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Koren MJ, Kelly NA, Lau JD, Jonas CK, Pinheiro LC, Banerjee S, Safford MM, Goyal P. Association of Healthy Lifestyle and Incident Polypharmacy. Am J Med 2024; 137:433-441.e2. [PMID: 38176533 PMCID: PMC11058024 DOI: 10.1016/j.amjmed.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/15/2023] [Accepted: 12/28/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Polypharmacy, commonly defined as taking ≥5 medications, is an undesirable state associated with lower quality of life. Strategies to prevent polypharmacy may be an important priority for patients. We sought to examine the association of healthy lifestyle, a modifiable risk factor, with incident polypharmacy. METHODS We performed a secondary analysis of the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study, including 15,478 adults aged ≥45 years without polypharmacy at baseline. The primary exposure was healthy lifestyle at baseline as measured by the Healthy Behavior Score (HBS), a cumulative assessment of diet, exercise frequency, tobacco smoking, and sedentary time. HBS ranges from 0-8, whereby 0-2 indicates low HBS, 3-5 indicates moderate HBS, and 6-8 indicates high HBS. We used multinomial logistic regression to examine the association between HBS and incident polypharmacy, survival without polypharmacy, and death. RESULTS Higher HBS (i.e., healthier lifestyle) was inversely associated with incident polypharmacy after adjusting for sociodemographic and baseline health variables. Compared with participants with low HBS, those with moderate HBS had lower odds of incident polypharmacy (odds ratio [OR] 0.85; 95% confidence interval [CI], 0.73-0.98) and lower odds of dying (OR 0.74; 95% CI, 0.65-0.83). Participants with high HBS had even lower odds of both incident polypharmacy (OR 0.75; 95% CI, 0.64-0.88) and death (OR 0.62; 95% CI, 0.54-0.70). There was an interaction for age, where the association between HBS and incident polypharmacy was most pronounced for participants aged ≤65 years. CONCLUSIONS Healthier lifestyle was associated with lower risk for incident polypharmacy.
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Affiliation(s)
- Melanie J Koren
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Jennifer D Lau
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | - Chanel K Jonas
- Department of Medicine, Weill Cornell Medicine, New York, NY
| | | | - Samprit Banerjee
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | | | - Parag Goyal
- Department of Medicine, Weill Cornell Medicine, New York, NY.
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Adjeroh L, Brothers T, Shawwa K, Ikram M, Al-Mamun MA. The association between polypharmacy and health-related quality of life among non-dialysis chronic kidney disease patients. PLoS One 2023; 18:e0293912. [PMID: 37956162 PMCID: PMC10642842 DOI: 10.1371/journal.pone.0293912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 10/22/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The United States government spends over $85 billion annually on treating non-dialysis chronic kidney disease (CKD). Patients with CKD are prescribed a multitude of medications to manage numerous comorbidities associated with CKD. Thus, this study aims to investigate the association between polypharmacy and health-related quality of life (HRQoL) in non-dialysis CKD patients. METHODS This cross-sectional study utilized data from the Medical Expenditure Panel Survey (MEPS) from 2010 through 2019. We classified polypharmacy into three groups based on the number of medication classes: ≤ 4 (minor polypharmacy), 5 through 9 (major polypharmacy), and ≥ 10 (hyperpolypharmacy). To measure HRQoL, a Physical Component Summary (PCS) and a Mental Component Summary (MCS) were obtained from the 12-item Short-Form Health Survey version 2 and Veteran's Rand 12 item. We applied multivariable ordinary least squares regression to assess the association between polypharmacy and HRQoL in non-dialysis CKD patients. RESULTS A total of 649 CKD patients (weighted n = 667,989) were included. Patients with minor polypharmacy, major polypharmacy, and hyperpolypharmacy were 22.27%, 48.24%, and 29.48%, respectively. Major polypharmacy and hyperpolypharmacy were significantly and negatively associated with lower PCS scores when compared with minor polypharmacy [Beta = -3.12 (95% CI: -3.62, -2.62), p-value<0.001; Beta = -4.13 (95CI: -4.74, -3.52), p-value<0.001]. Similarly, major polypharmacy and hyperpolypharmacy were significantly and negatively associated with lower MCS scores when compared to minor polypharmacy [Beta = -0.38 (95% CI: -0.55, -0.20), p-value<0.001; Beta = -1.70 (95% CI: -2.01, -1.40), p-value<0.001]. The top 5 classes of medications used by CKD patients were antihyperlipidemic (56.31%), beta-adrenergic blockers (49.71%), antidiabetics (42.14%), analgesics (42.17%), and diuretics (39.65%). CONCLUSION Our study found that both major polypharmacy and hyperpolypharmacy were associated with lower HRQoL among non-dialysis CKD patients. This study highlights the need for further evaluation of the combination of medications taken by non-dialysis CKD patients to minimize unnecessary and inappropriate medication use.
