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Suzuki H, Yamamoto A, Ono K, Yamada Y, Oki Y, Ohira M, Ishikawa A. Is polypharmacy a risk factor for aspiration pneumonia in older adults? A case-control study. Arch Gerontol Geriatr 2024; 122:105363. [PMID: 38367525 DOI: 10.1016/j.archger.2024.105363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/13/2024] [Accepted: 02/04/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION The incidence of aspiration pneumonia and the number of medicines prescribed increase with older age. Many medicines pose a risk for aspiration pneumonia, especially those that decrease swallowing function. Older adults with polypharmacy often receive a combination of these medicines. This study aimed to clarify whether polypharmacy is a risk factor for aspiration pneumonia. METHODS Older adults aged ≥ 65 years receiving oral medicines were included in this case-control study. Patients hospitalized for pneumonia served as the case group, and other age-matched hospitalized patients served as the control group. Patient data were collected retrospectively, and logistic regression analysis was performed using items that showed significant differences in the univariate analysis as explanatory variables. RESULTS Logistic regression analysis revealed that the number of medicines was not a risk factor for aspiration pneumonia; however, it was associated with the Functional Oral Intake Scale score, male sex, body mass index, and number of comorbidities. CONCLUSION Although polypharmacy is often defined only by the number of medicines, it is not a risk factor for aspiration pneumonia. A detailed comparison of prescription medicines between the pneumonia and non-pneumonia groups is necessary.
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Affiliation(s)
- Haruko Suzuki
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan; National Hospital Organization Shinshu Ueda Medical Center, 1-27-21 Midorigaoka, Ueda City, Nagano Prefecture, Japan.
| | - Akio Yamamoto
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
| | - Kumiko Ono
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
| | - Yoji Yamada
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
| | - Yutaro Oki
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
| | - Mineko Ohira
- National Hospital Organization Higashi Nagano Hospital, 2-477 Ueno, Nagano City, Nagano Prefecture, Japan
| | - Akira Ishikawa
- Kobe University Graduate School of Health Sciences, 7-10-2 Tomogaoka, Suma-ku, Kobe City, Hyogo Prefecture, Japan
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Papillon-Ferland L, Sadowski CA. Case mapping of geriatrics: Looking beyond age in skills laboratories. CURRENTS IN PHARMACY TEACHING & LEARNING 2024; 16:377-385. [PMID: 38609769 DOI: 10.1016/j.cptl.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/31/2023] [Accepted: 03/11/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND AND PURPOSE Development of competencies related to care of older adults is necessary in pharmacy education. Skills laboratories as an essential part of the curriculum represent an important setting to teach geriatrics. The purpose of this research was to describe geriatrics cases in skills/simulation activities of an undergraduate pharmacy program. EDUCATIONAL ACTIVITY AND SETTING A retrospective review of one academic year of skills laboratories from the pharmacy program at the Faculty of Pharmacy of University of Montreal was performed. Sessions including cases aged ≥65 years were selected. Content was extracted for characteristics relating to the patient, health, medications, and care context. A framework including geriatric considerations such as geriatric syndromes, frailty status, and potentially inappropriate medications was developed for data collection. FINDINGS In total, 210 patient cases were extracted. Older adults (≥ 65 years) were represented in 51 cases (24%), with 8 cases (4%) aged ≥80 years. Geriatric syndromes were documented in 8%, functional status in 10%, and mobility in 12% of the cases. The median number of comorbidities and medications were 4 and 7, respectively. Regarding polypharmacy, only 10 cases had >10 medications, and none had >15 medications. Potentially inappropriate medications were found in 47% (n = 24) of the cases but were addressed in only 14% (n = 7) cases. SUMMARY This mapping of skills laboratories highlights gaps in geriatrics content. Inclusion of the oldest patients and geriatrics issues were incorporated in a minority of cases and lacked many characteristics essential for geriatrics care.
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Affiliation(s)
- Louise Papillon-Ferland
- Faculty of pharmacy, University of Montreal, 2940, chemin de Polytechnique, Montréal, QC H3T 1J4, Canada.
| | - Cheryl A Sadowski
- Faculty of Pharmacy & Pharmaceutical Sciences, College of Health Sciences, University of Alberta, 11405 - 87 Ave NW, Edmonton, Alberta T6G 1C9, Canada.
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Nicholson K, Liu W, Fitzpatrick D, Hardacre KA, Roberts S, Salerno J, Stranges S, Fortin M, Mangin D. Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. THE LANCET. HEALTHY LONGEVITY 2024; 5:e287-e296. [PMID: 38452787 DOI: 10.1016/s2666-7568(24)00007-2] [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: 08/22/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024] Open
Abstract
Multimorbidity (multiple conditions) and polypharmacy (multiple medications) are increasingly common, yet there is a need to better understand the prevalence of co-occurrence. In this systematic review, we examined the prevalence of multimorbidity and polypharmacy among adults (≥18 years) and older adults (≥65 years) in clinical and community settings. Six electronic databases were searched, and 87 studies were retained after two levels of screening. Most studies focused on adults 65 years and older and were done in population-based community settings. Although the operational definitions of multimorbidity and polypharmacy varied across studies, consistent cut-points (two or more conditions and five or more medications) were used across most studies. In older adult samples, the prevalence of multimorbidity ranged from 4·8% to 93·1%, while the prevalence of polypharmacy ranged from 2·6% to 86·6%. High heterogeneity between studies indicates the need for more consistent reporting of specific lists of conditions and medications used in operational definitions.
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Affiliation(s)
- Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
| | - Winnie Liu
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daire Fitzpatrick
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kate Anne Hardacre
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sarah Roberts
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Salerno
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, Western University, London, ON, Canada; Department of Medicine, Western University, London, ON, Canada; Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of General Practice, University of Otago, Christchurch, New Zealand
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Loyd C, Picken L, Sanders R, Zhang Y, Kennedy RE, Brown CJ. Changes in multimorbidity among hospitalized adults in the US. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241283436. [PMID: 39239101 PMCID: PMC11375669 DOI: 10.1177/26335565241283436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 08/22/2024] [Indexed: 09/07/2024]
Abstract
Objective This investigation examines burden of comorbidity measured by the Charlson Comorbidity Index (CCI) and Elixhauser Comorbidity Index (ECI) among inpatients based on age, sex, and race. Methods Cross-sectional analysis of 2012-2018 US NIS datasets. Participants were inpatients 55y+. ICD-9/10 codes for admitting diagnoses were used to calculate disease burden using the CCI and ECI. Unweighted mean CCI and ECI scores were compared across demographic variables. Results An increase in mean CCI and ECI scores across age, sex, and races (p<.001) was identified. Compared to the youngest age group (55-59y), all age groups had higher mean CCI and ECI adjusting for time (p<.001). Increases were greatest in older age groups until age 80-84 for CCI and 85-89 for ECI. The female group had lower CCI adjusting for time (p<.001) compared to males. There was no difference between sex groups in mean ECI (p=.409). Compared with the White group, all other race groups had higher mean CCI adjusting for time (p<.001). Black inpatients had the highest CCI followed by Native American inpatients. Findings were similar for ECI, but with no difference between Hispanic and White groups (p=.434). Conclusions Growing multimorbidity burden among adult inpatients across age, sex, and race supports the continued need for programs for preventing and reducing multimorbidity, especially among communities that experience health inequity including older, Black, and Native American patients.
