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Martín-Díaz M, Pino-Merlo G, Bueno-Cabanillas A, Khan KS. [Longitudinality in Primary Care and Polypharmacy. A Systematic Review]. Semergen 2023; 49:101994. [PMID: 37276757 DOI: 10.1016/j.semerg.2023.101994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/14/2023] [Accepted: 04/26/2023] [Indexed: 06/07/2023]
Abstract
The aim of this work was to collect, evaluate and interpret the available evidence on the relationship between continuity in primary care (i.e., longitudinality), and the prevalence of polypharmacy and its associated problems. Following the PRISMA reporting statement, we carried out a systematic review of the literature searching PubMed and Scopus databases. The screening of titles and summaries and the review of references carried out independently by two authors detected 16 works of potential interest, of which 4 were discarded after the independent review of all the originals because they did not meet inclusion criteria. The 12 papers selected studied the relationship between Longitudinality, measured with various quantitative indices, and the rate of polypharmacy or various associated problems, such as duplicate drugs, inadequate prescriptions or drug interactions. They all showed a significant relationship, often strong (RR>2 or<0.5), between longitudinality indicators and the various dependent variables. Although our knowledge could be improved by prospective studies that more directly evaluate longitudinality and its impact on problems due to excess medication, with the existing evidence, we can affirm that the protection and promotion of continuity in primary care can be a key element for the control of polypharmacy and associated problems.
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Affiliation(s)
- M Martín-Díaz
- Cirugía General y del Aparato Digestivo, Hospital General Básico Santa Ana de Motril, Área de Gestión Sanitaria Sur de Granada, Motril, Granada, España.
| | - G Pino-Merlo
- Unidad de Calidad y Seguridad del Paciente, Área de Gestión Sanitaria Sur de Granada, Granada, España
| | - A Bueno-Cabanillas
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España; Instituto de Investigación BioSanitaria de Granada (IBS-Granada), Granada, España
| | - K S Khan
- Departamento de Medicina Preventiva y Salud Pública, Universidad de Granada, Granada, España; CIBER de Epidemiología y Salud Pública (CIBERESP), España
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Jang S, Kang HJ, Kim Y, Jang S. Association of potentially inappropriate medications and need for long-term care among older adults: a matched cohort study. BMC Geriatr 2022; 22:972. [PMID: 36522694 PMCID: PMC9756678 DOI: 10.1186/s12877-022-03681-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND With an increase in the aging population, the number of older adults who require long-term care (LTC) is growing, enhancing drug-related issues. The reduced capacity of LTC users to precisely utilize medical services poses additional challenges owing to restrictions in daily activities. We compared older adults who required LTC with those who did not require LTC to confirm differences in the use of potentially inappropriate medications (PIMs), frequently used PIMs, and associating factors in Korea. METHODS Using the Korean National Health Insurance Service cohort data, adults aged ≥ 65 years as of 2017 who were LTC beneficiaries (at home and LTC facilities) were selected and matched 1:1 with a control group (LTC non-beneficiaries). PIM was defined based on the 2019 American Society of Geriatrics Beers criteria. PIM use and medical resource utilization according to LTC requirements were compared for one year after the index date. After correcting for other confounding variables, differences in the risk of PIM use on person-based according to LTC eligibility were assessed using multivariate logistic regression. RESULTS Among the 13,251 older adults requiring LTC in 2017, 9682 were matched with counterparts and included. Among those who received an outpatient prescription including PIM at least once yearly, 83.6 and 87.6% were LTC beneficiaries and LTC non-beneficiaries, respectively (p < 0.001). Using the number of outpatient prescriptions as the baseline, 37.2 and 33.2% were LTC beneficiaries and LTC non-beneficiaries, respectively (p < 0.001). In both groups, elevated PIM use depended on increased medical resource utilization, as shown by increased outpatient visits and medical care institutions visited. Adjusting other influencing factors, the need for LTC did not significantly associated with PIM use (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.84-1.04); the number of drugs consumed (3-4: OR 1.42, 95% CI 1.25-1.61; 5-9: OR 2.24, 95% CI 1.98-2.53; 10 and more: OR 3.72, 95% CI 3.03-4.55; reference group: 2 and less), frequency of visits (7-15: OR 1.95, 95% CI 1.71-2.23; 16-26: OR 3.51, 95% CI 3.02-4.07; 27-42: OR 5.84, 95% CI 4.84-7.05; 43 and more: OR 10.30, 95% CI 8.15-13.01; reference group: 6 and less), and visits to multiple medical care institutions (3-4: OR 1.96, 95% CI 1.76-2.19; 5 and more: OR 3.21, 95% CI 2.76-3.73; reference group: 2 and less) emerged as primary influencing factors. PIMs mainly prescribed included first-generation antihistamines, benzodiazepines, and Z-drugs in both groups; quetiapine ranked second-highest among LTC beneficiaries. CONCLUSIONS The LTC demand did not significantly associated with PIM utilization. However, the number of drugs consumed, and the pattern of medical resource use were important factors, regardless of LTC requirements. This highlights the need to implement comprehensive drug management focusing on patients receiving polypharmacy and visiting multiple care institutions, regardless of LTC needs.
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Affiliation(s)
- Suhyun Jang
- grid.256155.00000 0004 0647 2973College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936 Republic of Korea
| | - Hee-Jin Kang
- grid.256155.00000 0004 0647 2973College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936 Republic of Korea ,Clinical Development Division, Kangstem Biotech Co., Ltd, 512 Teheran-ro, Gangnam-Gu, Seoul, 06179 Republic of Korea
| | - Yeji Kim
- grid.264381.a0000 0001 2181 989XDepartment of Statistics, Graduate School, Sungkyunkwan University, 25-2, Seonggyungwan-Ro, Jongno-Gu, Seoul, 03063 Republic of Korea
| | - Sunmee Jang
- grid.256155.00000 0004 0647 2973College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoe‑Ro, Yeonsu‑Gu, Incheon, 21936 Republic of Korea
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Lee Y, Jang S, Kang HJ, Jang S. Comparative analysis of potentially inappropriate medication use in long-term care facility residents and community-dwelling elders: A matched cohort study. Medicine (Baltimore) 2022; 101:e31739. [PMID: 36626501 PMCID: PMC9750672 DOI: 10.1097/md.0000000000031739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
As the population of the elderly in long-term care facilities has grown, the number of users of potentially inappropriate medication (PIM) is also increasing. With this study, we aimed to investigate the pattern of PIM usage and related factors among the elderly receiving long-term care services. Using the South Korean National Health Insurance Service Elderly Cohort Database, we conducted a retrospective matched cohort study. Elderly residents (n = 1980) in long-term care facilities in 2013 were selected and matched 1:1 with elderly persons living in the community applying propensity score method. The matching variables were sex, age, health insurance type, long-term care grade, Charlson's Comorbidity Index score, presence of dementia, cerebrovascular disease, or Parkinson's disease, and number of drugs prescribed. PIM use was assessed according to Beers criteria 2019. The prevalence of PIM was found to be higher among the elderly in long-term care facilities (86.77%) than among community-dwelling individuals (75.35%). Logistic regression showed that long-term care facility residents were 1.84 odds more likely to use PIM than community-dwelling older adults. We also confirmed that the average number of medications taken per day and the number of outpatient visits were the major influencing factors affecting PIM prescriptions. In addition, elders living in long-term care facilities were prescribed more PIM drugs acting on the central nervous system than community-dwelling older adults. The results of this study show that among those receiving long-term care services, older people in long-term care facilities use PIM more than do the elderly living at home. Medication management programs need to be developed to reduce the use of PIM in long-term care facilities.
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Affiliation(s)
- Yumin Lee
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Suhyun Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Hee-Jin Kang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
| | - Sunmee Jang
- College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, Incheon, Republic of Korea
- * Correspondence: Sunmee Jang, College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea (e-mail: )
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Cho HJ, Chae J, Yoon S, Kim D. Factors related to polypharmacy and hyper-polypharmacy for the elderly: A nationwide cohort study using National Health Insurance data in South Korea. Clin Transl Sci 2022; 16:193-205. [PMID: 36401587 PMCID: PMC9926077 DOI: 10.1111/cts.13438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Polypharmacy may cause adverse health outcomes in the elderly. This study examined the prevalence of continuous polypharmacy and hyper-polypharmacy, factors associated with polypharmacy, and the most frequently prescribed medications among older adults in South Korea. This was a retrospective observational study using National Health Insurance claims data. In total, 7,358,953 Korean elderly patients aged 65 years and older were included. Continuous polypharmacy and hyper-polypharmacy were defined as the use of ≥5 and ≥10 medications, respectively, for both ≥90 days and ≥180 days within 1 year. A multivariate logistic regression analysis was conducted with adjustment for general characteristics (sex, age, insurance type), comorbidities (12 diseases, number of comorbidities, and Elixhauser Comorbidity Index [ECI] classification), and healthcare service utilization. Among 7.36 million elderly patients, 47.8% and 36.9% had polypharmacy for ≥90 and ≥180 days, and 11.9% and 7.1% of patients exhibited hyper-polypharmacy for ≥90 and ≥180 days, respectively. Male sex, older age, insurance, comorbidities (cardio-cerebrovascular disease, diabetes mellitus, depressive disorder, dementia, an ECI score of ≥3), and healthcare service utilization were associated with an increased probability of polypharmacy. The therapeutic class with the most prescriptions was drugs for acid-related disorders (ATC A02). The number of outpatient visit days more strongly influenced polypharmacy than hospitalizations and ED visits. This study provides health policymakers with important evidence about the critical need to reduce polypharmacy among older adults.