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Affiliation(s)
- Leonie Adjeroh
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, West Virginia, United States of America
| | - Todd Brothers
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, United States of America
| | - Khaled Shawwa
- Department of Medicine, Section of Nephrology, West Virginia University, Morgantown, West Virginia, United States of America
| | - Mohammad Ikram
- Department of Surgery, Penn State, Hershey, Pennsylvania, United States of America
| | - Mohammad A. Al-Mamun
- Department of Pharmaceutical Systems and Policy, West Virginia University, Morgantown, West Virginia, United States of America
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Jarab AS, Al-Qerem W, Alzoubi KH, Abu Heshmeh S, Mukattash TL, Naser AY, Al Hamarneh YN. Health-related quality of life and its associated factors in patients with chronic obstructive pulmonary disease. PLoS One 2023; 18:e0293342. [PMID: 37883370 PMCID: PMC10602230 DOI: 10.1371/journal.pone.0293342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE The present study aimed to evaluate HRQOL and to explore the factors associated with poor HRQOL among patients with COPD. METHODS In the present cross-sectional study, the validated St George's Respiratory Questionnaire for COPD patients (SGRQ-C) was used to evaluate HRQOL among 702 patients with COPD at two major hospitals in Jordan in the period between January and April 2022. Quantile regression analysis was used to explore the factors associated with HRQOL among the study participants. RESULTS According to SGRQ-C, the HRQOL of the study participants was greatly impaired with a total SGRQ of 55.2 (34-67.8). The highest impairment in the HRQOL was in the impact domain with a median of 58.7 (29-76.3). Increased number of prescribed medications (β = 1.157, P<0.01), older age (β = 0.487, P<0.001), male gender (β = 5.364, P<0.01), low education level (β = 9.313, P<0.001), low and moderate average income (β = 6.440, P<0.05, and β = 6.997, P<0.01, respectively) were associated with poorer HRQOL. On the other hand, being married (β = -17.122, P<0.001), living in rural area (β = -6.994, P<0.01), non-use of steroids inhalers (β = -3.859, P<0.05), not receiving long acting muscarinic antagonists (LAMA) (β = -9.269, P<0.001), not receiving LABA (β = -8.243, P<0.001) and being adherent to the prescribed medications (β = -6.016, P<0.001) were associated with improved HRQOL. Furthermore, lower disease severity (stage A, B, and C) (β = -23.252, -10.389, and -9.696 respectively, P<0.001), and the absence of comorbidities (β = -14.303, P<0.001) were associated with better HRQOL. CONCLUSIONS In order to maximize HRQOL in patients with COPD, future COPD management interventions should adopt a multidisciplinary approach involving different healthcare providers, which aims to provide patient-centered care, implement personalized interventions, and improve medication adherence, particularly for patients who are elderly, males, have low socioeconomic status, receive multiple medications and have multiple comorbid diseases.
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Affiliation(s)
- Anan S. Jarab
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- College of Pharmacy, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Walid Al-Qerem
- Department of Pharmacy, Faculty of Pharmacy, Al-Zaytoonah University of Jordan, Amman, Jordan
| | - Karem H. Alzoubi
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates
- Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Shrouq Abu Heshmeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Abdallah Y. Naser
- Department of Applied Pharmaceutical Sciences and Clinical Pharmacy, Faculty of Pharmacy, Isra University, Amman, Jordan
| | - Yazid N. Al Hamarneh
- Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Vitorino LM, Lopes Mendes JH, de Souza Santos G, Oliveira C, José H, Sousa L. Prevalence of Polypharmacy of Older People in a Large Brazilian Urban Center and its Associated Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095730. [PMID: 37174248 PMCID: PMC10177927 DOI: 10.3390/ijerph20095730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND With the aging population comes greater risks associated with polypharmacy, a significant public health problem. OBJECTIVE This study aimed to identify the prevalence of polypharmacy and its associated factors through Comprehensive Geriatric Assessment (CGA) among older adults treated in primary health care (PHC) in a large Brazilian urban center. METHODS We conducted a cross-sectional study with a random sampling of 400 older adults using primary health care. Polypharmacy was defined as the cumulative use of five or more daily medications. An assessment of a sociodemographic and health survey, fear of falling, and physical disabilities affecting activities of daily living and instrumental activities of daily living was conducted. RESULTS The mean age was 75.23 (SD: 8.53) years. The prevalence of polypharmacy and hyperpolypharmacy was 37% (n = 148) and 1% (n = 4), respectively. The adjusted logistic regression showed that participants with chronic non-communicable diseases (CNCDs) (OR = 9.24; p = 0.003), diabetes (OR = 1.93; p = 0.003), and obesity (OR = 2.15; p = 0.005) were associated with a greater propensity to use polypharmacy. CONCLUSION Our results show that older adults with CNCDs, diabetes, and obesity were more likely to use polypharmacy. The results reinforce the importance of using CGA in clinical practice in PHC.