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Affiliation(s)
- Christine Loyd
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lauren Picken
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richelle Sanders
- Department of Clinical and Diagnostic Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Yue Zhang
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Richard E Kennedy
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Cynthia J Brown
- Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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Nazar G, Díaz-Toro F, Petermann-Rocha F, Lanuza F, Troncoso C, Leiva-Ordóñez AM, Concha-Cisternas Y, Celis-Morales C. Multimorbidity and 11-year mortality in adults: a prospective analysis using the Chilean National Health Survey. Health Promot Int 2023; 38:daad176. [PMID: 38128083 DOI: 10.1093/heapro/daad176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Research on morbidity and mortality often emphasizes individual diseases over the cumulative effects of multimorbidity, especially in low- and middle-income countries. This study aimed to analyze the association between multimorbidity and all-cause mortality in a representative sample of the Chilean population. This longitudinal study used data from 3701 subjects aged ≥15 years who participated in the Chilean National Health Survey conducted between 2009 and 2010. We included 16 self-reported highly prevalent morbidities. All-cause mortality data from an 11-year follow-up were collected from the Chilean Civil Registry. The Cox proportional hazard model, adjusted for confounders, determined the association between multimorbidity categories and all-cause mortality. Of the total sample, 24.3% reported no morbidity, while 50.4% two or more. After adjustment, participants with four or more morbidities had a 1.66 times higher mortality risk [95% confidence interval (CI): 1.03-2.67] than those without morbidities. The mortality risk increased by 10% for each additional morbidity [HR: 1.09 (CI: 1.04-1.16)]. Multimorbidity was common in the Chilean population and increased the mortality risk, which greatly challenges the health system to provide an integral and coordinated approach to healthcare.
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Affiliation(s)
- Gabriela Nazar
- Departamento de Psicología, Universidad de Concepción, Concepción, 834-0518, Chile
| | - Felipe Díaz-Toro
- Facultad de Enfermería, Universidad Andres Bello, Santiago, 8370134, Chile
| | - Fanny Petermann-Rocha
- Facultad de Medicina, Centro de Investigación Biomédica, Universidad Diego Portales, Santiago, 8370134, Chile
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, United Kingdom
| | - Fabián Lanuza
- Departamento de Procesos Diagnósticos y Evaluación, Facultad de Ciencias de la Salud, Universidad Católica de Temuco, 4813302, Chile
| | - Claudia Troncoso
- Facultad de Medicina. Departamento de Salud Pública, Centro de Investigación en Educación y Desarrollo (CIEDE-UCSC), Universidad Católica de la Santísima Concepción, Concepción, 4090541, Chile
| | - Ana María Leiva-Ordóñez
- Facultad de Medicina, Instituto de Anatomía, Histología y Patología, Universidad Austral de Chile, Valdivia, 4811230, Chile
| | - Yeny Concha-Cisternas
- Facultad de Salud, Escuela de Kinesiología, Universidad Santo Tomás, Talca, 3465548, Chile
- Facultad de Educación, Pedagogía en Educación Física, Universidad Autónoma de Chile, Talca, Chile
| | - Carlos Celis-Morales
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, United Kingdom
- Human Performance Laboratory, Education, Physical Activity and Health Research Unit, Universidad Católica del Maule, Talca, 34809112, Chile
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Zahlan G, De Clifford-Faugère G, Nguena Nguefack HL, Guénette L, Pagé MG, Blais L, Lacasse A. Polypharmacy and Excessive Polypharmacy Among Persons Living with Chronic Pain: A Cross-Sectional Study on the Prevalence and Associated Factors. J Pain Res 2023; 16:3085-3100. [PMID: 37719270 PMCID: PMC10505027 DOI: 10.2147/jpr.s411451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/27/2023] [Indexed: 09/19/2023] Open
Abstract
Purpose Polypharmacy can be defined as the concomitant use of ≥5 medications and excessive polypharmacy, as the use of ≥10 medications. Objectives were to (1) assess the prevalence of polypharmacy and excessive polypharmacy among persons living with chronic pain, and (2) identify sociodemographic and clinical factors associated with excessive polypharmacy. Patients and Methods This cross-sectional study used data from 1342 persons from the ChrOnic Pain trEatment (COPE) Cohort (Quebec, Canada). The self-reported number of medications currently used by participants (regardless of whether they were prescribed or taken over-the-counter, or were used for treating pain or other health issues) was categorized to assess polypharmacy and excessive polypharmacy. Results Participants reported using an average of 6 medications (median: 5). The prevalence of polypharmacy was 71.4% (95% CI: 69.0-73.8) and excessive polypharmacy was 25.9% (95% CI: 23.6-28.3). No significant differences were found across gender identity groups. Multivariable logistic regression revealed that factors associated with greater chances of reporting excessive polypharmacy (vs <10 medications) included being born in Canada, using prescribed pain medications, and reporting greater pain intensity (0-10) or pain relief from currently used pain treatments (0-100%). Factors associated with lower chances of excessive polypharmacy were using physical and psychological pain treatments, reporting better general health/physical functioning, considering pain to be terrible/feeling like it will never get better, and being employed. Conclusion Polypharmacy is the rule rather than the exception among persons living with chronic pain. Close monitoring and evaluation of the different medications used are important for all persons, especially those with limited access to care.
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Affiliation(s)
- Ghita Zahlan
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | | | - Hermine Lore Nguena Nguefack
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
| | - Line Guénette
- Faculté de pharmacie, Université Laval, Quebec, Quebec, Canada
- Centre de recherche, CHU de Québec - Université Laval, Quebec, Quebec, Canada
| | - M Gabrielle Pagé
- Centre de recherche, Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, Quebec, Canada
- Département d’anesthésiologie et de médecine de la douleur, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Montreal, Quebec, Canada
| | - Anaïs Lacasse
- Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, Quebec, Canada
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Mohamud MA, Campbell DJT, Wick J, Leung AA, Fabreau GE, Tonelli M, Ronksley PE. 20-year trends in multimorbidity by race/ethnicity among hospitalized patient populations in the United States. Int J Equity Health 2023; 22:137. [PMID: 37488549 PMCID: PMC10367428 DOI: 10.1186/s12939-023-01950-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 07/03/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND The challenges presented by multimorbidity continue to rise in the United States. Little is known about how the relative contribution of individual chronic conditions to multimorbidity has changed over time, and how this varies by race/ethnicity. The objective of this study was to describe trends in multimorbidity by race/ethnicity, as well as to determine the differential contribution of individual chronic conditions to multimorbidity in hospitalized populations over a 20-year period within the United States. METHODS This is a serial cross-sectional study using the Nationwide Inpatient Sample (NIS) from 1993 to 2012. We identified all hospitalized patients aged ≥ 18 years old with available data on race/ethnicity. Multimorbidity was defined as the presence of 3 or more conditions based on the Elixhauser comorbidity index. The relative change in the proportion of hospitalized patients with multimorbidity, overall and by race/ethnicity (Black, White, Hispanic, Asian/Pacific Islander, Native American) were tabulated and presented graphically. Population attributable fractions were estimated from modified Poisson regression models adjusted for sex, age, and insurance type. These fractions were used to describe the relative contribution of individual chronic conditions to multimorbidity over time and across racial/ethnic groups. RESULTS There were 123,613,970 hospitalizations captured within the NIS between 1993 and 2012. The prevalence of multimorbidity increased in all race/ethnic groups over the 20-year period, most notably among White, Black, and Native American populations (+ 29.4%, + 29.7%, and + 32.0%, respectively). In both 1993 and 2012, Black hospitalized patients had a higher prevalence of multimorbidity (25.1% and 54.8%, respectively) compared to all other race/ethnic groups. Native American populations exhibited the largest overall increase in multimorbidity (+ 32.0%). Furthermore, the contribution of metabolic diseases to multimorbidity increased, particularly among Hispanic patients who had the highest population attributable fraction values for diabetes without complications (15.0%), diabetes with complications (5.1%), and obesity (5.8%). CONCLUSIONS From 1993 to 2012, the secular increases in the prevalence of multimorbidity as well as changes in the differential contribution of individual chronic conditions has varied substantially by race/ethnicity. These findings further elucidate the racial/ethnic gaps prevalent in multimorbidity within the United States. PRIOR PRESENTATIONS Preliminary finding of this study were presented at the Society of General Internal Medicine (SGIM) Annual Conference, Washington, DC, April 21, 2017.
