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Lunghi C, Rochette L, Massamba V, Tardif I, Ouali A, Sirois C. Psychiatric and non-psychiatric polypharmacy among older adults with schizophrenia: Trends from a population-based study between 2000 and 2016. Front Pharmacol 2023; 14:1080073. [PMID: 36825148 PMCID: PMC9941679 DOI: 10.3389/fphar.2023.1080073] [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: 10/25/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
Background: Schizophrenia is a severe psychiatric disorder associated with multiple psychiatric and non-psychiatric comorbidities. As adults with schizophrenia age, they may use many medications, i.e., have polypharmacy. While psychiatric polypharmacy is well documented, little is known about trends and patterns of global polypharmacy. This study aimed to draw a portrait of polypharmacy among older adults with schizophrenia from 2000 to 2016. Methods: This population-based cohort study was conducted using the data of the Quebec Integrated Chronic Disease Surveillance System of the National Institute of Public Health of Quebec to characterize recent trends and patterns of medication use according to age and sex. We identified all Quebec residents over 65 years with an ICD-9 or ICD-10 diagnosis of schizophrenia between 2000 and 2016. We calculated the total number of medications used by every individual each year and the age-standardized proportion of individuals with polypharmacy, as defined by the usage of 5+, 10+, 15+, and 20+ different medications yearly. We identified the clinical and socio-demographic factors associated with polypharmacy using robust Poisson regression models considering the correlation of the responses between subjects and analyzed trends in the prevalence of different degrees of polypharmacy. Results: From 2000 to 2016, the median number of medications consumed yearly rose from 8 in 2000 to 11 in 2016. The age-standardized proportion of people exposed to different degrees of polypharmacy also increased from 2000 to 2016: 5+ drugs: 76.6%-89.3%; 10+ drugs: 36.9%-62.2%; 15+: 13.3%-34.4%; 20+: 3.9%-14.4%. Non-antipsychotic drugs essentially drove the rise in polypharmacy since the number of antipsychotics remained stable (mean number of antipsychotics consumed: 1.51 in 2000 vs. 1.67 in 2016). In the multivariate regression, one of the main clinically significant factor associated with polypharmacy was the number of comorbidities (e.g., Polypharmacy-10+: RR[2 VS. 0-1] = 1.4; 99% IC:1.3-1.4, RR[3-4] = 1.7 (1.7-1.8); RR[5+] = 2.1 (2.1-2.2); Polypharmacy-15+: RR[2 VS 0-1] = 1.6; 99% IC:1.5-1.7, RR[3-4] = 2.5 (2.3-2.7); RR[5+] = 4.1 (3.8-4.5). Conclusion: There was a noticeable increase in polypharmacy exposure among older adults with schizophrenia in recent years, mainly driven by non-antipsychotic medications. This raises concerns about the growing risks for adverse effects and drug-drug interactions in this vulnerable population.
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Affiliation(s)
- Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, QC, Canada,Population Health and Optimal Health Practices, CHU de Québec - Université Laval Research Center, Québec, QC, Canada,Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy,Institut national de Santé Publique du Québec, Québec, QC, Canada,*Correspondence: Carlotta Lunghi, ,
| | - Louis Rochette
- Institut national de Santé Publique du Québec, Québec, QC, Canada
| | | | | | - Amina Ouali
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Caroline Sirois
- Population Health and Optimal Health Practices, CHU de Québec - Université Laval Research Center, Québec, QC, Canada,Institut national de Santé Publique du Québec, Québec, QC, Canada,Faculty of Pharmacy, Université Laval, Québec, QC, Canada,Quebec Excellence Centre on Aging, VITAM Research Centre on Sustainable Health, Québec, QC, Canada
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Campeau Calfat A, Simard M, Ouali A, Blais C, Sirois C. Polypharmacy among older individuals with heart failure: trends between 2000 and 2017 in the province of Quebec, Canada. Ther Adv Cardiovasc Dis 2022; 16:17539447221113946. [PMID: 35875931 PMCID: PMC9310220 DOI: 10.1177/17539447221113946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Pharmacological management of heart failure and comorbidities may result in polypharmacy, but there are few population-based studies that portray the use of medications over time. We aimed to describe the trends in polypharmacy and medication use in older adults with heart failure. METHODS We performed a study including all adults >65 years with heart failure between 2000 and 2017 using health administrative databases in Quebec, Canada. Medication use was ascertained by the presence of at least one claim in each year. We defined three levels of polypharmacy: ⩾10, ⩾15 and ⩾20 different medications/year, and evaluated the use of guideline-recommended and potentially inappropriate medications. We calculated age- and sex-standardized proportions of users each year. RESULTS The use of ⩾10, ⩾15 and ⩾20 medications increased from 62.2%, 30.6% and 12.2% in 2000 to 71.9%, 43.9% and 22.7%, respectively, in 2017. The combination of β-blocker and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB) was used by 30.4% of individuals in 2000 and 45.5% in 2017. ACEI/ARB users decreased from 65.8% in 2000 to 62.1% in 2017. Potentially inappropriate medication use decreased over time. CONCLUSION Polypharmacy is significant among older adults with heart failure. Implications of such medication burden should be investigated.
