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Polypharmacy and specific comorbidities in university primary care settings.
- Source :
-
European journal of internal medicine [Eur J Intern Med] 2016 Nov; Vol. 35, pp. 35-42. Date of Electronic Publication: 2016 Jun 09. - Publication Year :
- 2016
-
Abstract
- 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.<br />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.<br />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).<br />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.<br /> (Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Aged
Aged, 80 and over
Cardiovascular Diseases drug therapy
Cross-Sectional Studies
Databases, Factual
Diabetes Mellitus drug therapy
Female
Humans
Hypertension drug therapy
Logistic Models
Male
Middle Aged
Multivariate Analysis
Renal Insufficiency, Chronic drug therapy
Switzerland
Comorbidity
Hospitals, University
Inappropriate Prescribing statistics & numerical data
Polypharmacy
Primary Health Care
Subjects
Details
- Language :
- English
- ISSN :
- 1879-0828
- Volume :
- 35
- Database :
- MEDLINE
- Journal :
- European journal of internal medicine
- Publication Type :
- Academic Journal
- Accession number :
- 27289492
- Full Text :
- https://doi.org/10.1016/j.ejim.2016.05.022