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Affiliation(s)
- Mursal A Mohamud
- Cumming School of Medicine, Undergraduate Medical Education, University of Calgary, Calgary, AB, Canada
| | - David J T Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - James Wick
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alexander A Leung
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gabriel E Fabreau
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Chuang YN, Chen CC, Wang CJ, Chang YS, Liu YH. Frailty and polypharmacy in the community-dwelling elderly with multiple chronic diseases. Psychogeriatrics 2023; 23:337-344. [PMID: 36717278 DOI: 10.1111/psyg.12936] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Both multi-morbidity (MM) and polypharmacy (PP) are common in the elderly and pose a challenge for health and social care systems. However, high-quality patient-centred care requires context-bound understanding of the patterns and use of medications in those with MM. Therefore, the aim of this study was to investigate the prevalence of PP in community-dwelling elderly, and the factors associated with MM, PP, excessive polypharmacy (EPP), and the types of drugs used. METHODS We analysed data of 164 community-dwelling subjects aged ≥60 years from January to December 2020 at a general hospital in a rural area of Taiwan. MM was defined as >4 diagnoses of chronic health conditions. Non-polypharmacy (NP), PP, and EPP were defined as <5, 5-8, and >8 prescriptions, respectively. Other variables including basic activities of daily living (BADL), severity of frailty, depressive mood, screening for intellectual impairment, and nutritional status were also analysed. RESULTS Of the 164 participants, 34.8% had >4 diagnoses, 66.5% had PP, and 26.2% had EPP. The patients with >4 diagnoses had worse performance in BADL, higher levels of frailty, and more prescriptions than those with fewer diagnoses. The EPP group had worse performance in BADL, a higher level of frailty, more comorbidities, and higher prevalences of diabetes mellitus and chronic kidney disease compared to the NP and PP groups. After adjusting for covariates, we further found a higher number of medications associated with having more comorbidities, and a higher level of frailty associated with having a greater number of medications. CONCLUSION We found relationships between frailty and PP, and between PP and MM, but frailty did not associate with MM. Since frailty, PP, and MM may be viewed as an inevitable trinity of ageing, reducing PP could be a method to both prevent frailty and disentangle this trinity in the elderly.
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Affiliation(s)
- Yuan N Chuang
- Department of Community Health Center, Catholic Mercy Hospital, Catholic Mercy Medical Foundation, Hsinchu, Taiwan
| | - Chia C Chen
- Department of Pharmacy, Catholic Mercy Hospital, Catholic Mercy Medical, Hsinchu, Taiwan
| | - Chin J Wang
- Department of Neuropsychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Yu S Chang
- Department of Psychiatry, Catholic Mercy Hospital, Catholic Mercy Medical Foundation, Hsinchu, Taiwan
| | - Yi H Liu
- Department of Family Medicine, Catholic Mercy Hospital, Catholic Mercy Medical Foundation, Hsinchu, Taiwan
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9
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Subramanian A, Azcoaga-Lorenzo A, Anand A, Phillips K, Lee SI, Cockburn N, Fagbamigbe AF, Damase-Michel C, Yau C, McCowan C, O'Reilly D, Santorelli G, Hope H, Kennedy JI, Abel KM, Eastwood KA, Locock L, Black M, Loane M, Moss N, Plachcinski R, Thangaratinam S, Brophy S, Agrawal U, Vowles Z, Brocklehurst P, Dolk H, Nelson-Piercy C, Nirantharakumar K. Polypharmacy during pregnancy and associated risk factors: a retrospective analysis of 577 medication exposures among 1.5 million pregnancies in the UK, 2000-2019. BMC Med 2023; 21:21. [PMID: 36647047 PMCID: PMC9843951 DOI: 10.1186/s12916-022-02722-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The number of medications prescribed during pregnancy has increased over the past few decades. Few studies have described the prevalence of multiple medication use among pregnant women. This study aims to describe the overall prevalence over the last two decades among all pregnant women and those with multimorbidity and to identify risk factors for polypharmacy in pregnancy. METHODS A retrospective cohort study was conducted between 2000 and 2019 using the Clinical Practice Research Datalink (CPRD) pregnancy register. Prescription records for 577 medication categories were obtained. Prevalence estimates for polypharmacy (ranging from 2+ to 11+ medications) were presented along with the medications commonly prescribed individually and in pairs during the first trimester and the entire pregnancy period. Logistic regression models were performed to identify risk factors for polypharmacy. RESULTS During the first trimester (812,354 pregnancies), the prevalence of polypharmacy ranged from 24.6% (2+ medications) to 0.1% (11+ medications). During the entire pregnancy period (774,247 pregnancies), the prevalence ranged from 58.7 to 1.4%. Broad-spectrum penicillin (6.6%), compound analgesics (4.5%) and treatment of candidiasis (4.3%) were commonly prescribed. Pairs of medication prescribed to manage different long-term conditions commonly included selective beta 2 agonists or selective serotonin re-uptake inhibitors (SSRIs). Risk factors for being prescribed 2+ medications during the first trimester of pregnancy include being overweight or obese [aOR: 1.16 (1.14-1.18) and 1.55 (1.53-1.57)], belonging to an ethnic minority group [aOR: 2.40 (2.33-2.47), 1.71 (1.65-1.76), 1.41 (1.35-1.47) and 1.39 (1.30-1.49) among women from South Asian, Black, other and mixed ethnicities compared to white women] and smoking or previously smoking [aOR: 1.19 (1.18-1.20) and 1.05 (1.03-1.06)]. Higher and lower age, higher gravidity, increasing number of comorbidities and increasing level of deprivation were also associated with increased odds of polypharmacy. CONCLUSIONS The prevalence of polypharmacy during pregnancy has increased over the past two decades and is particularly high in younger and older women; women with high BMI, smokers and ex-smokers; and women with multimorbidity, higher gravidity and higher levels of deprivation. Well-conducted pharmaco-epidemiological research is needed to understand the effects of multiple medication use on the developing foetus.
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Affiliation(s)
- Anuradhaa Subramanian
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Amaya Azcoaga-Lorenzo
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Astha Anand
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Katherine Phillips
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Siang Ing Lee
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Neil Cockburn
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Adeniyi Francis Fagbamigbe
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Christine Damase-Michel
- Medical and Clinical Pharmacology, School of Medicine, Université Toulouse III, Toulouse, France
- INSERM, Center for Epidemiology and Research in Population Health (CERPOP), Toulouse, CIC 1436, France
| | - Christopher Yau
- Division of Informatics, Imaging and Data Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
- Health Data Research UK, Oxford, UK
| | - Colin McCowan
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Dermot O'Reilly
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
| | | | - Holly Hope
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
| | | | - Kathryn M Abel
- Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology Medicine & Health, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Kelly-Ann Eastwood
- Centre for Public Health, Queen's University of Belfast, Belfast, UK
- St Michael's Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Louise Locock
- Health Services Research Unit, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Mairead Black
- Aberdeen Centre for Women's Health Research, School of Medicine, Medical Science and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Maria Loane
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
| | - Ngawai Moss
- Patient and Public Representative, London, UK
| | | | - Shakila Thangaratinam
- WHO Collaborating Centre for Global Women's Health, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Sinead Brophy
- Data Science, Medical School, Swansea University, Swansea, UK
| | - Utkarsh Agrawal
- Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, UK
| | - Zoe Vowles
- Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Peter Brocklehurst
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, The Institute of Nursing and Health Research, Ulster University, Coleraine, UK
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10
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Onaisi R, Dumont R, Hasselgard-Rowe J, Safar D, Haller DM, Maisonneuve H. Multimorbidity and statin prescription for primary prevention of cardiovascular diseases: A cross-sectional study in general practice in France. Front Med (Lausanne) 2023; 9:1089050. [PMID: 36698814 PMCID: PMC9868625 DOI: 10.3389/fmed.2022.1089050] [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: 11/03/2022] [Accepted: 12/12/2022] [Indexed: 01/11/2023] Open
Abstract
Background Statins are a first line, evidence-based yet underprescribed treatment for cardiovascular primary prevention. In primary care settings, multimorbidity is a complex situation which makes it difficult to apply prevention guidelines. Aim To assess the associations between multimorbidity and prescription of statins in accordance with the 2016 ESC recommendations ("appropriate prescription"), and to identify the factors and conditions associated with these prescriptions. Design and setting Cross-sectional prospective study in the French region of Rhône-Alpes among 40 general practitioners and their patients. Methods We examined the association between appropriate statin prescription and several patient characteristics, including multimorbidity, using multivariate logistic regression models. Results Between August 2017 and February 2019, 327 patients were included in the study. Seventy-four (22.6%) were on statin medication and 199 (60.9%) exhibited multimorbidity, defined as ≥2 diseases. Only 22.5% of eligible patients were prescribed statins for primary prevention. Diabetes was most strongly associated with appropriate statin prescription (aOR 8.10, CI 95: 3.81-17.80). Multimorbidity was not associated with appropriate statin prescription (aOR 1.31, CI 95: 0.54-3.26), except in the presence of diabetes which defined diabetic multimorbidity (aOR 10.46, CI 95: 4.87-23.35). Conversely, non-diabetic multimorbidity was associated with lower odds of being appropriately prescribed a statin (aOR 0.26, CI 95: 0.12-0.56). Conclusion Multimorbidity, in itself, does not seem to be a determinant factor for appropriate statin prescription. The latter appears to be determined by a patient's type of multimorbidity, especially the presence or not of diabetes. Differentiating between diabetic and non-diabetic multimorbidity may be a pragmatic way for GPs to improve primary prevention in a patient-centered and shared decision-making approach.