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Affiliation(s)
| | | | | | - Cláudia Oliveira
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School, 3045-043 Coimbra, Portugal
| | - Helena José
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Coimbra Nursing School, 3045-043 Coimbra, Portugal
| | - Luís Sousa
- School of Health Atlântica (ESSATLA), 2730-036 Oeiras, Portugal
- Comprehensive Health Research Centre (CHRC), 7000-811 Evora, Portugal
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Florescu C, Ciobanu P, Hădăreanu DR, Gheorman V, Mustafa ER, Glodeanu AD, Bunescu MG, Mită A, Dinescu VC. The Interplay between Conventional Cardiovascular Risk Factors and Health-Related Quality of Life in a Cohort of Working Young and Middle-Aged Adults: A Prospective Study. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122132. [PMID: 36556497 PMCID: PMC9782771 DOI: 10.3390/life12122132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
Psychosocial and work stress, socioeconomic status, and environmental health directly impact the onset and progression of cardiovascular diseases, irrespective of sex or conventional cardiovascular risk factors (cCRFs). On the other hand, the impact of cCRFs on health-related quality of life (HRQoL) is not well known, and the psychological socioeconomic environmental somatic health interaction is often neglected. Accordingly, we aimed to: (i) compare the self-reported HRQoL using the WHOQOL-BREF questionnaire between healthy subjects and those with cCRFs; and (ii) evaluate the interplay between HRQoL, cCRFs, and cardiovascular treatment adherence. We prospectively included 90 working adults (46 healthy and 44 with cCRFs age- and sex-matched adults) evaluated by clinical examination, 12-leads electrocardiography, and transthoracic echocardiography as part of a cardiovascular diseases screening program, that also filled in the WHOQOL-BREF questionnaire. Subjects with CRFs were less satisfied with their own individual health. The presence and the number of CRFs, as well as the need for cardiovascular treatment and the number of drugs taken correlated with reduced scores at the majority of HRQoL domains. The results in the social relationships domain were the best predictor of cardiovascular treatment adherence. Finally, the results of all HRQoL domains were strongly correlated to each other demonstrating the psychological socioeconomic environmental somatic health interaction.
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Affiliation(s)
- Cristina Florescu
- Department of Cardiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
- Filantropia Clinical Hospital, 200516 Craiova, Romania
| | - Petre Ciobanu
- Department of Cardiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
- Filantropia Clinical Hospital, 200516 Craiova, Romania
| | - Diana Ruxandra Hădăreanu
- Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
- Correspondence:
| | - Veronica Gheorman
- Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
| | - Edme Roxana Mustafa
- Department of Cardiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
- Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
| | - Adina Dorina Glodeanu
- Filantropia Clinical Hospital, 200516 Craiova, Romania
- Department of Internal Medicine, Faculty of Dentistry, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
| | - Marius Gabriel Bunescu
- Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
- Department of Health Promotion and Occupational Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
| | - Adrian Mită
- Filantropia Clinical Hospital, 200516 Craiova, Romania
- Department of Medical Semiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
| | - Venera Cristina Dinescu
- Clinical Emergency County Hospital of Craiova, 1 Tabaci St., 200642 Craiova, Romania
- Department of Health Promotion and Occupational Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 2 Petru Rares St., 200349 Craiova, Romania
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Heinze M, Lebherz L, Rimmele DL, Frese M, Jensen M, Barow E, Lettow I, Kriston L, Gerloff C, Härter M, Thomalla G. Higher comorbidity burden is associated with lower self-reported quality of life after stroke. Front Neurol 2022; 13:1023271. [DOI: 10.3389/fneur.2022.1023271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
