Polypharmacy and specific comorbidities in university primary care settings.
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.
Aubert CE, Streit S, Da Costa BR, Collet TH, Cornuz J, Gaspoz JM, Bauer D, Aujesky D, Rodondi N. Polypharmacy and specific comorbidities in university primary care settings. Eur J Intern Med. 2016 Nov;35:35-42. Available at: http://www.sciencedirect.com/science/article/pii/S0953620516301388
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.
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).
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.
Aubert CE, Streit S, Da Costa BR, Collet TH, Cornuz J, Gaspoz JM, Bauer D, Aujesky D, Rodondi N.
Resto de la Unión Europea
1. Enfermedades Crónicas
1.2. Enfermedades crónicas complejas (Pluripatología)
4.1. Tratamientos con medicación