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Affiliation(s)
- Racha Onaisi
- Department of General Practice, University of Bordeaux, Bordeaux, France
| | - Roxane Dumont
- Unit of Population Epidemiology, Division of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | - David Safar
- University College of General Medicine, University Claude Bernard Lyon 1, Lyon, France
| | - Dagmar M. Haller
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland
| | - Hubert Maisonneuve
- Faculty of Medicine, University Institute for Primary Care, University of Geneva, Geneva, Switzerland
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11
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Jin H, Wang Z, Guo A, Zhang H, Liu W, Zhu Y, Hua M, Shi J, Shi J, Yu D. Patterns of multimorbidity in community health centres in Shanghai, China: a retrospective, cross-sectional study based on outpatient data from 2014 to 2018. BMJ Open 2022; 12:e048727. [PMID: 36198446 PMCID: PMC9535180 DOI: 10.1136/bmjopen-2021-048727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Caring for patients with multimorbidity is an important part of primary care. It has become increasingly relevant that understanding the spectrum of multimorbidity will help general practitioners (GPs) acquire working knowledge and improve management skills. However, there was little research on characteristics of multimorbidity in primary care in China. This study aimed to identify the spectrum of frequency, proportion and ranking of multimorbidity patterns in adult patients seen at community health centres (CHCs) in Shanghai, China. DESIGN AND SETTING This was an observational, retrospective, cross-sectional study analysis of outpatient data of 244 CHCs in Shanghai, China. PARTICIPANTS Adult patients with chronic disease who visited Shanghai CHCs during 2014-2018 were selected from Shanghai CHC electronic medical records database using the International Classification of Diseases 10th Revision codes matched to the Second Version of International Classification of Primary Care codes. PRIMARY AND SECONDARY OUTCOME MEASURES A number of adult patients with chronic disease were counted. Then frequency, proportion and rank of disease patterns of multimorbidity were analysed. RESULTS Analysis of 301 651 158 electronic health records of 5 909 280 adult patients (54.2% females) found the multimorbidity proportion to be 81.2%. The prevalence of multimorbidity increased with age, which climbed from 43.7% among those aged 19-34 to 94.9% among those more than 80 years of age. The proportion of multimorbidity was higher in females (83.2%) than males (79.7%). Vascular and metabolic diseases were the most frequent diseases for patients over 45 years old. CONCLUSIONS Multimorbidity has brought huge challenges to primary care practice in Shanghai. The Shanghai government should strengthen its support for the multitargeted prevention of chronic diseases and the improvement of GPs' management capabilities.
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Affiliation(s)
- Hua Jin
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Zhaoxin Wang
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
- Department of Social Medicine and Health Management, School of Public Health,Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Management, Hainan Medical University, Haikou, China
| | - Aizhen Guo
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Hanzhi Zhang
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Wei Liu
- Huangpu District Dapuqiao Community Health Center, Shanghai, China
| | - Yuqin Zhu
- Department of Emergency, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming Hua
- Jing'an District Daning Community Health Center, Shanghai, China
| | - Jianjun Shi
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Jianwei Shi
- Department of Social Medicine and Health Management, School of Public Health,Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dehua Yu
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
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12
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Mesa‐Melgarejo L, Carreño Moreno S, Chaparro‐Diaz L, Quintero González LA, Garcia‐Quintero D, Carrillo‐Algarra AJ, Castiblanco‐Montañez RA, Hernandez‐Zambrano SM. Effectiveness of a case management model for people with multimorbidity: Mixed methods study. J Adv Nurs 2022; 78:3830-3846. [DOI: 10.1111/jan.15417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/07/2022] [Accepted: 08/03/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Lorena Mesa‐Melgarejo
- Care Perspectives Group Fundación Universitaria de Ciencias de la Salud – FUCS Bogotá Colombia
- Instituto de Evaluación Tecnológica en Salud – IETS Bogotá Colombia
| | | | | | | | - Diana Garcia‐Quintero
- Grupo Hospital de San José Investiga Sociedad de Cirugía de Bogotá – Hospital de San José Bogotá Colombia
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13
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D'Aiuto C, Lunghi C, Guénette L, Berbiche D, Pitrou I, Bertrand K, Vasiliadis HM. Factors associated with potentially inappropriate opioid use in community-living older adults consulting in primary care. Int J Geriatr Psychiatry 2022; 37. [PMID: 35795908 DOI: 10.1002/gps.5780] [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] [Received: 03/01/2022] [Accepted: 06/20/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To study the factors associated with opioid use and potentially inappropriate opioid use (PIOU) in primary care older adults with non-cancer pain referring to the conceptual framework developed by the American Agency for Healthcare Research and Quality. METHODS This is a secondary analysis of health survey and medico-administrative data from Québec, Canada. Individuals aged ≥65 were recruited between 2011 and 2013 in primary care clinics to participate in face-to-face interviews. The sample included 945 older adults without a malignant tumor over the study period or any tumor in the 2 years surrounding opioid use. Opioid use within a 3 year follow-up period was identified from the public drug plan database. Potentially inappropriate opioid use (PIOU) was defined using the American Geriatrics Society Beers 2019 list. Multinomial regression analyses were performed to study the factors (patient, pain, substance use, provider, healthcare system) associated with opioid use and PIOU. RESULTS In this sample of older adults, 26.2% used an opioid and 18.4% were categorized as PIOU. Factors associated with PIOU compared to opioid use included female sex, higher psychological distress, number of emergency department visits, and recruitment type of healthcare practice. Factors associated with PIOU compared to no use included female sex, country of origin, presence of a trauma, physical/psychiatric multimorbidity, number of outpatient consultations, pain severity/type, and number of prescribers. CONCLUSIONS Mental health and health system factors were associated with PIOU. Results highlights the importance of a multidisciplinary approach for pain management, and the urgent need for implementing organizational efforts to optimize opioid use in primary care.
