Changes in prescribed medicines in older patients with multimorbidity and polypharmacy in general practice

Abstract

BackgroundTreatment complexity rises in line with the number of drugs, single doses, and administration methods, thereby threatening patient adherence. Patients with multimorbidity often need flexible, individualised treatment regimens, but alterations during the course of treatment may further increase complexity. The objective of our study was to explore medication changes in older patients with multimorbidity and polypharmacy in general practice.MethodsWe retrospectively analysed data from the cluster-randomised PRIMUM trial (PRIoritisation of MUltimedication in Multimorbidity) conducted in 72 general practices. We developed an algorithm for active pharmaceutical ingredients (API), strength, dosage, and administration method to assess changes in physician-reported medication data during two intervals (baseline to six-months: ∆1; six- to nine-months: ∆2), analysed them descriptively at prescription and patient levels, and checked for intervention effects.ResultsOf 502 patients (median age 72 years, 52% female), 464 completed the study. Changes occurred in 98.6% of patients (changes were 19% more likely in the intervention group): API changes during ∆1 and ∆2 occurred in 414 (82.5%) and 338 (67.3%) of patients, dosage alterations in 372 (74.1%) and 296 (59.2%), and changes in API strength in 158 (31.5%) and 138 (27.5%) respectively. Administration method changed in 79 (16%) of patients in both ∆1 and ∆2. Simvastatin, metformin and aspirin were most frequently subject to alterations.ConclusionMedication regimens in older patients with multimorbidity and polypharmacy changed frequently. These are mostly due to discontinuations and dosage alterations, followed by additions and restarts. These findings cast doubt on the effectiveness of cross-sectional assessments of medication and support longitudinal assessments where possible.Trial registration.1. Prospective registration: Trial registration number: NCT01171339; Name of registry: ClinicalTrials.gov; Date of registration: July 27, 2010; Date of enrolment of the first participant to the trial: August 12, 2010.2. Peer reviewed trial registration: Trial registration number: ISRCTN99526053; Name of registry: Controlled Trials; Date of registration: August 31, 2010; Date of enrolment of the first participant to the trial: August 12, 2010.Electronic supplementary materialThe online version of this article (10.1186/s12875-018-0825-3) contains supplementary material, which is available to authorized users.

Daily Medication Management and Adherence in the Polymedicated Elderly: A Cross-Sectional Study in Portugal

“…Nonadherence to medication leads to a lack of treatment effectiveness, increased hospital admissions, healthcare expenditures, and ultimately can lead to an overtreatment of a disease [22,23]. Due to the presence of multiple comorbidities that require multiple therapies, and, consequently polypharmacy, elderlies are more prone to compliance problems and nonadherence than younger [8,14]. In our study, a positive correlation between the adherence levels and age was found.…”

“…Medicines are the medical technology mostly used and, according to literature, the concomitant use of five or more medicines, the most widely accepted definition of polypharmacy, affects 40-50% of elderly in high-income countries [4][5][6][7]. The use of multiple medication contributes to an incorrect use of medicines by the elderly and may potentially increase the risk for a Drug Related Problems (DRPs) occurrence, therefore interfering with the treatment effectiveness and safety [8][9][10]. In this context, DRPs in the elderly account for a large percentage of emergency treatment and hospitalizations, increasing the costs with health in the most aged regions [11][12][13].…”

“…In this context, DRPs in the elderly account for a large percentage of emergency treatment and hospitalizations, increasing the costs with health in the most aged regions [11][12][13]. In addition, levels of adherence to drug therapy correlate inversely with the number of drugs prescribed, especially in the elderly who do not live in nursing homes [8,14].…”

‘Optimising PharmacoTherapy In the multimorbid elderly in primary CAre’ (OPTICA) to improve medication appropriateness: study protocol of a cluster randomised controlled trial

“…It is also possible that patients on the list changed their GP or have died. Since prescriptions frequently change,38 some patients with polypharmacy might not have qualified for the screening list when data was last exported. For all these reasons, the protocol allows GPs to skip patients on the screening list if they provide an explanation, or to recruit patients who are not on the list but fulfil the inclusion and do not meet the exclusion criteria.…”

Big data analysis techniques to address polypharmacy in patients – a scoping review

“…Neuropsychological problems like delirium, acute renal failure and hypotension are the most common unwanted side effects [ 2 ].. Furthermore, polypharmacy can lead to problems with medication adherence, especially in older adults if associated with visual or cognitive decline as well as aging, resulting in unwanted outcomes such as treatment failure or hospitalizations [ 4 ]. The prevalence of polypharmacy at hospital admission in various countries was reported to be between 20 and 60% [ 5 – 7 ] and it was recently reported that rehospitalization results in a significant increase in the number of drugs given to patients at discharge.…”