IntroductionThis study assesses the association of comorbidity burden and polypharmacy with self-reported quality of life after stroke.Patients and methodsWe performed a post-hoc analysis of a prospective, single-center, observational study of outcome evaluation by patient-reported outcome measures in stroke clinical practice. Consecutive patients with acute ischemic stroke (AIS) were enrolled and self-reported health–related quality of life (HrQoL) was assessed 90 days after acute stroke using the Patient-reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10). Comorbidities at baseline were assessed by the Charlson Comorbidity Index (CCI). Polypharmacy was defined as medication intake of ≥5 at baseline. We used linear regression analysis to study the association of CCI, polypharmacy and other clinical covariates with HrQoL after stroke.ResultsOf 781 patients (median age 76 years, 48.4% female) enrolled, 30.2% had a CCI Score ≥2, and 31.5% presented with polypharmacy. At follow up, 71 (9.1%) had died. In 409 (52.4%) reached for outcome evaluation, Global Physical Health T-Score was 43.8 ± 10 and Global Mental Health T-Score was 43.5 ± 8.76, indicating lower HrQoL than the average population. A CCI Score ≥2, higher NIHSS Score, female sex, dependency on others for dressing, toileting and mobility before index stroke, atrial fibrillation and hypertension were independent predictors of worse physical and mental health outcomes, while polypharmacy was not.ConclusionIn patients with AIS, high comorbidity burden and polypharmacy are frequent. Comorbidity burden at admission is independently associated with worse self-reported physical and mental health three months after stroke.
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Ye L, Yang-Huang J, Franse CB, Rukavina T, Vasiljev V, Mattace-Raso F, Verma A, Borrás TA, Rentoumis T, Raat H. Factors associated with polypharmacy and the high risk of medication-related problems among older community-dwelling adults in European countries: a longitudinal study. BMC Geriatr 2022; 22:841. [PMID: 36344918 PMCID: PMC9641844 DOI: 10.1186/s12877-022-03536-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/11/2022] [Indexed: 11/09/2022] Open
Abstract
Background Polypharmacy can be defined as using five or more medications simultaneously. “Medication-related problems”, an extension of polypharmacy, includes inappropriate prescribing, poor adherence, overdosage, underdosage, inappropriate drug selection, inadequate monitoring, adverse drug effects, and drug interactions. Polypharmacy and the high risk of medication-related problems among older people are associated with adverse health consequences due to drug-drug interactions, drug-disease interactions, and adverse drug effects. This study aims to assess the factors associated with polypharmacy and the high risk of medication-related problems among community-dwelling older people in the Netherlands, Greece, Croatia, Spain, United Kingdom. Method This longitudinal study used baseline and follow-up data from 1791 participants of the Urban Health Center European project. Polypharmacy and the risk of medication-related problems were evaluated at baseline and follow-up using the Medication Risk Questionnaire. We studied factors in the domains (a) sociodemographic characteristics, (b) lifestyle and nutrition, and (c) health and health care use. Hierarchical logistic regression analyses were used to examine the factors associated with polypharmacy and the high risk of medication-related problems. Results Mean age was 79.6 years (SD ± 5.6 years); 60.8% were women; 45.2% had polypharmacy, and 41.8% had a high risk of medication-related problems. Women participants had lower odds of polypharmacy (OR = 0.55;95%CI:0.42–0.72) and a high risk of medication-related problems (OR = 0.50; 95%CI:0.39–0.65). Participants with a migration background (OR = 1.67;95%CI:1.08–2.59), overweight (OR = 1.37; 95%CI:1.04–1.79) and obesity (OR = 1.78;95%CI:1.26–2.51) compared to ‘normal weight’, with lower physical HRQoL (OR = 0.96, 95%CI:0.95–0.98), multi-morbidity (OR = 3.73, 95%CI:2.18–6.37), frailty (OR = 1.69, 95%CI:1.24–2.30), visited outpatient services (OR = 1.77, 95%CI: 1.09–2.88) had higher odds of polypharmacy. The associations with the high risk of medication-related problems were similar. Conclusions Multiple factors in demography, lifestyle, nutrition, and health care use are associated with polypharmacy and the high risk of medication-related problems. Polypharmacy is a single element that may reflect the number of medications taken. The broader content of medication-related problems should be considered to assess the context of medication use among older people comprehensively. These provide starting points to improve interventions to reduce polypharmacy and high risk of medication-related problems. In the meantime, health professionals can apply these insights to identify subgroups of patients at a high risk of polypharmacy and medication-related problems. Trial registration The intervention of the UHCE project was registered in the ISRCTN registry as ISRCTN52788952. The date of registration is 13/03/2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03536-z.