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Affiliation(s)
- Carina D'Aiuto
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
| | - Carlotta Lunghi
- Department of Health Sciences, Université du Québec à Rimouski, Lévis, Quebec, Canada.,Population Health and Optimal Health Practices Research Axes, CHU de Québec Research Center, Quebec City, Quebec, Canada
| | - Line Guénette
- Population Health and Optimal Health Practices Research Axes, CHU de Québec Research Center, Quebec City, Quebec, Canada.,Faculty of Pharmacy, Laval University, Quebec City, Quebec, Canada
| | - Djamal Berbiche
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
| | - Isabelle Pitrou
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
| | - Karine Bertrand
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada.,Charles-Le Moyne Research Center (CR-CLM), Longueuil, Quebec, Canada
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14
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Prospective Association between Multimorbidity and Falls and Its Mediators: Findings from the Irish Longitudinal Study on Ageing. J Clin Med 2022; 11:jcm11154470. [PMID: 35956086 PMCID: PMC9370027 DOI: 10.3390/jcm11154470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/23/2022] [Accepted: 07/28/2022] [Indexed: 11/21/2022] Open
Abstract
This study including older adults from Ireland aimed to analyze the prospective association between multimorbidity and falls and to identify the mediators in this relationship. The present study used data from two consecutive waves of the Irish Longitudinal Study on Ageing (TILDA) survey. Multimorbidity was assessed at Wave 1 (2009–2011) and was defined as the presence of at least two chronic conditions. Falls occurring at Wave 2 (2012–2013) were self-reported. Mediating variables considered were polypharmacy, cognitive impairment, sleep problems, pain, low handgrip strength, difficulty in activities of daily living (ADL), obesity, and underweight. Multivariable binary logistic regression and mediation analysis using the Karlson Holm Breen method were conducted. This study included 6900 adults aged ≥50 years (51.6% women; mean [SD] age 63.1 [8.9] years). Compared to no chronic conditions at baseline, there was a positive and significant association between multimorbidity and falls at follow-up, with ORs ranging from 1.32 (95% CI = 1.06–1.64) for 2 conditions to 1.92 (95% CI = 1.54–2.38) for ≥4 conditions. Pain (23.5%), polypharmacy (13.3%), and difficulty in ADL (10.7%) explained the largest proportion of the multimorbidity-fall relationship. Multimorbidity increased risk for incident falls in older adults from Ireland. Interventions should be implemented to reduce fall risk in people with multimorbidity, especially targeting the identified mediators.
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15
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Oliveira FEG, Griep RH, Chor D, Giatti L, Machado LAC, Barreto SM, da Costa Pereira A, Fonseca MDJMD, Bastos LS. Racial inequalities in multimorbidity: baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). BMC Public Health 2022; 22:1319. [PMID: 35810284 PMCID: PMC9270815 DOI: 10.1186/s12889-022-13715-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/29/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence of multimorbidity has come mainly from high-income regions, while disparities among racial groups have been less explored. This study examined racial differences in multimorbidity in the multiracial cohort of the Longitudinal Study of Adult Health (Estudo Longitudinal de Saúde do Adulto), ELSA-Brasil. METHODS The study examined baseline (2008-2010) data for 14 099 ELSA-Brasil participants who self-reported being white, mixed-race, or black. A list of 16 morbidities was used to evaluate multimorbidity, operationalised by simple count into ≥ 2, ≥ 3, ≥ 4, ≥ 5 and ≥ 6 morbidities, in addition to evaluating the number of coexisting conditions. Prevalence ratios (PR) were estimated from logistic models and a quantile model was used to examine racial differences graphically in the distribution quantiles for the number of morbidities. RESULTS Overall prevalence of multimorbidity (≥ 2 morbidities) was 70% and, after controlling for age and sex, was greater among mixed-race and black participants - by 6% (PR: 1.06; 95% CI: 1.03-1.08) and 9% (PR: 1.09; 95% CI: 1.06-1.12), respectively - than among white participants. As the cutoff value for defining multimorbidity was raised, so the strength of the association increased, especially among blacks: if set at ≥ 6 morbidities, the prevalence was 27% greater for those of mixed-race (PR: 1.27; 95% CI: 1.07-1.50) and 47% greater for blacks (PR: 1.47; 95% CI: 1.22-1.76) than for whites. The disparities were smaller in the lower morbidity distribution quantiles and larger in the upper quantiles, indicating a heavier burden of disease, particularly on blacks. CONCLUSIONS Multimorbidity was common among adults and older adults in a Brazilian cohort, but important racial inequalities were found. Raising the cutoff point for defining multimorbidity revealed stronger associations between race/skin colour and multimorbidity, indicating a higher prevalence of multimorbidity among mixed-race and black individuals than among whites and that the former groups coexisted more often with more complex health situations (with more coexisting morbidities). Interventions to prevent and manage the condition of multimorbidity that consider the social determinants of health and historically discriminated populations in low- and middle-income regions are necessary.
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Affiliation(s)
| | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Dora Chor
- Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Luana Giatti
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Luciana A. C. Machado
- Clinical Hospital/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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16
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Maltais A, Simard M, Vedel I, Sirois C. Changes in Polypharmacy and Psychotropic Medication Use After Diagnosis of Major Neurocognitive Disorders: A Population-based Study in Québec, Canada. Alzheimer Dis Assoc Disord 2022; 36:222-229. [PMID: 35661072 DOI: 10.1097/wad.0000000000000513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 04/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Older adults with major neurocognitive disorder (MNCD) are often exposed to polypharmacy. We aimed to assess the prescribing and discontinuation patterns of medications following diagnosis of MNCD among community-dwelling older adults. METHODS Using the Quebec Integrated Chronic Disease Surveillance System, we conducted a population-based cohort study comparing 1-year prediagnosis and postdiagnosis use of medications between a group of individuals older than 65 years newly diagnosed with MNCD in 2016-2017 and a control group without MNCD. The difference-in-difference method was used to estimate the prediagnosis and postdiagnosis variation in the number of medications prescribed and in the proportion of psychotropic and anticholinergic medication users. RESULTS In the MNCD group, the mean number of medications used (excluding Alzheimer disease treatments) increased by 1.25 in the year after the diagnosis. The respective increase was 0.45 in the control group, yielding an adjusted difference-in-differences of 0.81 (95% confidence interval: 0.74; 0.87) between groups. The adjusted difference-in-differences in the proportions of antipsychotic, antidepressant, and anticholinergic medication users was 13.2% (12.5; 13.9), 7.1% (6.5; 7.7), and 3.8% (3.1; 4.6), respectively. CONCLUSIONS The medication burden among older adults tends to increase in the year following a diagnosis of MNCD. The use of antipsychotics and antidepressants may explain a part of the observed increase.
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Affiliation(s)
- Annie Maltais
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University
- Quebec Center of Excellence on Aging, Research Center of the CHU of Quebec
| | - Marc Simard
- Department of Social and Preventive Medicine, Faculty of Medicine, Laval University
- Quebec Center of Excellence on Aging, Research Center of the CHU of Quebec
- Quebec National Institute of Public Health, Québec
| | - Isabelle Vedel
- Quebec National Institute of Public Health, Québec
- Lady Davis Institute of the Jewish General Hospital
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Caroline Sirois
- Faculty of Pharmacy, Laval University
- Quebec Center of Excellence on Aging, Research Center of the CHU of Quebec
- Quebec National Institute of Public Health, Québec
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17
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Vos R, Boesten J, van den Akker M. Fifteen-year trajectories of multimorbidity and polypharmacy in Dutch primary care—A longitudinal analysis of age and sex patterns. PLoS One 2022; 17:e0264343. [PMID: 35213615 PMCID: PMC8880753 DOI: 10.1371/journal.pone.0264343] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 02/08/2022] [Indexed: 11/18/2022] Open
Abstract
Objective After stratifying for age, sex and multimorbidity at baseline, our aim is to analyse time trends in incident multimorbidity and polypharmacy in the 15-year clinical trajectories of individual patients in a family medicine setting. Methods This study was carried out using data from the Registration Network Family Medicine in the South of the Netherlands. The clinical trajectories of 10037 subjects during the 15-year period (2000–2014) were analyzed in a repeated measurement of using a generalized estimating equations model as well as a multilevel random intercept model with repeated measurements to determine patterns of incident multimorbidity and polypharmacy. Hierarchical age-period-cohort models were used to generate age and cohort trajectories for comparison with prevalence trends in multimorbidity literature. Results Multimorbidity was more common in females than in males throughout the duration of the 15-year trajectory (females: 39.6%; males: 33.5%). With respective ratios of 11.7 and 5.9 between the end and the beginning of the 15-year period, the youngest female and male groups showed a substantial increase in multimorbidity prevalence. Ratios in the oldest female and male groups were 2.2 and 1.9 respectively. Females had higher levels of multimorbidity than males in the 0-24-year and 25-44-year age groups, but the levels converged to a prevalence of 92.2% in the oldest male and 90.7% in the oldest female group. Similar, albeit, moderate differences were found in polypharmacy patterns. Conclusions We sought to specify the progression of multimorbidity from an early age. As a result, our study adds to the multimorbidity literature by specifying changes in chronic disease accumulation with relation to polypharmacy, and by tracking differences in patient trajectories according to age and sex. Multimorbidity and polypharmacy are common and their prevalence is accelerating, with a relatively rapid increase in younger groups. From the point of view of family medicine, this underlines the need for a longitudinal approach and a life course perspective in patient care.
