Polypharmacy and specific comorbidities in university primary care settings.
- Aubert CE Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: caroleelodie.aubert@insel.ch.
- Streit S Institute of Primary Health Care BIHAM, University of Bern, Switzerland. Electronic address: sven.streit@biham.unibe.ch.
- Da Costa BR Institute of Primary Health Care BIHAM, University of Bern, Switzerland. Electronic address: bruno.dacosta@biham.unibe.ch.
- Collet TH Service of Endocrinology, Diabetes and Metabolism, University Hospital of Lausanne, Switzerland; University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, UK. Electronic address: tinh-hai.collet@chuv.ch.
- Cornuz J Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland. Electronic address: jacques.cornuz@chuv.ch.
- Gaspoz JM Department of Community and General Medicine, Geneva University Hospital, Geneva, Switzerland. Electronic address: jean-michel.gaspoz@hcuge.ch.
- Bauer D Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, United States. Electronic address: dbauer@psg.ucsf.edu.
- Aujesky D Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland. Electronic address: drahomir.aujesky@insel.ch.
- Rodondi N Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland; Institute of Primary Health Care BIHAM, University of Bern, Switzerland. Electronic address: nicolas.rodondi@insel.ch.
- 2016-06-13
Published in:
- European journal of internal medicine. - 2016
Comorbidities
Inappropriate prescribing
Multimorbidity
Pharmacoepidemiology
Polypharmacy
Aged
Aged, 80 and over
Cardiovascular Diseases
Comorbidity
Cross-Sectional Studies
Databases, Factual
Diabetes Mellitus
Female
Hospitals, University
Humans
Hypertension
Inappropriate Prescribing
Logistic Models
Male
Middle Aged
Multivariate Analysis
Polypharmacy
Primary Health Care
Renal Insufficiency, Chronic
Switzerland
English
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 50-80years 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 63.5years, 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 (75-80years: OR 4.73, 95%CI 2.46-9.10 vs.50-54years). 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.
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 50-80years 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 63.5years, 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 (75-80years: OR 4.73, 95%CI 2.46-9.10 vs.50-54years). 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.
- Language
-
- English
- Open access status
- bronze
- Identifiers
-
- DOI 10.1016/j.ejim.2016.05.022
- PMID 27289492
- Persistent URL
- https://sonar.ch/global/documents/292531
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