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Huperz C, Sturm N, Frick E, Mächler R, Stolz R, Schalhorn F, Valentini J, Joos S, Straßner C. Experiences of German health care professionals with spiritual history taking in primary care: a mixed-methods process evaluation of the HoPES3 intervention. Fam Pract 2022; 40:369-376. [PMID: 36242538 DOI: 10.1093/fampra/cmac106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Spiritual needs gain importance in old age but are often ignored in health care. Within the 'Holistic care program for elderly patients to integrate spiritual needs, social activity and self-care into disease management in primary care (HoPES3)' a complex intervention was evaluated in a cluster-randomized trial. The aim of this study was to explore the acceptability, feasibility, benefits, and harms of a spiritual history taken by general practitioners (GPs) as part of the complex intervention. METHODS In this mixed-methods study telephone interviews with 11 German GPs and 12 medical assistants (MAs) of the HoPES3 intervention group were conducted and analysed using a content-analytical approach. Furthermore, GPs were asked to complete a questionnaire after each spiritual history. One hundred and forty-one questionnaires from 14 GPs were analysed descriptively. RESULTS GPs considered the spiritual history very/quite helpful for the patient in 27% (n= 38) and very/quite stressful in 2% (n = 3) of the cases. Interviews indicated that GPs found discussing spiritual history easier than anticipated. GPs and MAs saw a difficulty in that many patients associated spirituality with religion or church and reacted with surprise or rejection. Benefits for patients were seen in the opportunity to talk about non-medical topics, and increased awareness of their own resources. Benefits for GPs mainly related to information gain and an intensified patient-physician relationship. CONCLUSIONS A spiritual history in general practice has the potential to reveal important information about patients' lives and to improve the patient-physician relationship. Implementation barriers identified in this study have to be considered and addressed.
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Affiliation(s)
- Carolin Huperz
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany.,Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Noemi Sturm
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Eckhard Frick
- Department of Psychosomatic Medicine and Psychotherapy, Professorship of Spiritual Care and Psychosomatic Health, Technical University of Munich, München, Germany
| | - Ruth Mächler
- Department of Psychosomatic Medicine and Psychotherapy, Professorship of Spiritual Care and Psychosomatic Health, Technical University of Munich, München, Germany
| | - Regina Stolz
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Friederike Schalhorn
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Jan Valentini
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Stefanie Joos
- Institute of General Practice and Interprofessional Care, University Hospital Tübingen, Tübingen, Germany
| | - Cornelia Straßner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Muacevic A, Adler JR. Cross-Sectional Observational Study on Association of Polypharmacy With Health-Related Quality of Life in Patients With Hypertension. Cureus 2022; 14:e30361. [PMID: 36407267 PMCID: PMC9665331 DOI: 10.7759/cureus.30361] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/16/2022] [Indexed: 01/25/2023] Open
Abstract
Introduction Hypertension is one of the major co-morbidities affecting older Indians, though current trends show that it is increasingly being diagnosed in younger adults as well. In elderly members of the population, it has been shown to be associated with other co-morbidities, making its management difficult. Among the issues that have arisen with its treatment is the increased prevalence of polypharmacy. Thus, there is a need to identify the issues arising from this increase in medications. In particular, the patient's health-related quality of life (HRQoL) can be assessed and interpreted to ensure only appropriate polypharmacy is practiced. Methods The adjusted Research and Development (RAND) 36-Item Health Survey 1.0 for health-related quality of life was sent to a consecutive sampling of 100 hypertensive patients at a rural tertiary care hospital in Wardha District. They were all clinically diagnosed with hypertension and had been prescribed allopathic medication for the same. They were instructed to answer all the questions to the best of their abilities, and each question was then scored from 0 to 100. In addition, they were given questions regarding their age, sociodemographic details, number of medications and frequency of dosage, and additional co-morbidities. The independent variable, i.e., the number of medications (polypharmacy), was then compared to the physical and mental scores they received on the 36-Item Short Form survey (SF-36) to see if there was an association between the two. Result The patients with hypertension that satisfied the criteria for polypharmacy scored lower in the Physical Component Score (PCS) of the HRQoL with a mean difference of 10.4 points. This is a significant value, and when studied in a multivariate linear regression model, controlling for the covariates mentioned above, indicated a statistically significant and negative association between the number of medications and adjusted PCS scores (β = -5.437, p<0.05, 95% CI -8.392 to -2.482). In regards to the Mental Component Score (MCS) of the HRQoL, a difference of 3.72 points was observed unadjusted and, upon controlling for covariates, it was found to be statistically significant (β = -2.825, p<0.05, 95% CI -5.300 to -0.351). Conclusion There is a negative correlation between HRQoL and polypharmacy in hypertensive patients. This is especially evident in the physical aspect, as can be inferred from the Physical Component Scores attained in the study. A smaller but still significant negative correlation is seen in the mental component as well. Hence, a change of policy is indicated to idealize prescriptions and physicians must be vigilant about inappropriate polypharmacy.