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Affiliation(s)
- Rein Vos
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Jos Boesten
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Institute of General Practice, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
- Department of Public Health and Primary Care, Academic Centre of General Practice, KU Leuven, Leuven, Belgium
- * E-mail:
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18
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Faisal S, Ivo J, Tennant R, Prior KA, Grindrod K, McMillan C, Patel T. Integration of a smart multidose blister package for medication intake: A mixed method ethnographic informed study of older adults with chronic diseases. PLoS One 2022; 17:e0262012. [PMID: 35061773 PMCID: PMC8782488 DOI: 10.1371/journal.pone.0262012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Smart adherence products are marketed to assist with medication management. However, little is known about their in-home integration by older adults. It is necessary to investigate the facilitators and barriers older adults face when integrating these products into their medication taking routines before effectiveness can be examined. The aim of this study was to (a) examine the integration of a smart multidose blister package and (b) understand medication intake behaviour of adults with chronic diseases using an integrated theoretical model comprised of the Technology Acceptance Model (TAM), Theory of Planned Behaviour (TPB) and Capacity, Opportunity, Motivation and Behaviour (COM-B) Model. An ethnographic-informed study was conducted with older adults using the smart multidose blister package to manage their medications for eight weeks. Data was collected quantitatively and qualitatively using in-home observations, photo-elicitation, field notes, semi-structured interviews, system usability scale (SUS) and net promoter scale (NPS). The interview guide was developed with constructs from the TAM, TPB and COM-B Model. Data were analyzed using the Qualitative Analysis Guide of Leuven (QUAGOL) framework to generate themes and sub-themes which were mapped back to TAM, TBP and COM-B Model. Ten older adults with an average age of 76 years, of which 80% were female, participated in the study. On average, participants reported five medical conditions, while the average number of medications was 11.1. The mean SUS was 75.50 and overall NPS score was 0. Qualitative analysis identified three themes; (1) factors influencing medication intake behaviour (2) facilitators to the product use and, (3) barriers to the product use. The smart blister package was found to be easy to use and acceptable by older adults. Clinicians should assess an older adult’s medication intake behavior as well as barriers and facilitators to product use prior to recommending an adherence product for managing medications.
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Affiliation(s)
- Sadaf Faisal
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Jessica Ivo
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Ryan Tennant
- Faculty of Engineering, Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Kelsey-Ann Prior
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
| | - Colleen McMillan
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Renison University College, University of Waterloo, Waterloo, Ontario, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, Ontario, Canada
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Schlegel–University of Waterloo Research Institute of Aging, Waterloo, Ontario, Canada
- * E-mail:
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19
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Tomita S, Aoki T, Ohde S, Takahashi O, Kimura T, Matsushima M. Association between health literacy and multimorbidity: a nationwide, cross-sectional study of a Japanese population. BMJ Open 2022; 12:e052731. [PMID: 35046000 PMCID: PMC8772427 DOI: 10.1136/bmjopen-2021-052731] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To examine the relationship between health literacy and multimorbidity. DESIGN Nationwide cross-sectional study. SETTING Community settings across Japan. PARTICIPANTS Community-dwelling participants aged 20 years or older were selected based on a quota sampling method that adjusted for age, sex and residential area. In total, 3678 participants from the Health Diary Study, with a mean age of 52.3 years (SD, 18.2 years; 1943 (52.8%) female participants), were included. PRIMARY OUTCOME MEASURE Multimorbidity, the primary outcome measure, was defined as the presence of two or more chronic diseases. RESULTS Of the 3678 participants, 824 (22.4%) had multimorbidity. The mean functional health literacy (FHL) and communicative and critical health literacy (CCHL) scores were 3.2 (SD, 0.7) and 3.6 (SD, 0.9), respectively. In the univariable analysis, both scores were associated with multimorbidity (p<0.001). However, in the multivariable modified Poisson regression analysis, only the FHL score was significantly associated with multimorbidity (per 1-point increase, 0.91; 95% CI 0.84 to 0.99). CONCLUSIONS After adjusting for confounding variables, FHL, not CCHL, was significantly related to the presence of multimorbidity. Further longitudinal studies are required to examine the causal relationship between health literacy and multimorbidity.
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Affiliation(s)
- Shiori Tomita
- Department of General Internal Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
- Division of Clinical Epidemiology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Department of Community Medicine, Kyoto University, Kyoto, Japan
| | - Sachiko Ohde
- Graduate School of Public Health, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Osamu Takahashi
- Graduate School of Public Health, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Takeshi Kimura
- Center for Preventive Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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20
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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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21
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Fortin M, Stewart M, Almirall J, Berbiche D, Bélanger M, Katz A, Ryan BL, Wong ST, Zwarenstein M. One year follow-up and exploratory analysis of a patient-centered interdisciplinary care intervention for multimorbidity. JOURNAL OF COMORBIDITY 2021; 11:26335565211039780. [PMID: 34820337 PMCID: PMC8606917 DOI: 10.1177/26335565211039780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
Context Interventions for people with multimorbidity have obtained mixed results. We aimed to document the long-term effect of an intervention for people with multimorbidity. Methods 284 patients (18-80 years) presenting three or more chronic conditions were recruited from seven family medicine groups in the Saguenay-Lac St-Jean region, Quebec, Canada. The patient-centered intervention was based on motivational approach and self-management support. Outcomes were evaluated in a one-year pre-post study design with questionnaires that included the Health Education Questionnaire (heiQ), the Self-Efficacy for Managing Chronic Diseases, the Veteran RAND-12 Health Survey (VR-12), the EuroQoL 5-Domains questionnaire, the Kessler six item Psychological Stress Scale, and measures of smoking habit, physical activity, healthy eating and alcohol consumption. Subgroup analyses by age, number of conditions, sex, and income were also conducted. Results The heiQ domain of emotional wellbeing improved significantly. Improvement was also observed for the VR-12 and the K6. Among the health behaviours, only healthy eating was improved. Subgroup analyses in this exploratory study suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. Conclusion One year after the intervention, participants significantly improved a variety of outcomes. Subgroup analyses suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. This suggests that future interventions should be tailored to patients' characteristics including age, sex, income and number of conditions.