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Affiliation(s)
| | - Marc Simard
- Faculty of Medicine, Université Laval, Québec, QC, Canada.,Institut national de santé publique du Québec, Québec, QC, Canada
| | - Amina Ouali
- Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Claudia Blais
- Institut national de santé publique du Québec, Québec, QC, Canada.,Faculty of Pharmacy, Université Laval, Québec, QC, Canada
| | - Caroline Sirois
- Faculty of Pharmacy, Université Laval, CEVQ, 1050 Chemin Ste-Foy, Québec, QC G1S 4L8, Canada.,Institut national de santé publique du Québec, Québec, QC, Canada
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Ierodiakonou D, Theodorou E, Sifaki-Pistolla D, Bouloukaki I, Antonopoulou M, Poulorinakis I, Tsakountakis N, Voltiraki F, Chliveros K, Tsiligianni I. Clinical characteristics and outcomes of polypharmacy in chronic obstructive pulmonary disease patients: A cross-sectional study from Crete, Greece. THE CLINICAL RESPIRATORY JOURNAL 2021; 15:1310-1319. [PMID: 34425633 DOI: 10.1111/crj.13434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Polypharmacy and multimorbidity in chronic obstructive pulmonary disease (COPD) are highly prevalent, with potential associations with worse COPD outcomes. The aim of this study was to identify the clinical characteristics and outcomes of polypharmacy, investigate the relationship of polypharmacy with health status and exacerbations and assess the prevalence of inappropriate medication (PIM), risk of adverse drug reactions (ADRs) and drug-to-drug interactions in COPD patients. METHODS A total of 245 COPD patients were enrolled from primary care in Crete, Greece. Patients completed a questionnaire and the COPD Assessment Test (CAT). Multimorbidity was defined as having two or more comorbidities and polypharmacy was defined as taking five or more drugs per day. RESULTS Most of COPD patients (77.0%) and the majority (83.6%) of elderly (≥65 years) had multimorbidity, while polypharmacy was evident in 55.2% of all patients and 62.4% in elderly. After adjustments for age, gender and pack-years, polypharmacy was associated with CAT ≥ 10, multimorbidity, several cardiometabolic diseases, cancer and depression-anxiety and prostate disorders (all p values > 0.05). PIMs were found in 9.6% of subjects aged ≥65 years and were mainly mental health medication. Due to coadministration of medications, 22.3% of the population were at cumulative risk for falls, 17% for constipation and 12.8% for cardiovascular events. Finally, 15 pairs of drug-to-drug interactions were identified in 11.5% of patients. CONCLUSION Our data suggest that polypharmacy is highly prevalent and associated with worse health status and prescription risks in COPD patients. These findings potentially introduce an additional challenge on effective management of these patients.