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Van Wilder L, Devleesschauwer B, Clays E, Pype P, Vandepitte S, De Smedt D. Polypharmacy and Health-Related Quality of Life/Psychological Distress Among Patients With Chronic Disease. Prev Chronic Dis 2022; 19:E50. [PMID: 35980834 PMCID: PMC9390791 DOI: 10.5888/pcd19.220062] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction To date, no study has investigated the impact of polypharmacy (use of ≥5 medications concurrently) on health-related quality of life (HRQOL) and psychological distress in a combined sample of chronic disease patients and patients with multimorbidity, using diverse HRQOL measures. This study aimed to explore the association between polypharmacy and HRQOL/psychological distress by using data from a cross-sectional study in Flanders (Belgium). Methods We analyzed cross-sectional survey data on 544 chronically ill patients recruited from June 2019 through June 2021. HRQOL was measured with the EuroQol-5 Dimension-5 Level questionnaire (EQ-5D-5L) and the 12-Item Short Form Health Survey (SF-12); psychological distress was measured with the Hospital Anxiety and Depression Scale (HADS). Multiple linear regression models were built to assess the association between polypharmacy and HRQOL/psychological distress. Results Overall, compared with patients without polypharmacy, patients with polypharmacy reported worse EQ-5D-5L index values, EuroQol visual analogue scale (EQ-VAS) scores, SF-12 physical component scores (PCS), SF-12 mental component scores (MCS), and HADS anxiety and depression subscales. In the final regression model adjusting for age, sex, educational attainment, and multimorbidity, polypharmacy remained significantly associated with lower HRQOL in terms of the EQ-5D-5L index (β = −0.12; P = .008), EQ-VAS (β = −0.11; P = .01), and SF-12 PCS (β = −0.15; P = .002) but not with psychological distress (HADS) and SF-12 MCS. Conclusion This study found that polypharmacy was negatively associated with the physical domain of HRQOL, but not with the mental domain, among patients with chronic diseases. These results may be especially important for patients with multimorbidity, given their greater risk of polypharmacy.
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Affiliation(s)
- Lisa Van Wilder
- Department of Public Health and Primary Care, Ghent University, University Hospital, Corneel Heymanslaan 10 4K3, 9000 Ghent, Belgium.
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sophie Vandepitte
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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11
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Aljeaidi MS, Haaksma ML, Tan ECK. Polypharmacy and trajectories of health-related quality of life in older adults: an Australian cohort study. Qual Life Res 2022; 31:2663-2671. [PMID: 35476171 PMCID: PMC9356923 DOI: 10.1007/s11136-022-03136-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2022] [Indexed: 11/30/2022]
Abstract
Background Health-related quality of life (HRQoL) is an important outcome measure when considering medical treatment; however, the impact of polypharmacy on trajectories of HRQoL over time is unknown. This study aimed to investigate the association between polypharmacy status and trajectories of HRQoL in older adults. Methods A longitudinal cohort study of 2181 community-dwelling adults, 65 years and older, who participated in the 2013 to 2017 waves of the Household Income and Labour Dynamics in Australia (HILDA) Survey. Polypharmacy was defined as the regular use of ≥ 5 prescription medications. Polypharmacy status was categorised into no polypharmacy, in 2013 only (baseline only polypharmacy), in 2017 only (incident polypharmacy) or at both time points (persistent polypharmacy). HRQoL was assessed through the SF-36 questionnaire generating two summary scores: physical component summary (PCS) and mental component summary (MCS). Linear mixed-effects models stratified according to polypharmacy status and change in comorbidities were used to assess trajectories of HRQoL. Results Older adults with persistent polypharmacy had lowest scores for HRQoL measures from 2013 to 2017. After adjusting for all covariates, those with incident polypharmacy had the steepest annual decline in both the PCS and MCS: − 0.86 in PCS and − 0.76 in MCS for those with decreasing or stable comorbidities, and − 1.20 in PCS and − 0.75 in MCS for those with increasing comorbidities. Conclusions Polypharmacy was associated with poorer HRQoL, even after adjusting for confounders. Incident polypharmacy was found to be associated with a clinically important decline in HRQoL and this should be considered when prescribing additional medication to older adults. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03136-9.