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Affiliation(s)
| | | | | | | | | | - Alan Katz
- University of Manitoba, Winnipeg, MB, Canada
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22
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Okui T, Park J. Analysis of the regional difference in the number of multi-drug prescriptions and its predictors in Japan, 2015-2018. BMC Res Notes 2021; 14:367. [PMID: 34544503 PMCID: PMC8454144 DOI: 10.1186/s13104-021-05787-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 09/14/2021] [Indexed: 11/29/2022] Open
Abstract
Objective Polypharmacy and multi-drug prescription are major public health problems in Japan, but only a few studies have investigated the regional differences. By revealing regional differences in the multi-drug prescriptions, we can infer regions with high rates of multimorbidity or inappropriate prescribing. This study revealed regional differences in multi-drug prescriptions (the number of simultaneous prescriptions of seven or more internal medicines) and investigated the factors affecting the difference using the National Database of Health Insurance Claims and Specific Health Checkups of Japan data. Results The standardized claim ratio (SCR) of the number of multi-drug prescriptions, which corrected the difference in sex and age distribution of prefectures, varied depending on prefectures. A panel data analysis investigating the association between the SCR and explanatory variables (Medical institutions, socioeconomic factors, and physical characteristics of people in prefectures) revealed that the number of public assistance recipients per 1,000 persons was positively and significantly associated with the SCR (Standardized partial regression coefficient = 0.244, p-value = 0.038). In conclusion, regional differences in the number of the multi-drug prescriptions were revealed in Japan, suggesting that public assistance recipients tend to experience multi-drug prescriptions. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-021-05787-2.
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Affiliation(s)
- Tasuku Okui
- Medical Information Center, Kyushu University Hospital, Maidashi 3-1-1 Higashi-ku, Fukuoka City, Fukuoka Prefecture, 812-8582, Japan.
| | - Jinsang Park
- Department of Pharmaceutical Sciences, International University of Health and Welfare, Fukuoka, Japan
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23
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Moin JS, Glazier RH, Kuluski K, Kiss A, Upshur REG. Examine the association between key determinants identified by the chronic disease indicator framework and multimorbidity by rural and urban settings. JOURNAL OF COMORBIDITY 2021; 11:26335565211028157. [PMID: 34262879 PMCID: PMC8252380 DOI: 10.1177/26335565211028157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022]
Abstract
Background Multimorbidity, often defined as having two or more chronic conditions is a global phenomenon. This study examined the association between key determinants identified by the chronic disease indicator framework and multimorbidity by rural and urban settings. The prevalence of individual diseases was also investigated by age and sex. Methods The Canada Community Health Survey and linked health administrative databases were used to examine the association between multimorbidity, sociodemographic, behavioral, and other risk factors in the province of Ontario. A multivariable logistic regression model was used to conduct the main analysis. Results Analyses were stratified by age (20-64 and 65-95) and area of residence (rural and urban). A total sample of n = 174,938 residents between the ages of 20-95 were examined in the Ontario province, of which 18.2% (n = 31,896) were multimorbid with 2 chronic conditions, and 23.4% (n = 40,883) with 3+ chronic conditions. Females had a higher prevalence of 2 conditions (17.9% versus 14.6%) and 3+ conditions (19.7% vs. 15.6%) relative to males. Out of all examined variables, poor self-perception of health, age, Body Mass Index, and income were most significantly associated with multimorbidity. Smoking was a significant risk factor in urban settings but not rural, while drinking was significant in rural and not urban settings. Income inequality was associated with multimorbidity with greater magnitude in rural areas. Prevalence of multimorbidity and having three or more chronic conditions were highest among low-income populations. Conclusion Interventions targeting population weight, age/sex specific disease burdens, and additional focus on stable income are encouraged.
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Affiliation(s)
- John S Moin
- University of Toronto, Institute of Health Policy Management and Evaluation (Dalla Lana School of Public Health), Toronto, ON, Canada
| | - Richard H Glazier
- Central Site (ICES Central), Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Kerry Kuluski
- University of Toronto, Institute of Health Policy Management and Evaluation (Dalla Lana School of Public Health), Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Alex Kiss
- University of Toronto, Institute of Health Policy Management and Evaluation (Dalla Lana School of Public Health), Toronto, ON, Canada.,Central Site (ICES Central), Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Ross E G Upshur
- University of Toronto, Institute of Health Policy Management and Evaluation (Dalla Lana School of Public Health), Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Sinai Health Systems, Toronto, ON, Canada
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24
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Jin H, Wang Z, Shi L, Chen C, Huo Y, Huang W, Zhang Y, Lu Y, Ge X, Shi J, Yu D. Multimorbid Patient Experiences With Primary Care at Community Health Centers in Shanghai, China. Front Public Health 2021; 9:606188. [PMID: 34169053 PMCID: PMC8218628 DOI: 10.3389/fpubh.2021.606188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: Primary care in China is facing mounting challenges with multimorbidity as the aging population grows. Knowing how patients experience primary care may highlight the deficiencies of the care system and guide health system reform. The purpose of this study was to compare the quality of primary care experienced by patients with and without multimorbidity at community health centers (CHCs) in Shanghai, China and to examine the factors influencing these experiences. Methods: A cross-sectional survey was conducted from August to December 2019 using the validated Chinese Primary Care Assessment Tool-Adult Edition (PCAT-AE). ANOVA was performed to compare the overall and domain-specific quality of primary care for patients with and without multimorbidity. Multivariate linear regressions were used to assess the factors associated with primary care quality while controlling for patients' sociodemographic and healthcare characteristics. Results: From 2,404 completed questionnaires, patients with multimorbidity reported higher PCAT scores in the domains of first contact-utilization (3.54 ± 0.55 vs. 3.48 ± 0.56, P < 0.01), accessibility (2.93 ± 0.49 vs. 2.86 ± 0.47, P < 0.001), and ongoing care (3.20 ± 0.39 vs. 3.14 ± 0.43, P < 0.001), while reporting lower scores in coordination (information system) (2.72 ± 0.41 vs. 2.79 ± 0.35, P < 0.001) and family-centeredness (3.23 ± 0.63 vs. 3.30 ± 0.64, P < 0.01). Multimorbidity (ß = 0.355, P < 0.01), education level (ß = 0.826, P < 0.01), district (suburb: ß = 1.475, P < 0.001), and self-perceived good health status (ß = 0.337, P < 0.05) were associated with better patient experiences in primary care. Patients between the age 61 and 70 (ß = −0.623, P < 0.001; >70 years: ß = −0.573, P < 0.01), with a monthly household income ≥6,000 RMB (ß = −1.385, P < 0.001) and with more than 20 outpatient visits the previous year (ß = −1.883, P < 0.001) reported lower total PCAT scores. Conclusion: The findings of our study suggest that CHCs in China have contributed to better primary care experiences for patients with multimorbidity in certain quality domains, including first contact-utilization, accessibility, and ongoing care. However, there is still room for improvement in care coordination and family-centeredness.
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Affiliation(s)
- Hua Jin
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Zhaoxin Wang
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China.,School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Leiyu Shi
- Department of Health Policy and Management, Primary Care Policy Center, Johns Hopkins University, Baltimore, MD, United States
| | - Chen Chen
- Shanghai Jing'an District Jiangning Road Community Health Service Center, Shanghai, China
| | - Yongyan Huo
- Shanghai Jiading District Anting Town Huangdu Community Health Service Center, Shanghai, China
| | - Wuquan Huang
- Shanghai Jiading District Jiading Town Community Health Service Center, Shanghai, China
| | - Yi Zhang
- Shanghai Xuhui District Fenglin Community Health Service Center, Shanghai, China
| | - Yuan Lu
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Xuhua Ge
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Jianwei Shi
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China.,School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
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25
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Maxwell CJ, Mondor L, Pefoyo Koné AJ, Hogan DB, Wodchis WP. Sex differences in multimorbidity and polypharmacy trends: A repeated cross-sectional study of older adults in Ontario, Canada. PLoS One 2021; 16:e0250567. [PMID: 33901232 PMCID: PMC8075196 DOI: 10.1371/journal.pone.0250567] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background Multimorbidity is increasing among older adults, but the impact of these recent trends on the extent and complexity of polypharmacy and possible variation by sex remains unknown. We examined sex differences in multimorbidity, polypharmacy (5+ medications) and hyper-polypharmacy (10+ medications) in 2003 vs 2016, and the interactive associations between age, multimorbidity level, and time on polypharmacy measures. Methods and findings We employed a repeated cross-sectional study design with linked health administrative databases for all persons aged ≥66 years eligible for health insurance in Ontario, Canada at the two index dates. Descriptive analyses and multivariable logistic regression models were conducted; models included interaction terms between age, multimorbidity level, and time period to estimate polypharmacy and hyper-polypharmacy probabilities, risk differences and risk ratios for 2016 vs 2003. Multimorbidity, polypharmacy and hyper-polypharmacy increased significantly over the 13 years. At both index dates prevalence estimates for all three were higher in women, but a greater absolute increase in polypharmacy over time was observed in men (6.6% [from 55.7% to 62.3%] vs 0.9% [64.2%-65.1%] for women) though absolute increases in multimorbidity were similar for men and women (6.9% [72.5%-79.4%] vs 6.2% [75.9%-82.1%], respectively). Model findings showed that polypharmacy decreased over time among women aged < 90 years (especially for younger ages and those with fewer conditions), whereas it increased among men at all ages and multimorbidity levels (with larger absolute increases typically at older ages and among those with 4 or fewer conditions). Conclusions There are sex and age differences in the impact of increasing chronic disease burden on changes in measures of multiple medication use among older adults. Though the drivers and health consequences of these trends warrant further investigation, the findings support the heterogeneity and complexity in the evolving association between multimorbidity and polypharmacy measures in older populations.
