD, who developed the Beers Criteria, evidence-based recommendations tailored specifically for older adults, and Jerry Gurwitz, MD, whose canonical work shed light on the significance of preventable medication problems.

“We are extremely thrilled that Dr. Antimisiaris has received such recognition for her innovative work including her success in the creation of online technologies and other novel approaches to reduce the risk arising from polypharmacy for vulnerable populations,” said Christopher E. Johnson, chair, Department of Health Management and System Sciences, UofL School of Public Health and Information Sciences. “As a mentor and teacher, she has led many students on scholarly projects and continues to make a lasting impact on future, as well as current health care practitioners.”