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Affiliation(s)
- Muhamad S Aljeaidi
- Medical School, The University of Western Australia, Perth, WA, Australia
| | - Miriam L Haaksma
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Edwin C K Tan
- Faculty of Medicine and Health, School of Pharmacy, The University of Sydney, Pharmacy Building A15, Science Road, Camperdown, Sydney, NSW, 2006, Australia.
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12
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Mayo NE, Ow N, Asano M, Askari S, Barclay R, Figueiredo S, Hawkins M, Hum S, Inceer M, Kaur N, Kuspinar A, Mate KKV, Moga AM, Mozafarinia M. Reducing research wastage by starting off on the right foot: optimally framing the research question. Qual Life Res 2022; 31:2889-2899. [PMID: 35312956 DOI: 10.1007/s11136-022-03117-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Strongly framed research questions are clear as to the population (P), the exposures or interventions (E/I), comparison groups (C), outcomes (O), time when relevant (T), and what the investigator wants to know. A solid framework sets up the measurement model, analysis, and anticipated results. The purpose of this study was to estimate the extent to which research questions in journals that focused on patient-reported outcome measures (PROM) and quality of life (QOL) are clear. METHODS All 440 research articles published in four PROM journals in 2020. excluding reviews, psychometric, and qualitative papers, were reviewed. Research questions were classified as: (i) adequately framed (ii) poorly framed; or (iii) unframed based on clarity criteria. Examples from each journal were presented and reframed to match results in the article. RESULTS Of 440 articles, 195 (44.3%) were classified as adequately framed; 230 (52.2%) as poorly framed; and 15 (3.4%) as unframed. There was heterogeneity across journals (Chi-square: 20.8; 6 df; p = 0.002). Only 29% were framed according to what the investigators wanted to know; 72% were framed like a "to do" list; and 6% were framed as a research agenda. CONCLUSION Almost half of the questions were poorly framed or unframed a practice that could contribute to research wastage. Even "adequately framed" questions rarely stated what they wanted to know a priori, increasing the risk of biased reporting. Researchers, reviewers, and editors should encourage the use established frameworks for research questions.
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Affiliation(s)
- Nancy E Mayo
- School of Physical and Occupational Therapy, Divisions of Clinical Epidemiology, Geriatrics, Experimental Medicine, Department of Medicine, McGill University, Center for Outcomes Research and Evaluation (CORE) McGill University Health Centre (MUHC)-Research Institute, Montreal, Canada. .,School of Physical and Occupational Therapy, Divisions of Clinical Epidemiology, Geriatrics, Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Center for Outcomes Research and Evaluation (CORE) McGill University Health Centre-Research Institute (RI-MUHC), Montreal, QC, Canada.
| | - Nikki Ow
- Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Foundry Central Office, Vancouver, Canada
| | - Miho Asano
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sorayya Askari
- School of Occupational Therapy, Dalhousie University, Halifax, Canada
| | - Ruth Barclay
- Department of Physical Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sabrina Figueiredo
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Melanie Hawkins
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - Stanley Hum
- Brain Health Outcomes Platform, Montreal Neurological Institute and Hospital, Montreal, Canada
| | - Mehmet Inceer
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Center for Outcomes Research and Evaluation (CORE) McGill University Health Centre (MUHC)-Research Institute, Montreal, Canada
| | - Navaldeep Kaur
- Department of Physical Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Kedar K V Mate
- Centre for Neurological Restoration, Cleveland Clinic, Cleveland, USA
| | - Ana Maria Moga
- School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Center for Outcomes Research and Evaluation (CORE) McGill University Health Centre (MUHC)-Research Institute, Montreal, Canada
| | - Maryam Mozafarinia
- Division of Experimental Medicine, Faculty of Medicine and Health Sciences, McGill University, Center for Outcomes Research and Evaluation (CORE) McGill University Health Centre (MUHC)-Research Institute, Montreal, Canada
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13
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Alrasheed M, Guo JJ, Lin AC, Wigle PR, Hardee A, Hincapie AL. The effect of polypharmacy on quality of life in adult patients with nonalcoholic fatty liver disease in the United States. Qual Life Res 2022; 31:2481-2491. [DOI: 10.1007/s11136-022-03090-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 02/08/2023]
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14
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Al Shidhani A, Al Salmani A, Al Saidi Y, Al Shehhi M, Al Khanjari H, Al Aamri M, Al Hadabi F. Polypharmacy and Medication Compliance among Patients with Type 2 Diabetes in Oman: A Cross-Sectional Study. ARCHIVES OF PHARMACY PRACTICE 2022. [DOI: 10.51847/zimw7hb8od] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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15