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Affiliation(s)
- Ho Jin Cho
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Jungmi Chae
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Sang‐Heon Yoon
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
| | - Dong‐Sook Kim
- Department of ResearchHealth Insurance Review and Assessment ServiceWonjuSouth Korea
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Chen C, Feng Z, Fu Q, Wang J, Zheng Z, Chen H, Feng D. Predictors of Polypharmacy Among Elderly Patients in China: The Role of Decision Involvement, Depression, and Taking Chinese Medicine Behavior. Front Pharmacol 2021; 12:745688. [PMID: 34938179 PMCID: PMC8685318 DOI: 10.3389/fphar.2021.745688] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: The prevalence of polypharmacy is gradually increasing in geriatrics, which may contribute to adverse effects, such as potential drug-drug and drug-disease interactions. These side effects remain an important challenge in patient safety, which has a significant impact on mortality and incidence rate. Aims: Therefore, this study aims to understand the epidemiology of polypharmacy and identify factors that have an impact on the management of potentially inappropriate prescribing. Methods: This study is a cross-sectional study, analyzing the prescription data from 720 hospitalized patients aged 50+ with a random cluster sampling method. We used inverse probability treatment weighting (IPTW) method to group and match polypharmacy and non-polypharmacy patients, and logistic regression was conducted to explore the factors associated with polypharmacy. Results: The prevalence of polypharmacy accounted for 50.14% among the old patients in this study. Female patients (67.34%) have more polypharmacy than male patients, and key predictors associated with polypharmacy in the logistic regression model included the following: domicile (AOR = 0.63, 95% CI 0.42-0.95), annual income (AOR = 0.38, 95% CI 0.20-0.70), the number of chronic diseases (AOR = 3.68, 95% CI 2.69-5.06), taking Chinese medicine (AOR = 1.70, 95% CI 1.22-2.36), decision involvement (AOR = 1.49 95% CI 1.10-2.03), and depression (AOR = 1.42, 95% CI 1.03-1.96). Conclusion: Polypharmacy is common among the participants with chronic diseases in Hubei province, China. The study emphasizes that gerontology practitioners should be prudent in applying clinical guidelines to provide personalized, comprehensive assessment of decision making of prescriptions, especially in socioeconomically deprived areas.
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Affiliation(s)
- Chaoyi Chen
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jia Wang
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zehao Zheng
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hao Chen
- Second People's Hospital of Yichang City, Yichang, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Xue L, Boudreau RM, Donohue JM, Zgibor JC, Marcum ZA, Costacou T, Newman AB, Waters TM, Strotmeyer ES. Persistent polypharmacy and fall injury risk: the Health, Aging and Body Composition Study. BMC Geriatr 2021; 21:710. [PMID: 34911467 PMCID: PMC8675466 DOI: 10.1186/s12877-021-02695-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/16/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Older adults receive treatment for fall injuries in both inpatient and outpatient settings. The effect of persistent polypharmacy (i.e. using multiple medications over a long period) on fall injuries is understudied, particularly for outpatient injuries. We examined the association between persistent polypharmacy and treated fall injury risk from inpatient and outpatient settings in community-dwelling older adults. METHODS The Health, Aging and Body Composition Study included 1764 community-dwelling adults (age 73.6 ± 2.9 years; 52% women; 38% black) with Medicare Fee-For-Service (FFS) claims at or within 6 months after 1998/99 clinic visit. Incident fall injuries (N = 545 in 4.6 ± 2.9 years) were defined as the initial claim with an ICD-9 fall E-code and non-fracture injury, or fracture code with/without a fall code from 1998/99 clinic visit to 12/31/08. Those without fall injury (N = 1219) were followed for 8.1 ± 2.6 years. Stepwise Cox models of fall injury risk with a time-varying variable for persistent polypharmacy (defined as ≥6 prescription medications at the two most recent consecutive clinic visits) were adjusted for demographics, lifestyle characteristics, chronic conditions, and functional ability. Sensitivity analyses explored if persistent polypharmacy both with and without fall risk increasing drugs (FRID) use were similarly associated with fall injury risk. RESULTS Among 1764 participants, 636 (36%) had persistent polypharmacy over the follow-up period, and 1128 (64%) did not. Fall injury incidence was 38 per 1000 person-years. Persistent polypharmacy increased fall injury risk (hazard ratio [HR]: 1.31 [1.06, 1.63]) after adjusting for covariates. Persistent polypharmacy with FRID use was associated with a 48% increase in fall injury risk (95%CI: 1.10, 2.00) vs. those who had non-persistent polypharmacy without FRID use. Risks for persistent polypharmacy without FRID use (HR: 1.22 [0.93, 1.60]) and non-persistent polypharmacy with FRID use (HR: 1.08 [0.77, 1.51]) did not significantly increase compared to non-persistent polypharmacy without FRID use. CONCLUSIONS Persistent polypharmacy, particularly combined with FRID use, was associated with increased risk for treated fall injuries from inpatient and outpatient settings. Clinicians may need to consider medication management for FRID and other fall prevention strategies in community-dwelling older adults with persistent polypharmacy to reduce fall injury risk.
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Affiliation(s)
- Lingshu Xue
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N Bellefield Avenue, Suite 300, Pittsburgh, PA 15213 USA
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Robert M. Boudreau
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N Bellefield Avenue, Suite 300, Pittsburgh, PA 15213 USA
| | - Julie M. Donohue
- Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA USA
| | - Janice C. Zgibor
- College of Public Health, University of South Florida, Tampa, FL 33612 USA
| | - Zachary A. Marcum
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA USA
| | - Tina Costacou
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N Bellefield Avenue, Suite 300, Pittsburgh, PA 15213 USA
| | - Anne B. Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N Bellefield Avenue, Suite 300, Pittsburgh, PA 15213 USA
| | - Teresa M. Waters
- Department of Health Management and Policy, University of Kentucky College of Public Health, Lexington, KY USA
| | - Elsa S. Strotmeyer
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 N Bellefield Avenue, Suite 300, Pittsburgh, PA 15213 USA
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Lin GS, Tseng PL, Chang CC, Yiang GT, Yen ZS, Jian JW, Tung CY. Adequate emergency department resource usage: Applying simulation-based workshop to improve teaching competence among elementary and junior high school teachers in Taiwan. Medicine (Baltimore) 2021; 100:e27258. [PMID: 34664876 PMCID: PMC8448039 DOI: 10.1097/md.0000000000027258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 08/30/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION More than 80% of patients who visited Emergency Department (ED) was not urgent in Taiwan in 2019. It causes insufficient medical services and a latent fiscal threat to the Nation Health Insurance (NHI). This study adopted simulation-based educating modules to explore the effect in teaching competence among primary and middle school teachers for efficient AEDRU (adequate emergency department resource usage) education in the future. METHOD The subjects were 414 elementary and junior high school teachers in Taiwan. 214 participants attended the simulation-based workshop as the simulation-based group, whereas 200 participants took an online self-learning module as the self-learning group. The workshop was created by an expert panel for decreasing the unnecessary usage amount of ED medial resources. The materials are lecture, board games, miniature ED modules, and simulation-based scenarios. A teaching competence questionnaire including ED knowledge, teaching attitude, teaching skills, and teaching self-efficacy was conducted among participants before and after the intervention. Data were analyzed via McNemar, paired t test and the generalized estimating equations (GEE). RESULTS The study showed that teachers who participated in the simulation-based workshop had improved more in teaching competence than those who received the online self-learning module. In addition, there were significant differences between the pre-test and post-test among the two groups in teaching competence. CONCLUSION The simulation-based workshop is effective and it should be spread out. When students know how to use ED medical resources properly, they could affect their families. It can help the ED service to be used properly and benefits the finance of the NHI. The health care cost will be managed while also improving health.