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Affiliation(s)
- Colleen J. Maxwell
- Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- * E-mail:
| | - Luke Mondor
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
| | - Anna J. Pefoyo Koné
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- Department of Health Sciences, Lakehead University, Thunder Bay, Ontario, Canada
| | - David B. Hogan
- Division of Geriatric Medicine, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Walter P. Wodchis
- ICES, Toronto, Ontario, Canada
- Health System Performance Network (HSPN), Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Toronto, Ontario, Canada
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26
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Kone AP, Mondor L, Maxwell C, Kabir US, Rosella LC, Wodchis WP. Rising burden of multimorbidity and related socio-demographic factors: a repeated cross-sectional study of Ontarians. Canadian Journal of Public Health 2021; 112:737-747. [PMID: 33847995 PMCID: PMC8043089 DOI: 10.17269/s41997-021-00474-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/06/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to provide population-level data regarding trends in multimorbidity over 13 years. METHODS We linked provincial health administrative data in Ontario, Canada, to create 3 cross-sectional panels of residents of any age in 2003, 2009, and 2016 to describe: (i) 13-year trends in multimorbidity prevalence and constellations among residents and across age, sex, and income; and (ii) chronic condition clusters. Multimorbidity was defined as having at least any 2 of 18 selected conditions, and further grouped into levels of 2, 3, 4, or 5 or more conditions. Age-sex standardized multimorbidity prevalence was estimated using the 2009 population as the standard. Clustering was defined using the observed combinations of conditions within levels of multimorbidity. RESULTS Standardized prevalence of multimorbidity increased over time (26.5%, 28.8%, and 30.0% across sequential panels), across sex, age, and area-based income. Females, older adults and those living in lower income areas exhibited higher rates in all years. However, multimorbidity increased relatively more among males, younger adults, and those with 4 or 5 or more conditions. We observed numerous and increasing diversity in disease clusters, namely at higher levels of multimorbidity. CONCLUSION Our study provides relevant and needed population-based information on the growing burden of multimorbidity, and related socio-demographic risk factors. Multimorbidity is markedly increasing among younger age cohorts. Also, there is an increasing complexity and lack of common clustering patterns at higher multimorbidity levels.
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Affiliation(s)
- Anna Pefoyo Kone
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada. .,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. .,Health System Performance Network (HSPN), Toronto, ON, Canada.
| | - Luke Mondor
- Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Colleen Maxwell
- Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,School of Pharmacy, University of Waterloo, Waterloo, ON, Canada.,School of Public Health & Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Umme Saika Kabir
- Department of Health Sciences, Lakehead University, Thunder Bay, ON, Canada
| | - Laura C Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Walter P Wodchis
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Health System Performance Network (HSPN), Toronto, ON, Canada.,ICES, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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27
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Cohen-Stavi CJ, Key C, Giveon S, Molcho T, Balicer RD, Shadmi E. Assessing guideline-concordant care for patients with multimorbidity treated in a care management setting. Fam Pract 2020; 37:479-485. [PMID: 32219299 DOI: 10.1093/fampra/cmaa024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Disease-specific guidelines are not aligned with multimorbidity care complexity. Meeting all guideline-recommended care for multimorbid patients has been estimated but not demonstrated across multiple guidelines. OBJECTIVE Measure guideline-concordant care for patients with multimorbidity; assess in what types of care and by whom (clinician or patient) deviation from guidelines occurs and evaluate whether patient characteristics are associated with concordance. METHODS A retrospective cohort study of care received over 1 year, conducted across 11 primary care clinics within the context of multimorbidity-focused care management program. Patients were aged 45+ years with more than two common chronic conditions and were sampled based on either being new (≤6 months) or veteran to the program (≥1 year). MEASURES Three guideline concordance measures were calculated for each patient out of 44 potential guideline-recommended care processes for nine chronic conditions: overall score; referral score (proportion of guideline-recommended care referred) and patient-only score (proportion of referred care completed by patients). Guideline concordance was stratified by care type. RESULTS 4386 care processes evaluated among 204 patients, mean age = 72.3 years (standard deviation = 9.7). Overall, 79.2% of care was guideline concordant, 87.6% was referred according to guidelines and patients followed 91.4% of referred care. Guideline-concordant care varied across care types. Age, morbidity burden and whether patients were new or veteran to the program were associated with guideline concordance. CONCLUSIONS Patients with multimorbidity do not receive ~20% of guideline recommendations, mostly due to clinicians not referring care. Determining the types of care for which the greatest deviation from guidelines exists can inform the tailoring of care for multimorbidity patients.
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Affiliation(s)
- Chandra J Cohen-Stavi
- Clalit Research Institute, Clalit Health Services, Tel Aviv.,Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa
| | | | - Shmuel Giveon
- Community Medical Division, Clalit Health Services, Tel Aviv
| | | | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, Tel Aviv.,Epidemiology Department, Ben Gurion University of the Negev, Be'er Sheba, Israel
| | - Efrat Shadmi
- Clalit Research Institute, Clalit Health Services, Tel Aviv.,Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa
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28
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Physical multimorbidity and subjective cognitive complaints among adults in the United Kingdom: a cross-sectional community-based study. Sci Rep 2019; 9:12417. [PMID: 31455875 PMCID: PMC6711967 DOI: 10.1038/s41598-019-48894-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 08/14/2019] [Indexed: 02/06/2023] Open
Abstract
Our goal was to examine the association between physical multimorbidity and subjective cognitive complaints (SCC) using UK nationally representative cross-sectional community-based data, and to quantify the extent to which a broad range of mainly psychological and behavioral factors explain this relationship. Data from the 2007 Adult Psychiatric Morbidity Survey were analyzed [N = 7399 adults, mean (SD) age 46.3 (18.6) years, 48.6% men]. Multimorbidity was defined as ≥2 physical diseases. SCC included two different cognitive constructs: subjective concentration and memory complaints. Multivariable logistic regression and mediation analyses were conducted. Multimorbidity was associated with higher prevalence of subjective concentration (30.7% vs. 17.3%) and memory complaints (42.8% vs. 22.9%) compared to no multimorbidity. In the regression model adjusted for sociodemographics, multimorbidity was associated with subjective concentration (OR = 2.58; 95% CI = 2.25–2.96) and memory complaints (OR = 2.34; 95% CI = 2.08–2.62). Sleep problems, stressful life events and any anxiety disorder explained 21–23%, 20–22% and 14–15% of the multimorbidity-SCC association, respectively. Multimorbidity and SCC are highly co-morbid. The utility of SCC screening in identifying individuals at high risk for future cognitive decline among individuals with multimorbidity should be assessed.
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