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Abstract
Age is an independent risk factor for cardiovascular disease. With the accelerated growth of the population of older adults, geriatric and cardiac care are becoming increasingly entwined. Although cardiovascular disease in younger adults often occurs as an isolated problem, it is more likely to occur in combination with clinical challenges related to age in older patients. Management of cardiovascular disease is transmuted by the context of multimorbidity, frailty, polypharmacy, cognitive dysfunction, functional decline, and other complexities of age. This means that additional insight and skills are needed to manage a broader range of relevant problems in older patients with cardiovascular disease. This review covers geriatric conditions that are relevant when treating older adults with cardiovascular disease, particularly management considerations. Traditional practice guidelines are generally well suited for robust older adults, but many others benefit from a relatively more personalized therapeutic approach that allows for a range of medical circumstances and idiosyncratic goals of care. This requires weighing of risks and benefits amidst the patient's aggregate clinical status and the ability to communicate effectively about this with patients and, where appropriate, their care givers in a process of shared decision making. Such a personalized approach can be particularly gratifying, as it provides opportunities to optimize an older patient's function and quality of life at a time in life when these often become foremost therapeutic priorities.
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Affiliation(s)
| | - Daniel E Forman
- University of Pittsburgh, University of Pittsburgh Medical Center and VA Pittsburgh Geriatric, Research, Education and Clinical Center (GRECC), Pittsburgh, PA, USA
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16
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Assessing forgetfulness and polypharmacy and their impact on health-related quality of life among patients with hypertension and dyslipidemia in Greece during the COVID-19 pandemic. Qual Life Res 2021; 31:193-204. [PMID: 34156596 PMCID: PMC8218571 DOI: 10.1007/s11136-021-02917-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/03/2022]
Abstract
Purpose We estimate the association between forgetfulness to take medications as prescribed and polypharmacy and health-related quality of life (HRQoL) among a cohort of patients with hypertension, dyslipidemia or both in Greece during the COVID-19 pandemic. Methods A telephone survey of 1018 randomly selected adults was conducted in Greece in June 2020. Participants were included in the survey, if they (a) had a diagnosis of hypertension, dyslipidemia or both and (b) were on prescription treatment for these conditions. HRQoL was calculated using the short form (SF) -12 Patient Questionnaire. A multivariable generalized linear regression model (GLM) was used to estimate the association between forgetfulness and polypharmacy and HRQoL, controlling for sociodemographic and health-related covariates. Results Overall, 351 respondents met the inclusion criteria, of whom 28 did not fully complete the questionnaire (response rate: 92%, n = 323). Of those, 37% were diagnosed with hypertension only, 28% with dyslipidemia only, and 35% with both. Most reported good to average physical (64.1%) and mental health (48.6%). Overall, 25% indicated that they sometimes forget to take their prescribed medications, and 12% took two or more pills multiple times daily. Total HRQoL score was 68.9% (s.d. = 18.0%). About 10% of participants reported paying less attention to their healthcare condition during the pandemic. Estimates of multivariable analyses indicated a negative association between forgetfulness (− 9%, adjusted β: − 0.047, 95% confidence interval − 0.089 to − 0.005, p = 0.029), taking two or more pills multiple times daily compared to one pill once a day (− 16%, adjusted β: − 0.068, 95% confidence interval − 0.129 to − 0.008, p = 0.028) and total HRQoL. Conclusion Our results suggest that among adult patients with hypertension, dyslipidemia or both in Greece, those who forget to take their medications and those with more complex treatment regimens had lower HRQoL. Such patients merit special attention and require targeted approaches by healthcare providers to improve treatment compliance and health outcomes.
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17
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Umegaki H. Association of polypharmacy with decline in quality of life in mild cognitive impairment and mild dementia. Geriatr Gerontol Int 2020; 20:840-842. [DOI: 10.1111/ggi.13988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/14/2020] [Accepted: 06/26/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Hiroyuki Umegaki
- Department of Community Healthcare & Geriatrics Nagoya University Graduate School of Medicine Nagoya Japan
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