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Affiliation(s)
- Geng-Shiau Lin
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
- Emergency Medicine Department, Taipei City Hospital, Taipei, Taiwan
| | - Pei-Ling Tseng
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Chia-Chen Chang
- Department of Senior Citizen Service Business, College of Human Ecology and Design, St. John's University, New Taipei, Taiwan
| | - Giou-Teng Yiang
- Emergency Medicine Department, Buddhist Tzu Chi General Hospital, New Taipei, Taiwan
| | - Zui-Shen Yen
- Emergency Medicine Department, National Taiwan University Hospital, Taipei, Taiwan
| | - Jang-Wei Jian
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
| | - Chen-Yin Tung
- Department of Health Promotion and Health Education, College of Education, National Taiwan Normal University, Taipei, Taiwan
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Pazan F, Wehling M. Polypharmacy in older adults: a narrative review of definitions, epidemiology and consequences. Eur Geriatr Med 2021; 12:443-452. [PMID: 33694123 PMCID: PMC8149355 DOI: 10.1007/s41999-021-00479-3] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND The number of older adults has been constantly growing around the globe. Consequently, multimorbidity and related polypharmacy have become an increasing problem. In the absence of an accepted agreement on the definition of polypharmacy, data on its prevalence in various studies are not easily comparable. Besides, the evidence on the potential adverse clinical outcomes related to polypharmacy is limited though polypharmacy has been linked to numerous adverse clinical outcomes. This narrative review aims to find and summarize recent publications on definitions, epidemiology and clinical consequences of polypharmacy. METHODS The MEDLINE database was used to identify recent publications on the definition, prevalence and clinical consequences of polypharmacy using their respective common terms and their variations. Systematic reviews and original studies published between 2015 and 2020 were included. RESULTS One hundred and forty-three definitions of polypharmacy and associated terms were found. Most of them are numerical definitions. Its prevalence ranges from 4% among community-dwelling older people to over 96.5% in hospitalized patients. In addition, numerous adverse clinical outcomes were associated with polypharmacy. CONCLUSION The term polypharmacy is imprecise, and its definition is yet subject to an ongoing debate. The clinically oriented definitions of polypharmacy found in this review such as appropriate or necessary polypharmacy are more useful and relevant. Regardless of the definition, polypharmacy is highly prevalent in older adults, particularly in nursing home residents and hospitalized patients. Approaches to increase the appropriateness of polypharmacy can improve clinical outcomes in older adults.
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Affiliation(s)
- Farhad Pazan
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Martin Wehling
- Clinical Pharmacology Mannheim, Medical Faculty Mannheim, Ruprecht-Karls-Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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Targeting continuity of care and polypharmacy to reduce drug-drug interaction. Sci Rep 2020; 10:21279. [PMID: 33277524 PMCID: PMC7718252 DOI: 10.1038/s41598-020-78236-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022] Open
Abstract
Drug–drug interaction (DDI) is common among the elderly, and it can have detrimental effects on patients. However, how DDI can be targeted has been under-researched. This study investigates whether DDI can be reduced by targeting continuity of care (COC) through reducing polypharmacy. Population claims data of Taiwan National Health Insurance were used to conduct a 7-year-long longitudinal study on patients aged ≥ 65 years (n = 2,318,766). Mediation analysis with counterfactual method and a 4-way decomposition of the effect of COC on DDI was conducted. Mediation effect through excessive polypharmacy differed from that through lower-level polypharmacy. Compared with the low COC group, the high COC group demonstrated reduced excess relative risk of DDI by 26% (excess relative risk = − 0.263; 95% Confidence Interval (CI) = − 0.263 to − 0.259) to 30% (excess relative risk = − 0.297; 95% CI = − 0.300 to − 0.295) with excessive polypharmacy as the mediator. The risk only reduced by 8% (excess relative risk = − 0.079; 95% CI, − 0.08 to − 0.078) to 10% (excess relative risk = − 0.096; 95% CI, − 0.097 to − 0.095) when the mediator was changed to lower-level polypharmacy. The effect of COC on DDI was mediated by polypharmacy, and the mediation effect was higher with excessive polypharmacy. Therefore, to reduce DDI in the elderly population, different policy interventions should be designed by considering polypharmacy levels to maximize the positive effect of COC on DDI.
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Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Ther Adv Drug Saf 2020; 11:2042098620933741. [PMID: 32587680 PMCID: PMC7294476 DOI: 10.1177/2042098620933741] [Citation(s) in RCA: 172] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 05/16/2020] [Indexed: 01/10/2023] Open
Abstract
A high rate of polypharmacy is, in part, a consequence of the increasing proportion of multimorbidity in the ageing population worldwide. Our understanding of the potential harm of taking multiple medications in an older, multi-morbid population, who are likely to be on a polypharmacy regime, is limited. This is a narrative literature review that aims to appraise and summarise recent studies published about polypharmacy. We searched MEDLINE using the search terms polypharmacy (and its variations, e.g. multiple prescriptions, inappropriate drug use, etc.) in titles. Systematic reviews and original studies in English published between 2003 and 2018 were included. In this review, we provide current definitions of polypharmacy. We identify the determinants and prevalence of polypharmacy reported in different studies. Finally, we summarise some of the findings regarding the association between polypharmacy and health outcomes in older adults, with a focus on frailty, hospitalisation and mortality. Polypharmacy was most often defined in terms of the number of medications that are being taken by an individual at any given time. Our review showed that the prevalence of polypharmacy varied between 10% to as high as around 90% in different populations. Chronic conditions, demographics, socioeconomics and self-assessed health factors were independent predictors of polypharmacy. Polypharmacy was reported to be associated with various adverse outcomes after adjusting for health conditions. Optimising care for polypharmacy with valid, reliable measures, relevant to all patients, will improve the health outcomes of older adult population.
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Affiliation(s)
- Mina Khezrian
- Institute of Medical Sciences, Lilian Sutton Building, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Chris J McNeil
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Alison D Murray
- Institute of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
| | - Phyo K Myint
- Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, UK
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Wongpakaran N, Wongpakaran T, Sirirak T, Jenraumjit R, Jiraniramai S, Lerttrakarnnon P. Predictors of polypharmacy among elderly Thais with depressive and anxiety disorders: findings from the DAS study. BMC Geriatr 2018; 18:309. [PMID: 30541459 PMCID: PMC6292154 DOI: 10.1186/s12877-018-1001-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/30/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Polypharmacy is a geriatric syndrome defined variously as the use of potentially inappropriate drugs and/or the concurrent use of multiple medications including prescription and over-the-counter drugs. An association has been shown between polypharmacy and physical health, increased morbidity and increased mortality. However, there is little information regarding the association between polypharmacy and physical disease, personality trait and mental health problems in elderly. The aim of this study was to investigate potential predictive psychosocial factors related to polypharmacy in elderly Thai people. METHODS The study analysed the secondary data from the Depressive Disorders, Anxiety Disorders, Suicide Risk and Associated Factors Among Elderly Thai People Program (DAS Study) which was funded by National Research Council of Thailand and conducted between January 2012 and April 2013. Demographic and baseline clinical characteristics including sex, age, education, living alone or with others, access to health care privilege and monthly income were described. The number of medication, physical diseases and mental health problems (i.e. depression, anxiety, and personality trait of neuroticism) were analyzed using descriptive statistics, chi-square and proportional odds logistic regression. RESULTS The 803 participants consumed an average of 2.13 prescribed medicines daily (SD 1.46, median = 2). The largest group used 3 medications (18.6%). Predictors found to be associated with polypharmacy in the logistic regression model included hypertension (OR = 1.985, 95% CI = 1.420-2.775), anxiety disorder (OR = 4.402, 95% CI = 2.630-7.367), number of diseases (OR = 2.140, 95% CI = 1.874-2.445), depressive disorder (OR = 1.470, 95% CI = 1.080-2.001), diabetes mellitus (OR = 1.864, 95% CI = 1.122-3.098) and dyslipidemia (OR = 0.511, 95%CI = 0.325-0.803). CONCLUSIONS The prevalence of polypharmacy among Thai elderly was relatively high compared to other related studies. Several aspects should be taken into consideration before starting an additional medication in elderly patients. In addition to the number of physical disease that leads to polypharmacy, general practitioners should be aware of anxiety, depression, and personality trait of neuroticism that may be related to polypharmacy. Early detection for such condition as well as non-pharmacological intervention could be one way to help reduce polypharmacy in the elderly.