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Affiliation(s)
- Despo Ierodiakonou
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Erotokritos Theodorou
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Dimitra Sifaki-Pistolla
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | | | | | | | | | - Filothei Voltiraki
- Primary Care, 4th Public Primary Care Unit of Heraklion, Heraklion, Crete, Greece
| | | | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
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Beaudoin C, Jean S, Moore L, Gamache P, Bessette L, Ste-Marie LG, Brown JP. Prediction of Osteoporotic Fractures in Elderly Individuals: A Derivation and Internal Validation Study Using Healthcare Administrative Data. J Bone Miner Res 2021; 36:2329-2342. [PMID: 34490952 DOI: 10.1002/jbmr.4438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/11/2021] [Accepted: 09/04/2021] [Indexed: 12/27/2022]
Abstract
In Canada and other countries, osteoporosis is monitored as part of chronic disease population surveillance programs. Although fractures are the principal manifestation of osteoporosis, very few algorithms are available to identify individuals at high risk of osteoporotic fractures in current surveillance systems. The objective of this study was to derive and validate predictive models to accurately identify individuals at high risk of osteoporotic fracture using information available in healthcare administrative data. More than 270,000 men and women aged ≥66 years were randomly selected from the Quebec Integrated Chronic Disease Surveillance System. Selected individuals were followed between fiscal years 2006-2007 and 2015-2016. Models were constructed for prediction of hip/femur and major osteoporotic fractures for follow-up periods of 5 and 10 years. A total of 62 potential predictors measurable in healthcare administrative databases were identified. Predictor selection was performed using a manual backward algorithm. The predictive performance of the final models was assessed using measures of discrimination, calibration, and overall performance. Between 20 and 25 predictors were retained in the final prediction models (eg, age, sex, social deprivation index, most of the major and minor risk factors for osteoporosis, diabetes, Parkinson's disease, cognitive impairment, anemia, anxio-depressive disorders). Discrimination of the final models was higher for the prediction of hip/femur fracture than major osteoporotic fracture and higher for prediction for a 5-year than a 10-year period (hip/femur fracture for 5 years: c-index = 0.77; major osteoporotic fracture for 5 years: c-index = 0.71; hip/femur fracture for 10 years: c-index = 0.73; major osteoporotic fracture for 10 years: c-index = 0.68). The predicted probabilities globally agreed with the observed probabilities. In conclusion, the derived models had adequate predictive performance in internal validation. As a final step, these models should be validated in an external cohort and used to develop indicators for surveillance of osteoporosis. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Claudia Beaudoin
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada.,Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Sonia Jean
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Lynne Moore
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.,CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada
| | - Philippe Gamache
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Quebec, QC, Canada
| | - Louis Bessette
- CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | | | - Jacques P Brown
- CHU de Québec - Université Laval Research Centre, Quebec, QC, Canada.,Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Sirois C, Lunghi C, Berthelot W, Laroche ML, Frini A. Benefits, risks and impacts on quality of life of medications used in multimorbid older adults: a Delphi study. Int J Clin Pharm 2019; 42:40-50. [PMID: 31721038 DOI: 10.1007/s11096-019-00935-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022]
Abstract
Background Multimorbidity and polypharmacy are common in older people. Despite the existence of quality criteria for medication use among this population, there is little guidance for managing the complex pharmacological arsenal in a multimorbidity context. Objective To establish consensus on benefits, risks and impacts on quality of life of medications used in an older adult with three chronic diseases that require complex pharmacotherapy. Setting International experts in pharmacology. Method A panel of experts responded to three rounds of a Delphi survey. They assessed the benefits, risks and positive impacts on quality of life of 50 different medications or medication classes that could be used by a hypothetical multimorbid older patient aged 65-75 years, with type 2 diabetes, heart failure and chronic obstructive pulmonary disease. Each aspect was evaluated on a 5-level Likert scale. Main outcome measure Percentage of agreement on each of the three aspects for all medication. Results Consensus was reached on 95% of items (166/174). Only two medication classes were associated with both the highest category of benefits and positive impacts on quality of life, and the lowest risk category: long-acting anticholinergics and long-acting beta-2-agonists. Nine other medications/classes of medications were categorized within the highest benefits level (metformin, DPP-4-inhibitors, short-acting beta-2-agonists, ACE inhibitors, beta-blockers, warfarin, non-vitamin K oral anticoagulants, nitrates and acetaminophen). Fifteen medications were included in the highest level of risks, among which warfarin and Non-vitamin K oral anticoagulants. Conclusions Medications recommended in clinical guidelines for individual diseases are generally considered positive for multimorbid older patients. Nevertheless, a non-negligible number of medications was deemed negative or very negative by our panelists. For multimorbid patients, individualizing treatment according to their preferences seems of utmost importance.
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Affiliation(s)
- Caroline Sirois
- Department of Social and Preventive Medicine, Laval University, Quebec, Canada. .,Centre d'excellence sur le vieillissement de Québec, CIUSSS-CN, Hôpital St-Sacrement, Local L2-28, 1050, Chemin Ste-Foy, Quebec, QC, G1S 4L8, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Quebec, Canada.
| | | | | | - Marie-Laure Laroche
- Service de Pharmacologie, Toxicologie et Pharmacovigilance, Centre Régional de Pharmacovigilance, de Pharmacoépidémiologie et d'information sur les médicaments, Centre Hospitalier Universitaire de Limoges, Limoges, France.,Faculty of Medicine, Limoges University, Limoges, France.,INSERM 1248, Limoges University, Limoges, France
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