Journal
EUROPEAN JOURNAL OF INTERNAL MEDICINE
Volume 35, Issue -, Pages 35-42Publisher
ELSEVIER
DOI: 10.1016/j.ejim.2016.05.022
Keywords
Comorbidities; Inappropriate prescribing; Multimorbidity; Pharmacoepidemiology; Polypharmacy
Categories
Funding
- Swiss National Science Foundation [SNSF 320030-150025, PBLAP3-145870, P3SMP3-155318]
- project OPERAM (OPtiminising thERapy to prevent Avoidable hospital admissions in the Multimorbid elderly) - European Commission (EC) HORIZON [634238]
- Swiss State Secretariat for Education, Research and Innovation (SERI) [15.0137]
- Swiss University Conference
- State Secretariat for Education, Research and Innovation (SUC project) [P-10]
- Swiss National Science Foundation (SNF) [PBLAP3_145870] Funding Source: Swiss National Science Foundation (SNF)
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Aims: Polypharmacy is associated with adverse events and multimorbidity, but data are limited on its association with specific comorbidities in primary care settings. We measured the prevalence of polypharmacy and inappropriate prescribing, and assessed the association of polypharmacy with specific comorbidities. Methods: We did a cross-sectional analysis of 1002 patients aged 50-80 years followed in Swiss university primary care settings. We defined polypharmacy as >= 5 long-term prescribed drugs and multimorbidity as >= 2 comorbidities. We used logistic mixed-effects regression to assess the association of polypharmacy with the number of comorbidities, multimorbidity, specific sets of comorbidities, potentially inappropriate prescribing (PIP) and potential prescribing omission (PPO). We used multilevel mixed-effects Poisson regression to assess the association of the number of drugs with the same parameters. Results: Patients (mean age 63.5 years, 67.5% >= 2 comorbidities, 37.0% >= 5 drugs) had a mean of 3.9 (range 0-17) drugs. Age, BMI, multimorbidity, hypertension, diabetes mellitus, chronic kidney disease, and cardiovascular diseases were independently associated with polypharmacy. The association was particularly strong for hypertension (OR 8.49, 95% CI 5.25-13.73), multimorbidity (OR 6.14, 95% CI 4.16-9.08), and oldest age (75-80 years: OR 4.73, 95% CI 2.46-9.10 vs. 50-54 years). The prevalence of PPO was 32.2% and PIP was more frequent among participants with polypharmacy (9.3% vs. 3.2%, p < 0.006). Conclusions: Polypharmacy is common in university primary care settings, is strongly associated with hypertension, diabetes mellitus, chronic kidney disease and cardiovascular diseases, and increases potentially inappropriate prescribing. Multimorbid patients should be included in further trials for developing adapted guidelines and avoiding inappropriate prescribing. (C) 2016 European Federation of Internal Medicine. Published by Elsevier B. V. All rights reserved.
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