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Affiliation(s)
- Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Thanitha Sirirak
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90112, Thailand
| | - Rewadee Jenraumjit
- Department of Pharmaceutical care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Surin Jiraniramai
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Peerasak Lerttrakarnnon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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12
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Baek YH, Shin JY. Trends in polypharmacy over 12 years and changes in its social gradients in South Korea. PLoS One 2018; 13:e0204018. [PMID: 30226885 PMCID: PMC6143262 DOI: 10.1371/journal.pone.0204018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 09/01/2018] [Indexed: 12/16/2022] Open
Abstract
Polypharmacy is associated with adverse drug reactions and represents an economic burden on the health insurance system. The objective of our study was to assess the trends in polypharmacy and its associated factors in South Korea. This cross-sectional study used a nationwide sampled database between 2002 and 2013, including outpatients of all ages who received at least 1 prescription in the same period. Polypharmacy was defined as the concomitant prescription of ≥6 distinct medications on a single prescription at least once without a given duration. The yearly prescribing trends were calculated and plotted. We conducted comparative analyses to identify the changes in social gradients of polypharmacy between the first 2 years, 2002‒2003, and the final 2 years, 2012‒2013. We repeated logistic regressions for pediatrics <20 years of age and adults ≥20 years of age to estimate the adjusted odds ratios (aOR) and 95% confidence intervals (CI). The distributions of polypharmacy in the respective periods were examined according to patient economic status (0 = most deprived and 10 = most affluent). The age-standardized prevalence of polypharmacy decreased from 65.8% in 2002 to 43.7% in 2013. Our study included 1,108,298 outpatients throughout 2002–2013. Pediatric patients aged 1–9 years had the highest number of medications among all age groups (mean: 5.1 ± 1.1 in 2002–2003 vs. 4.1 ± 1.1 in 2012–2013) in both periods. Changes in the association between deprivation and polypharmacy over 10 years were observed in adults (aOR = 0.68; 95% CI = 0.62–0.75 in 2002–2003 vs. 1.60; 95% CI = 1.54–1.66 in 2012–2013) and pediatrics (aOR = 0.60; 95% CI = 0.52–0.68 in 2002–2003 vs. 1.07; 95% CI = 1.01–1.14 in 2012–2013) compared with those in the most affluent patients. The high level of polypharmacy in pediatric patients is a public health concern that warrants policymaker attention.
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Affiliation(s)
- Yeon-Hee Baek
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Gyeonggi-do, South Korea
- * E-mail:
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13
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Lin CHR, Tsai JH, Wu SS, Chang YP, Wen YH, Liu JS, Lung FW. Quantitative comorbidity risk assessment of dementia in Taiwan: A population-based cohort study. Medicine (Baltimore) 2018; 97:e0298. [PMID: 29642154 PMCID: PMC5908585 DOI: 10.1097/md.0000000000010298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Dementia is one of the most burdensome illnesses in elderly populations worldwide. However, the literature about multiple risk factors for dementia is scant.To develop a simple, rapid, and appropriate predictive tool for the clinical quantitative assessment of multiple risk factors for dementia.A population-based cohort study.Based on the Taiwan National Health Insurance Research Database, participants first diagnosed with dementia from 2000 to 2009 and aged ≥65 years in 2000 were included.A logistic regression model with Bayesian supervised learning inference was implemented to evaluate the quantitative effects of 1- to 6-comorbidity risk factors for dementia in the elderly Taiwanese population: depression, vascular disease, severe head injury, hearing loss, diabetes mellitus (DM), and senile cataract, identified from a nationwide longitudinal population-based database.This study enrolled 4749 (9.5%) patients first diagnosed as having dementia. Aged, female, urban residence, and low income were found as independent sociodemographic risk factors for dementia. Among all odds ratios (ORs) of 2-comorbidity risk factors for dementia, comorbid depression and vascular disease had the highest adjusted OR of 6.726. The 5-comorbidity risk factors, namely depression, vascular disease, severe head injury, hearing loss, and DM, exhibited the highest OR of 8.767. Overall, the quantitative effects of 2 to 6 comorbidities and age difference on dementia gradually increased; hence, their ORs were less than additive. These results indicate that depression is a key comorbidity risk factor for dementia.The present findings suggest that physicians should pay more attention to the role of depression in dementia development. Depression is a key cormorbidity risk factor for dementia. It is the urgency of evaluating the nature of the link between depression and dementia; and further testing what extent controlling depression could effectively lead to the prevention of dementia.
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Affiliation(s)
| | - Jui-Hsiu Tsai
- Program in Environmental and Occupation Medicine, National Health Research Institutes (Taiwan) and Kaohsiung Medical University
- Calo Psychiatric Center, Pingtung
| | | | - Yang-Pei Chang
- Department of Neurology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung
| | | | - Jain-Shing Liu
- Department of Computer Science and Information Engineering, Providence University, Taichung, Taiwan
| | - For-Wey Lung
- Program in Environmental and Occupation Medicine, National Health Research Institutes (Taiwan) and Kaohsiung Medical University
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14
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Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr 2017; 17:230. [PMID: 29017448 PMCID: PMC5635569 DOI: 10.1186/s12877-017-0621-2] [Citation(s) in RCA: 1578] [Impact Index Per Article: 225.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 10/02/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. METHODS The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016. Definitions were categorised as i. numerical only (using the number of medications to define polypharmacy), ii. numerical with an associated duration of therapy or healthcare setting (such as during hospital stay) or iii. Descriptive (using a brief description to define polypharmacy). RESULTS A total of 1156 articles were identified and 110 articles met the inclusion criteria. Articles not only defined polypharmacy but associated terms such as minor and major polypharmacy. As a result, a total of 138 definitions of polypharmacy and associated terms were obtained. There were 111 numerical only definitions (80.4% of all definitions), 15 numerical definitions which incorporated a duration of therapy or healthcare setting (10.9%) and 12 descriptive definitions (8.7%). The most commonly reported definition of polypharmacy was the numerical definition of five or more medications daily (n = 51, 46.4% of articles), with definitions ranging from two or more to 11 or more medicines. Only 6.4% of articles classified the distinction between appropriate and inappropriate polypharmacy, using descriptive definitions to make this distinction. CONCLUSIONS Polypharmacy definitions were variable. Numerical definitions of polypharmacy did not account for specific comorbidities present and make it difficult to assess safety and appropriateness of therapy in the clinical setting.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia Australia
- Department of Pharmacy, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia Australia
| | - Lisa Kalisch-Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia Australia
| | - Gillian E. Caughey
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, South Australia Australia
- Department of Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, South Australia Australia
- Discipline of Pharmacology, School of Medicine, University of Adelaide, North Terrace, Adelaide, South Australia Australia
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15
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Lim LM, McStea M, Chung WW, Nor Azmi N, Abdul Aziz SA, Alwi S, Kamarulzaman A, Kamaruzzaman SB, Chua SS, Rajasuriar R. Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia. PLoS One 2017; 12:e0173466. [PMID: 28273128 PMCID: PMC5342241 DOI: 10.1371/journal.pone.0173466] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 02/22/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Polypharmacy has been associated with increased morbidity and mortality in the older population. OBJECTIVES The aim of this study was to determine the prevalence, risk factors and health outcomes associated with polypharmacy in a cohort of urban community-dwelling older adults receiving chronic medications in Malaysia. METHODS This was a baseline study in the Malaysian Elders Longitudinal Research cohort. The inclusion criteria were individuals aged ≥55years and taking at least one medication chronically (≥3 months). Participants were interviewed using a structured questionnaire during home visits where medications taken were reviewed. Health outcomes assessed were frequency of falls, functional disability, potential inappropriate medication use (PIMs), potential drug-drug interactions (PDDIs), healthcare utilisation and quality of life (QoL). Risk factors and health outcomes associated with polypharmacy (≥5 medications including dietary supplements) were determined using multivariate regression models. RESULTS A total of 1256 participants were included with a median (interquartile range) age of 69(63-74) years. The prevalence of polypharmacy was 45.9% while supplement users made up 56.9% of the cohort. The risk factors associated with increasing medication use were increasing age, Indian ethnicity, male, having a higher number of comorbidities specifically those diagnosed with cardiovascular, endocrine and gastrointestinal disorders, as well as supplement use. Health outcomes significantly associated with polypharmacy were PIMS, PDDIs and increased healthcare utilisation. CONCLUSION A significant proportion of older adults on chronic medications were exposed to polypharmacy and use of dietary supplements contributed significantly to this. Medication reviews are warranted to reduce significant polypharmacy related issues in the older population.
