Polypharmacy and specific comorbidities in university primary care settings.

Aubert, Carole E; Streit, Sven; Da Costa, Bruno; Collet, Tinh-Hai; Cornuz, Jacques; Gaspoz, Jean-Michel; Bauer, Doug; Aujesky, Drahomir; Rodondi, Nicolas (2016). Polypharmacy and specific comorbidities in university primary care settings. European journal of internal medicine, 35, pp. 35-42. Elsevier 10.1016/j.ejim.2016.05.022

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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 50-80years 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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine

UniBE Contributor:

Aubert, Carole Elodie; Streit, Sven; Da Costa, Bruno; Aujesky, Drahomir and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0953-6205

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

21 Jun 2016 11:18

Last Modified:

11 Sep 2017 19:18

Publisher DOI:

10.1016/j.ejim.2016.05.022

PubMed ID:

27289492

Uncontrolled Keywords:

Comorbidities; Inappropriate prescribing; Multimorbidity; Pharmacoepidemiology; Polypharmacy

BORIS DOI:

10.7892/boris.83884

URI:

https://boris.unibe.ch/id/eprint/83884

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