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Affiliation(s)
- Li Min Lim
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Megan McStea
- The Malaysian Elders Longitudinal Research (MELOR) Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Wen Wei Chung
- Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Nuruljannah Nor Azmi
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
| | - Siti Azdiah Abdul Aziz
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Faculty of Pharmacy, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Syireen Alwi
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Adeeba Kamarulzaman
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Bahyah Kamaruzzaman
- The Malaysian Elders Longitudinal Research (MELOR) Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Siew Siang Chua
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Reena Rajasuriar
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Centre of Excellence for Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
- Peter Doherty Institute for Infection and Immunity, Melbourne University, Melbourne, Australia
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16
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Martin-Pérez M, López de Andrés A, Hernández-Barrera V, Jiménez-García R, Jiménez-Trujillo I, Palacios-Ceña D, Carrasco-Garrido P. [Prevalence of polypharmacy among the population older than 65 years in Spain: Analysis of the 2006 and 2011/12 National Health Surveys]. Rev Esp Geriatr Gerontol 2016; 52:2-8. [PMID: 27756482 DOI: 10.1016/j.regg.2016.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Polypharmacy in older people is the result of several inter-connected factors, and is very common despite the associated risks. Not many population-based studies have been conducted in Spain to ascertain the magnitude of polypharmacy in this population. MATERIAL AND METHODS A descriptive, cross-sectional study was conducted with individualised data for non-institutionalised older people (65 or older) of both sexes from the Spanish National Health Surveys (SNHS) 2006 (N=7,835) and 2011/12 (N=5,896). The prevalence of polypharmacy (use of 4 or more drugs within the 2 weeks preceding the survey) was ascertained for the 2 surveys used, as well as by sex and age groups. The prevalence of use of the different drug groups was also estimated in the elderly who used polypharmacy. RESULTS Polypharmacy occurred in about a third of the older people in the 2006 SNHS (32.54%), and was significantly higher in the 2011/12 SNHS (36.37%) (P<.05). In both surveys, the prevalence of polypharmacy was higher in women than men and among the older individuals (≥85 years) compared to the less old. The type of drugs most commonly used were analgesics (2006 SNHS: 71.93%, 2011/12 SNHS: 76.27%; P<.05), and antihypertensive drugs 2006 SNHS: 70.26%, 2011/12 SNHS: 78.10%; P<.05). CONCLUSIONS The magnitude of polypharmacy is considerable in older people and increasing over time. Further research on this issue is needed to identify those individuals who are at higher risk of using multiple drugs concomitantly.
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Affiliation(s)
- Mar Martin-Pérez
- Departamento de Medicina Preventiva y Salud Pública e Inmunología y Microbiología Médicas, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
| | - Ana López de Andrés
- Departamento de Medicina Preventiva y Salud Pública e Inmunología y Microbiología Médicas, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Valentín Hernández-Barrera
- Departamento de Medicina Preventiva y Salud Pública e Inmunología y Microbiología Médicas, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Rodrigo Jiménez-García
- Departamento de Medicina Preventiva y Salud Pública e Inmunología y Microbiología Médicas, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Isabel Jiménez-Trujillo
- Departamento de Medicina Preventiva y Salud Pública e Inmunología y Microbiología Médicas, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Domingo Palacios-Ceña
- Departamento de Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - Pilar Carrasco-Garrido
- Departamento de Medicina Preventiva y Salud Pública e Inmunología y Microbiología Médicas, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
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17
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Wang HY, Yeh MK, Ho CH, Hu MK, Huang YB. Cross-sectional investigation of drug-related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud. Pharmacoepidemiol Drug Saf 2016; 26:71-80. [PMID: 27730699 DOI: 10.1002/pds.4117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/13/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE To analyze and characterize data regarding the prevalence and types of outpatient drug-related problems (DRPs) found by clinical pharmacists after implementation of the Virtual Medicine Record in Cloud System (VMRCS). METHODS A cross-sectional study regarding outpatient pharmaceutical care was conducted at a medical center in Taiwan. Patients aged >20 years old with multiple chronic diseases and polypharmacy were enrolled. In Stage I (1 October-31 December 2014), patients received pharmaceutical care according to prescription data accessed online in the VMRCS. In Stage II (1 June-31 August 2015), the VMRCS were pre-download and arranged to the institute's required format, facilitated DRP detection. Clinical pharmacists then reviewed and evaluated the prescription data through pre-downloaded VMRCS. Overall, 1539 and 1600 prescriptions were evaluated in these two stages, respectively. DRPs were recorded using the Pharmaceutical Care Network Europe (PCNE)-DRP. RESULTS DRPs were found for 50.2% of patients in Stage I and 55.2% in Stage II (p < 0.05) and were most frequently encountered for "Drugs for the cardiovascular system" and caused by "Inappropriate duplication of therapeutic group or active ingredient." In terms of problems, incidence of "Unnecessary drug treatment" was highest. Duplicate medications were most frequently seen for "Drugs for acid-related disorders." The efficiency to identify DRPs was at least 2.4 times higher with pre-downloaded prescription data than with real-time online queries. CONCLUSIONS With VMRCS, DRPs were more easily identified whether patients received medical care in the same hospital or not. DRPs could be efficiently prevented through the use of pre-downloaded patient prescription data. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hue-Yu Wang
- Department of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan.,College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taiwan.,Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Kuan Hu
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taiwan
| | - Yaw-Bin Huang
- College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
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18
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Chen CC, Cheng SH. Potentially Inappropriate Medication and Health Care Outcomes: An Instrumental Variable Approach. Health Serv Res 2015; 51:1670-91. [PMID: 26601656 DOI: 10.1111/1475-6773.12417] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To examine the effects of potentially inappropriate medication (PIM) use on health care outcomes in elderly individuals using an instrumental variable (IV) approach. DATA SOURCES/STUDY SETTING Representative claim data from the universal health insurance program in Taiwan from 2007 to 2010. STUDY DESIGN We employed a panel study design to examine the relationship between PIM and hospitalization. We applied both the naive generalized estimating equation (GEE) model, which controlled for the observed patient and hospital characteristics, and the two-stage residual inclusion (2SRI) GEE model, which further accounted for the unobserved confounding factors. The PIM prescription rate of the physician most frequently visited by each patient was used as the IV. PRINCIPAL FINDINGS The naive GEE models indicated that patient PIM use was associated with a higher likelihood of hospitalization (odds ratio [OR], 1.399; 95 percent confidence interval [CI], 1.363-1.435). Using the physician PIM prescribing rate as an IV, we identified a stronger significant association between PIM and hospitalization (OR, 1.990; 95 percent CI, 1.647-2.403). CONCLUSIONS PIM use is associated with increased hospitalization in elderly individuals. Adjusting for unobserved confounders is needed to obtain unbiased estimates of the relationship between PIM and health care outcomes.
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Affiliation(s)
- Chi-Chen Chen
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Shou-Hsia Cheng
- Department of Public Health, College of Medicine, Fu Jen Catholic University, Taiwan
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Chang CB, Yang SY, Lai HY, Wu RS, Liu HC, Hsu HY, Hwang SJ, Chan DC. Application of three different sets of explicit criteria for assessing inappropriate prescribing in older patients: a nationwide prevalence study of ambulatory care visits in Taiwan. BMJ Open 2015; 5:e008214. [PMID: 26546136 PMCID: PMC4636615 DOI: 10.1136/bmjopen-2015-008214] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To investigate the national prevalence of potentially inappropriate medications (PIMs) prescribed in ambulatory care clinics in Taiwan according to three different sets of regional criteria and the correlates of PIM use. DESIGN Cross-sectional study. SETTING This analysis included older patients who visited ambulatory care clinics in 2009 and represented half of the older population included on the Taiwanese National Health Insurance Research Database. PARTICIPANTS We identified 1,164,701 subjects who visited ambulatory care clinics and were over 65 years old in 2009. PRIMARY AND SECONDARY OUTCOME MEASURES PIM prevalence according to the 2012 Beers criteria, the PIM-Taiwan criteria and the PRISCUS criteria was estimated separately, and characteristics of PIM users were explored. Multivariate logistic regression analysis was used to determine patient factors associated with the use of at least one PIM. Leading PIMs for each set of criteria were also listed. RESULTS The prevalence of having at least one PIM at the patient level was highest with the Beers criteria (86.2%), followed by the PIM-Taiwan criteria (73.3%) and the PRISCUS criteria (66.9%). Polypharmacy and younger age were associated with PIM use for all three sets of criteria. The leading PIMs detected by the PIM-Taiwan and PRISCUS criteria were all included in the 2012 Beers criteria. Non-COX-selective non-steroidal anti-inflammatory drugs in the Beers criteria and benzodiazepines in the PIM-Taiwan and PRISCUS criteria accounted for most leading PIMs. CONCLUSIONS The prevalence of PIMs was high among older Taiwanese patients receiving ambulatory care visits. The prevalence of PIM and its associated factors varied according to three sets of criteria at the population level.
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Affiliation(s)
- Chirn-Bin Chang
- Division of Internal Medicine, National Taiwan University Chu-Tung Branch, Hsinchu County, Taiwan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Yu Yang
- College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Taipei City Psychiatry Center, Taipei City Hospital, Taipei, Taiwan
| | - Hsiu-Yun Lai
- Department of Family Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu City, Taiwan
| | - Ru-Shu Wu
- Taipei City Psychiatry Center, Taipei City Hospital, Taipei, Taiwan
| | - Hsing-Cheng Liu
- Taipei City Psychiatry Center, Taipei City Hospital, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hsiu-Ying Hsu
- Taipei City Psychiatry Center, Taipei City Hospital, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- National Yang-Ming University, School of Medicine, Taipei,Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Superintedent Office, National Taiwan University Hospital Chu-Tung Branch, Hsinchu County, Taiwan
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20
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Li IC, Kuo HT, Sin MK, Liu CT. Medication use in community-residing older adults in Taiwan: a comparison between conventional and complementary and alternative medications. J Community Health 2014; 40:301-7. [PMID: 25120230 DOI: 10.1007/s10900-014-9934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Older adults are at risk of problems of medication use including underuse, overuse, and misuse. The purposes of this study were to investigate the prevalence of the use of conventional and complementary and alternative medications (CAM) in older adults and to explore which factors related to their medication use. For this descriptive correlational study, 1,427 citizens who were 65 years old or older from two towns in Yilan County, Taiwan were interviewed by ten trained public health nurses between June and September, 2013. Instruments in this study were physical functional capacity, depressive symptoms, and medication use. Pearson product-moment correlation analysis and the Chi-square test were used to detect relationships among research variables. Of the 1,427 participants, 75.4 % used at least one type of conventional medication, and the average number of medications used was 2.9 (SD = 2.1). Polypharmacy (the use of five or more medications) was identified in 20.1 % of participants. Significant factors related to conventional medications use were older age (χ(2) = 41.7***), female (χ(2) = 7.6**), bad memory (χ(2) = 11.2**), defect cognition status (χ(2) = 7.8**), lost the interest to do anything depressive symptoms (χ(2) = 7.2**), and independent in their daily activities (χ(2) = 41.3***). We found that sociodemographic characteristics and factors pertaining to health status determine the difference between the use of conventional medications and CAM by rural older adults. Our study results suggested that health professionals in Taiwan must be educated and trained in how to integrate CAM into current conventional treatment.
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Affiliation(s)
- I-Chuan Li
- Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan,
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Kim HA, Shin JY, Kim MH, Park BJ. Prevalence and predictors of polypharmacy among Korean elderly. PLoS One 2014; 9:e98043. [PMID: 24915073 PMCID: PMC4051604 DOI: 10.1371/journal.pone.0098043] [Citation(s) in RCA: 91] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/28/2014] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Polypharmacy is widespread in the elderly because of their multiple chronic health problems. The objective of this study was to investigate the prevalence and predictors associated with polypharmacy in a nationally representative sample of Korean elderly individuals. METHODS We used the Korea Health Insurance Review and Assessment Service - National Patient Sample (HIRA-NPS) data from 2010 and 2011. We used information on 319,185 elderly patients (aged 65 years or older) between January 1, 2010 and December 31, 2011 from the HIRA-NPS database. We defined 'polypharmacy' as the concurrent use of 6 medications or more per person, 'major polypharmacy' as 11 medications or more, and 'excessive polypharmacy' as 21 medications or more. The frequency and proportion (%) and their 95% confidence intervals were presented according to the polypharmacy definition. Polypharmacy was visualized by the Quantum Geographic Information Systems (QGIS) program to describe regional differences in patterns of drug use. Multivariate ordinal logistic regression was performed to estimate odds ratios (ORs) and their 95% confidence intervals (CI) to investigate the risk factors for polypharmacy. RESULTS Of the Korean elderly studied, 86.4% had polypharmacy, 44.9% had major polypharmacy and 3.0% had excessive polypharmacy. Polypharmacy was found to be primarily concentrated in the Southwest region of the country. Significant associations between polypharmacy and the lower-income Medical Aid population (OR = 1.52, 95% CI 1.47, 1.56) compared with National Health Insurance patients was observed. CONCLUSIONS Nationwide efforts are needed for managing polypharmacy among Korean elderly patients. In particular, a national campaign and education to promote appropriate use of medicines for the Medical Aid population is needed.
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Affiliation(s)
- Hong-Ah Kim
- Korea Institute of Drug Safety and Risk Management (KIDS), Seoul, Korea
| | - Ju-Young Shin
- Korea Institute of Drug Safety and Risk Management (KIDS), Seoul, Korea
| | - Mi-Hee Kim
- Korea Institute of Drug Safety and Risk Management (KIDS), Seoul, Korea
| | - Byung-Joo Park
- Korea Institute of Drug Safety and Risk Management (KIDS), Seoul, Korea
- Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Korea
- * E-mail:
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Abstract
BACKGROUND The effects of continuity of care on health care outcomes are well documented. However, little is known about the effect of continuity at the physician or the site level on the process of care for patients with multiple chronic conditions (MCCs). OBJECTIVE The objective of this study was to examine the effects of physician continuity versus site continuity on duplicated medications received by patients with and without MCCs. RESEARCH DESIGN AND SUBJECTS This study utilized a longitudinal design with an 8-year follow-up from 2004 to 2011 of patients aged 65 or older under a universal health insurance program in Taiwan (55,573 subjects and 389,011 subject-years). Generalized estimating equation models with propensity score method were conducted to assess the association between continuity and medication duplication. RESULTS The rates of subjects receiving duplicated medications ranged from 40.38% to 43.50% with 1.45-1.62 duplicated medications during the study period. The findings revealed that better continuity, either at the physician level or the site level, was significantly associated with fewer duplicated medications. This study also indicated that the physician continuity had a stronger effect on medication duplication than did site continuity. Furthermore, the magnitude of the protective effect of continuity against duplicated medications increased when the patients had more chronic conditions [physician continuity: the marginal effect ranged from -10.7% to -52.9% (all P<0.001); site continuity: the marginal effect ranged from -0.4% (P=0.063) to -31.4% (P<0.001)]. CONCLUSION Improving either physician continuity or site continuity may result in fewer duplicated medications, particularly for patients with MCCs.
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Gamble JM, Hall JJ, Marrie TJ, Sadowski CA, Majumdar SR, Eurich DT. Medication transitions and polypharmacy in older adults following acute care. Ther Clin Risk Manag 2014; 10:189-96. [PMID: 24672243 PMCID: PMC3964163 DOI: 10.2147/tcrm.s58707] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background/objective Medication changes at transitions of care and polypharmacy are growing concerns that adversely impact optimal drug use. We aimed to describe transitions and patterns of medication use before and 1 year after older patients were hospitalized for community-acquired pneumonia, the second-most common reason for admission in North America. Materials and methods This was an analysis of a population-based clinical registry of patients treated in any of the six hospitals or seven emergency departments in Edmonton, Alberta, Canada, comprising 2,105 patients 65 years and older with community-acquired pneumonia who had survived at least 1 year. The prevalence of polypharmacy (five or more unique prescription drugs), as well as new use and persistence of common drug classes were assessed. Results The mean age was 78 years (standard deviation 8 years), 50% were female, 62% were hospitalized, and 58% had severe pneumonia. Among the 2,105 patients, 949 (45%) were using five or more medications prior to hospitalization, increasing to 1,559 (74%) within 90 days postdischarge and remaining over 70% at 1 year. Overall, 1,690 (80%) patients newly started and 1,553 (74%) patients stopped at least one medication in the first 90 days of follow-up. The prevalence of the most common drug classes (ie, cardiovascular, alimentary/metabolism) remained stable, with the exception of anti-infective agents, whereby 25% of patients were dispensed an anti-infective agent 3 months to 1 year after hospitalization. Conclusion Most older patients with pneumonia are subject to polypharmacy, and almost every patient had a medication started or stopped during 1-year follow-up, with 25% using antibiotics again. The period following an episode of pneumonia represents an opportunity potentially to optimize pharmacotherapy.
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Affiliation(s)
- John-Michael Gamble
- School of Pharmacy, Memorial University of Newfoundland, St John's, NL, Canada
| | - Jill J Hall
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | - Thomas J Marrie
- Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Cheryl A Sadowski
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, AB, Canada
| | | | - Dean T Eurich
- School of Public Health, University of Alberta, Edmonton, AB, Canada
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Chan DC, Chen JH, Wen CJ, Chiu LS, Wu SC. Effectiveness of the medication safety review clinics for older adults prescribed multiple medications. J Formos Med Assoc 2014; 113:106-13. [DOI: 10.1016/j.jfma.2012.04.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 04/14/2012] [Accepted: 04/25/2012] [Indexed: 11/29/2022] Open
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Fadare JO, Agboola SM, Opeke OA, Alabi RA. Prescription pattern and prevalence of potentially inappropriate medications among elderly patients in a Nigerian rural tertiary hospital. Ther Clin Risk Manag 2013; 9:115-20. [PMID: 23516122 PMCID: PMC3601648 DOI: 10.2147/tcrm.s40120] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction Polypharmacy and inappropriate prescriptions are prominent prescribing issues with elderly patients. Beers criteria and other guidelines have been developed to assist in the reduction of potentially inappropriate medications prescribed to elderly patients. The objectives of this study were to assess the prescribing pattern for elderly Nigerian outpatients and estimate the prevalence of potentially inappropriate medications among them using the Beers criteria. Methodology This was a prospective cross-sectional study of elderly patients (65 years and above) who were attending the general outpatients clinic of a rural Nigerian hospital. For the drug utilization aspect of the study, drug-use indicators were assessed using established World Health Organization guidelines, while the Beers criteria was used to screen for potentially inappropriate medications. Result The medical records of 220 patients aged 65 years and above were utilized for the study. A total of 837 drugs were prescribed for the patients, giving an average of 3.8 ± 1.3 drugs per person. Antihypertensive drugs accounted for 30.6% of the prescriptions, followed by multivitamins/food supplements (11.5%) and analgesics (10.8%). A review of the prescribed medications using the 2012 Updated Beers Criteria by the American Geriatric Society identified 56 patients with at least one potentially inappropriate medication prescribed giving a rate of 25.5%. The drug groups identified were nonsteroidal anti-inflammatory drugs, antihistamines, and amitriptyline. Conclusion Polypharmacy and prescription of potentially inappropriate medications are major therapeutic issues in Nigeria. There is a need for prescriber training and retraining with emphasis on the geriatric population.
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Affiliation(s)
- Joseph O Fadare
- Department of Medical Pharmacology and Therapeutics, Obafemi Awolowo University, Ile-Ife, Nigeria
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Chang YP, Huang SK, Tao P, Chien CW. A population-based study on the association between acute renal failure (ARF) and the duration of polypharmacy. BMC Nephrol 2012; 13:96. [PMID: 22935542 PMCID: PMC3447669 DOI: 10.1186/1471-2369-13-96] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Accepted: 08/27/2012] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Because of the rapid growth in elderly population, polypharmacy has become a serious public health issue worldwide. Although acute renal failure (ARF) is one negative consequence of polypharmacy, the association between the duration of polypharmacy and ARF remains unclear. We therefore assessed this association using a population-based database. METHODS Data were collected from the Taiwan National Health Insurance Research Database (NHIRD) from 2003 through 2006. The case group included patients hospitalized for ARF during 2006, but not admitted due to trauma, surgery, burn trauma, car accident, transplantation, or infectious diseases; the control group included patients hospitalized without ARF. The cumulative number of days of polypharmacy (defined as more than 5 prescriptions per day) for 1 year prior to admission was determined, with patients further subdivided into 4 categories: less than 30 days, 31-90 days, 91-180 days, and over 181 days. The dependent variable was ARF, and the control variables were age, gender, comorbidities in patients hospitalized for ARF, stay in ICUs during ARF hospitalization and site of operation for prior admissions within one month of ARF hospitalization. RESULTS Of 20,790 patients who were admitted to hospitals for ARF in 2006, 12,314 (59.23 %) were male and more than 60 % were older than 65 years. Of patients with and without ARF, 16.14 % and 10.61 %, respectively, received polypharmacy for 91-180 days and 50.22 % and 24.12 %, respectively, for over 181 days. A statistical model indicated that, relative to patients who received polypharmacy for less than 30 days, those who received polypharmacy for 31-90, 91-180 and over 181 days had odds ratios of developing ARF of 1.33 (p<0.001), 1.65 (p<0.001) and 1.74 (p<0.001), respectively. CONCLUSIONS We observed statistically significant associations between the duration of polypharmacy and the occurrence of ARF.
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Affiliation(s)
- Yi-Ping Chang
- Department of Nephrology, Taoyuan Veterans Hospital, 100 Cheng Kong Rd, Sec. 3, Taoyuan City 33010, Taiwan
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Lai SW, Lin CH, Liao KF, Su LT, Sung FC, Lin CC. Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan. Geriatr Gerontol Int 2012; 12:491-8. [PMID: 22233227 DOI: 10.1111/j.1447-0594.2011.00800.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim of the present study was to investigate whether polypharmacy correlates with the risk of dementia in older people. METHODS From representative claims data established from the National Health Insurance with a population coverage rate of 99% in Taiwan, we identified 7135 newly diagnosed patients with dementia in 2000-2008 and 2,8540 randomly selected controls without dementia, both aged ≥ 65 years. The daily use of prescribed drugs in the past 2 years was compared between cases and controls, controlling for demographic characters and comorbidities. RESULTS The incidence of dementia increased with the number of medications used and age. Cases were older than controls, predominant with women and more likely to use five or more drugs daily (44.0% vs 32.0%, P < 0.0001). Multivariate logistic regression analysis showed that, compared with participants using zero to one drug, the odds ratios (OR) of dementia were 1.28 (95% confidence interval [CI] 1.18-1.38) for those using two to four drugs, 1.34 (95% CI 1.23-1.46) for those using five to nine drugs and 1.56 (95% CI 1.38-1.76) for those using 10 or more drugs. Cerebrovascular disease (OR 3.19), diabetes mellitus (OR 1.23), chronic kidney disease (OR 1.21) and hypertension (OR 1.08) were significant comorbidities predicting the risk of dementia. There was significant interaction between cerebrovascular disease and the number of medications used in the dementia risk. CONCLUSIONS The risk of dementia increases steadily with the number of medications used and age in older people in Taiwan. Cerebrovascular disease, diabetes mellitus, chronic kidney disease and hypertension might also correlate with the risk of dementia.
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Affiliation(s)
- Shih-Wei Lai
- School of Medicine, China Medical University, Taichung, Taiwan
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Lai SW, Su LT, Lin CH, Tsai CH, Sung FC, Hsieh DPH. Polypharmacy increases the risk of Parkinson's disease in older people in Taiwan: a population-based study. Psychogeriatrics 2011; 11:150-6. [PMID: 21951955 DOI: 10.1111/j.1479-8301.2011.00369.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about the relationship between polypharmacy and Parkinson's disease (PD). In the present study, we tested the hypothesis that polypharmacy increases the risk of PD in older people in Taiwan. METHODS From a randomly sampled cohort of one million health insurance enrollees, we identified 2827 new cases of PD over the period 2000-2008 aged ≥ 65 years and selected 11 308 age-matched controls without PD. Medication history and baseline comorbidities were compared between the two groups. We defined 'polypharmacy' as an average daily use of five or more prescribed drugs. RESULTS Compared with patients using between none and one drug, the odds ratios (ORs) for PD increased to 1.53, 2.08, 2.64, and 2.95 for patients using two to four, five to seven, eight to nine, and ≥ 10 drugs, respectively. The other conditions associated with PD were dementia (OR 3.43), stroke (OR 2.30), depression (OR 2.15), and alcoholism (OR 2.11). Hyperlipidemia (OR 0.90) was inversely associated with PD. CONCLUSIONS Polypharmacy was shown to increase the risk of PD in older people in Taiwan, with risk increasing with the number of medications taken daily. Dementia, stroke, depression, and alcoholism were also associated with an increased risk of PD, whereas there was an inverse correlation between PD and hyperlipidemia.
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Affiliation(s)
- Shih-Wei Lai
- School of Medicine, China Medical University, Taichung, Taiwan
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Garrido-Garrido E, García-Garrido I, García-López-Durán J, García-Jiménez F, Ortega-López I, Bueno-Cavanillas A. Estudio de pacientes polimedicados mayores de 65 años en un centro de asistencia primaria urbano. ACTA ACUST UNITED AC 2011; 26:90-6. [DOI: 10.1016/j.cali.2010.10.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2010] [Revised: 10/04/2010] [Accepted: 10/07/2010] [Indexed: 11/15/2022]
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Nobili A, Franchi C, Pasina L, Tettamanti M, Baviera M, Monesi L, Roncaglioni C, Riva E, Lucca U, Bortolotti A, Fortino I, Merlino L. Drug utilization and polypharmacy in an Italian elderly population: the EPIFARM-elderly project. Pharmacoepidemiol Drug Saf 2011; 20:488-96. [PMID: 21264988 DOI: 10.1002/pds.2108] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Revised: 12/10/2010] [Accepted: 12/21/2010] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To investigate the prescribing patterns and the prevalence of polypharmacy in community-dwelling elderly people, and to analyze the association of chronic medications and number of drug prescriptions with age and sex. METHODS All prescriptions for people aged 65 years or older reimbursed by the Italian National Health Service (NHS) and dispensed by retail pharmacies of the 15 local health units (LHU) in the Lombardy Region during 2005 were analyzed. Logistic regression analysis was used to assess the association between drug prescription (overall, chronic drugs, and polypharmacy) and age, sex, and LHU of residence. RESULTS Eighty-eight percent of the 1 ,767 ,239 analyzed elderly received at least one drug prescription. The overall prescription rate was slightly higher for women than men (odds ratio [OR] 1.20; 95%CI 1.19-1.21). Seventy-six percent of the elderly received at least one chronic drug, 46% were exposed to polypharmacy, and 20% to chronic polypharmacy. At multivariate analysis, age and LHU residence of the elderly were the main determinants of drug exposure. A significant correlation was found between the overall prescription prevalence rate and exposure to chronic drugs and to chronic polypharmacy (r(s) = 0.79, p < 0.0005 and r(s) = 0.84, p < 0.0001, respectively). CONCLUSIONS Our findings indicate that age and LHU residence of the elderly are the main determinants of drug prescribing, and there is evidence of a significant correlation between the overall prescription prevalence rate and exposure to chronic drugs and to chronic polypharmacy.
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Affiliation(s)
- Alessandro Nobili
- Laboratory of Quality Assessment of Geriatric Therapies and Services, Mario Negri Institute for Pharmacological Research, Milan, Italy.
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Lai SW, Liao KF, Liao CC, Muo CH, Liu CS, Sung FC. Polypharmacy correlates with increased risk for hip fracture in the elderly: a population-based study. Medicine (Baltimore) 2010; 89:295-299. [PMID: 20827106 DOI: 10.1097/md.0b013e3181f15efc] [Citation(s) in RCA: 206] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Few studies have addressed the association between polypharmacy and hip fracture using population data. We conducted a population-based case-control study to investigate whether polypharmacy increases the risk for hip fracture in the elderly. We used insurance claims data from the Taiwan Bureau of National Health Insurance, a universal insurance program with a coverage rate of more than 98% of the population in Taiwan. We identified 2328 elderly patients with newly diagnosed hip fracture during the period 2005-2007. We randomly selected 9312 individuals without hip fracture to serve as the control group. Patient characteristics, drugs prescribed by physicians, and all types of hip fracture were ascertained. The odds ratio (OR) of hip fracture in association with the number of medications used per day in previous years was assessed.We found that patients were older than controls, predominantly female, and more likely to use 5 or more drugs (22.2% vs. 9.3%, p < 0.0001). The OR of hip fracture increased with the number of medications used per day and with age. Multivariate logistic regression analysis revealed that the overall OR for patients using 10 or more drugs was 8.42 (95% confidence interval [CI], 4.73-15.0) compared with patients who used 0-1 drug per day. However, age-specific analysis revealed that the risk for hip fracture was 23 times greater for patients aged > or = 85 years who used 10 or more drugs than for those aged 65-74 years who used 0-1 drug after controlling for covariates (OR, 23.0; 95% CI, 3.77-140).We conclude that the risk of hip fracture in older people increases with the number of medications used, especially in women. Age interacts with the daily medications for the risk of hip fracture.
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Affiliation(s)
- Shih-Wei Lai
- From Department of Family Medicine (SWL, CSL), China Medical University Hospital, Taichung City; Department of Internal Medicine (KFL), Taichung Tzu Chi General Hospital, Taichung County; and China Medical University and Hospital Department of Public Health and Management Office for Health Data (CCL, CHM, FCS), Taichung City, Taiwan
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Jeschke E, Ostermann T, Tabali M, Vollmar HC, Kröz M, Bockelbrink A, Witt CM, Willich SN, Matthes H. Pharmacotherapy of elderly patients in everyday anthroposophic medical practice: a prospective, multicenter observational study. BMC Geriatr 2010; 10:48. [PMID: 20663129 PMCID: PMC2916899 DOI: 10.1186/1471-2318-10-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 07/21/2010] [Indexed: 01/12/2023] Open
Abstract
Background Pharmacotherapy in the older adult is a complex field involving several different medical professionals. The evidence base for pharmacotherapy in elderly patients in primary care relies on only a few clinical trials, thus documentation must be improved, particularly in the field of complementary and alternative medicine (CAM) like phytotherapy, homoeopathy, and anthroposophic medicine. This study describes diagnoses and therapies observed in elderly patients treated with anthroposophic medicine in usual care. Methods Twenty-nine primary care physicians in Germany participated in this prospective, multicenter observational study on prescribing patterns. Prescriptions and diagnoses were reported for each consecutive patient. Data were included if patients were at least 60 years of age. Multiple logistic regression analysis was used to determine factors associated with anthroposophic prescriptions. Results In 2005, a total of 12 314 prescriptions for 3076 patients (68.1% female) were included. The most frequent diagnoses were hypertension (11.1%), breast cancer (3.5%), and heart failure (3.0%). In total, 30.5% of the prescriptions were classified as CAM remedies alone, 54.4% as conventional pharmaceuticals alone, and 15.1% as a combination of both. CAM remedies accounted for 41.7% of all medications prescribed (35.5% anthroposophic). The adjusted odds ratio (AOR) for receiving an anthroposophic remedy was significantly higher for the first consultation (AOR = 1.65; CI: 1.52-1.79), treatment by an internist (AOR = 1.49; CI: 1.40-1.58), female patients (AOR = 1.35; CI: 1.27-1.43), cancer (AOR = 4.54; CI: 4.12-4.99), arthropathies (AOR = 1.36; CI: 1.19-1.55), or dorsopathies (AOR = 1.34; CI: 1.16-1.55) and it decreased with patient age (AOR = 0.97; CI: 0.97-0.98). The likelihood of being prescribed an anthroposophic remedy was especially low for patients with hypertensive diseases (AOR = 0.36; CI: 0.32-0.39), diabetes mellitus (AOR = 0.17; CI: 0.14-0.22), or metabolic disorders (AOR = 0.17; CI: 0.13-0.22). Conclusion The present study is the first to provide a systematic overview of everyday anthroposophic medical practice in primary care for elderly patients. Practitioners of anthroposophic medicine prescribe both conventional and complementary treatments. Our study may facilitate further CAM-research on indications of, for example, dementia or adverse drug reactions in the elderly.
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Wu TY, Jen MH, Bottle A, Molokhia M, Aylin P, Bell D, Majeed A. Ten-year trends in hospital admissions for adverse drug reactions in England 1999-2009. J R Soc Med 2010; 103:239-50. [PMID: 20513902 DOI: 10.1258/jrsm.2010.100113] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES Adverse drug reactions (ADR) are an important cause of morbidity and mortality. We analysed trends in hospital admissions associated with ADRs in English hospitals between 1999 and 2008. DESIGN Data from the Hospital Episode Statistics database were examined for all English hospital admissions (1999-2008) with a primary or secondary diagnosis of an ADR recorded. SETTING All NHS (public) hospitals in England. MAIN OUTCOME MEASURES The number of admissions and in-hospital mortality rate with a primary (codes including 'adverse drug reaction', 'drug-induced', 'due to drug', 'due to medicament' or 'drug allergy') or secondary diagnosis of ADR (ICD-10 Y40-59) were obtained and analysed. Further analysis for the year 2008-2009 was performed with regard to age, gender, proportion aged >65 yrs and total bed-days. RESULTS Between 1999 and 2008, there were 557,978 ADR-associated admissions, representing 0.9% of total hospital admissions. Over this period the annual number of ADRs increased by 76.8% (from 42,453 to 75,076), and in-hospital mortality rate increased by 10% (from 4.3% to 4.7%). In 2008, there were 6,830,067 emergency admissions of which 75,076 (1.1%) were drug-related. Systemic agents were most commonly implicated (19.2%), followed by analgesics (13.3%) and cardiovascular drugs (12.9%).There has been a near two-fold increase in nephropathy and cardiovascular consequences secondary to drugs and a 6.8% fall in mental and behavioural disorders due to drugs. Conclusions ADRs have a major impact on public health. Our data suggest the number of ADR admissions has increased at a greater rate than the increase in total hospital admissions; some of this may be due to improved diagnostic coding. However, in-hospital mortality due to ADR admissions also increased during the period. Our findings should prompt policymakers to implement further measures to reduce ADR incidence and their associated in-hospital mortality, and methods to improve the recording of ADRs.
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Affiliation(s)
- Tai-Yin Wu
- Department of Primary Care and Public Health, Imperial College London Charing Cross Campus, London W6 8RP, UK
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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