Drug utilization pattern and factors associated with polypharmacy and excessive polypharmacy in geriatric medical out-patients at a rural health training centre in India

Selvaraj, Nitya; Ramya, G.; Sivagourounadin, Kiruthika; Ravindran, Meenakshi; Devi, Jayabalan Nalini; Ganesan, Suganeswari; Pravin, S

doi:10.4103/jfmpc.jfmpc_2417_20

Cited by 3 publications

(9 citation statements)

References 6 publications

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“…Fifty studies focussed on education [16, 18, Fig. 1 Study selection and exclusion according to the PRISMA flow diagram 20-67], 18 studies on income [16, 23, 30, 32-34, 37, 41, 46-48, 50, 53, 61, 63, 64, 66, 68], 6 on wealth [22,27,45,57,67,69], 4 studies on occupation [23,44,48,57], 7 studies on employment [16,17,49,58,60,63,66], 5 studies on social class [17,25,36,38,60], 2 used SES categories [31,70] and 1 used area-level deprivation [20]. Studies were conducted across a range of countries as follow: India [60,66], Jordan [21], Netherlands [70], Sweden [18,23,39,52], Spain [25], Belgium [26,30], Pakistan [29,68], UK [17,20,36,38,69], China …”

Section: Study Characteristicsmentioning

confidence: 99%

Section: Association Between Occupation Employment and Polypharmacymentioning

confidence: 99%

“…Four studies [23,44,48,57] reported the association between occupation and polypharmacy, and 7 [16,17,49,58,60,63,66] reported the association between employment and polypharmacy. Three studies [23,44,57] assessing occupation and 5 studies [17,58,60,63,66] Fig. 3 Forest plot showing the likelihood of polypharmacy according to income, wealth, employment, social class and SES categories assessing employment were eligible for meta-analysis (Fig.…”

Section: Association Between Occupation Employment and Polypharmacymentioning

confidence: 99%

Section: Association Between Social Class Ses and Polypharmacymentioning

confidence: 99%

“…Five studies [17,25,36,38,60] reported the association between social class and polypharmacy, and 2 studies [31,70] focused on SES and polypharmacy. Three studies [17,25,60] assessing social class were eligible for metaanalysis and the pooled OR was 1.31 (95% CI 1.21-1.42; I 2 = 0%) for receipt of polypharmacy in those of lower social class compared to higher social class. Two studies [31,70] assessing SES were eligible for meta-analysis and the pooled OR was 1.03 (95% CI 0.67-1.59; I 2 = 97%) for receipt of polypharmacy for those of lower, compared to higher, SES.…”

Section: Association Between Social Class Ses and Polypharmacymentioning

confidence: 99%

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Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

et al. 2023

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Background Socioeconomic status (SES) may influence prescribing, concordance and adherence to medication regimens. This review set out to investigate the association between polypharmacy and an individual’s socioeconomic status. Methods A systematic review and meta-analyses of observational studies was conducted across four databases. Older people (≥ 55 years) from any healthcare setting and residing location were included. The search was conducted across four databases: Medline (OVID), Web of Science, Embase (OVID) and CINAHL. Observational studies from 1990 that reported polypharmacy according to SES were included. A random-effects model was undertaken comparing those with polypharmacy (≥ 5 medication usage) with no polypharmacy. Unadjusted odds ratios (ORs), 95% confidence intervals (CIs) and standard errors (SE) were calculated for each study. Results Fifty-four articles from 13,412 hits screened met the inclusion criteria. The measure of SES used were education (50 studies), income (18 studies), wealth (6 studies), occupation (4 studies), employment (7 studies), social class (5 studies), SES categories (2 studies) and deprivation (1 study). Thirteen studies were excluded from the meta-analysis. Lower SES was associated with higher polypharmacy usage: individuals of lower educational backgrounds displayed 21% higher odds to be in receipt of polypharmacy when compared to those of higher education backgrounds. Similar findings were shown for occupation, income, social class, and socioeconomic categories. Conclusions There are socioeconomic inequalities in polypharmacy among older people, with people of lower SES significantly having higher odds of polypharmacy. Future work could examine the reasons for these inequalities and explore the interplay between polypharmacy and multimorbidity.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Association Between Occupation Employment and Polypharmacymentioning

confidence: 99%

Section: Association Between Occupation Employment and Polypharmacymentioning

confidence: 99%

Section: Association Between Social Class Ses and Polypharmacymentioning

confidence: 99%

Section: Association Between Social Class Ses and Polypharmacymentioning

confidence: 99%

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Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

et al. 2023

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Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study

Barrio-Cortes,

Benito-Sánchez,

Villimar-Rodriguez

et al. 2023

J of Pharm Policy and Pract

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Background Patients with polypharmacy suffer from complex medical conditions involving a large healthcare burden. This study aimed to describe the characteristics and utilization of primary care (PC) and hospital care (HC) and factors associated in chronic patients with polypharmacy, stratifying by adjusted morbidity groups (AMG) risk level, sex and age, and comparing with non-polypharmacy. Methods Cross-sectional study conducted in a Spanish basic healthcare area. Studied patients were those over 18 years with chronic diseases identified by the AMG tool from Madrid electronic clinical record, which was the data source. Sociodemographic, sociofunctional, clinical and healthcare utilization variables were described and compared by risk level, sex, age and having or not polypharmacy. Factors associated with healthcare utilization in polypharmacy patients were determined by a negative binomial regression model. Results In the area studied, 61.3% patients had chronic diseases, of which 16.9% had polypharmacy vs. 83.1% without polypharmacy. Patients with polypharmacy (vs. non-polypharmacy) mean age was 82.7 (vs. 52.7), 68.9% (vs. 60.7%) were women, and 22.0% (vs. 1.2%) high risk. Their average number of chronic diseases was 4.8 (vs. 2.2), and 95.6% (vs. 56.9%) had multimorbidity. Their mean number of annual healthcare contacts was 30.3 (vs. 10.5), 25.9 (vs. 8.8) with PC and 4.4 (vs. 1.7) with HC. Factors associated with a greater PC utilization in patients with polypharmacy were elevated complexity, high risk level and dysrhythmia. Variables associated with a higher HC utilization were also increased complexity and high risk, in addition to male sex, being in palliative care, having a primary caregiver, suffering from neoplasia (specifically lymphoma or leukaemia) and arthritis, whereas older age and immobilization were negatively associated. Conclusions Polypharmacy population compared to non-polypharmacy was characterized by a more advanced age, predominance of women, high-risk, complexity, numerous comorbidities, dependency and remarkable healthcare utilization. These findings could help healthcare policy makers to optimize the distribution of resources and professionals within PC and HC systems, aiming for the improvement of polypharmacy management and rational use of medicines while reducing costs attributed to healthcare utilization by these patients.

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Prescription Analysis and Evaluation of Potential Drug–Drug Interactions among Patients Attending the Geriatric Unit at a Tertiary Care Hospital

Joshi,

Majumdar,

Patel

et al. 2023

Journal of the Indian Academy of Geriatrics

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Background: The elderly stand a greater risk of drug-drug interactions (DDIs). This study was an earnest attempt at in-depth prescriptions analysis and evaluating the potential DDIs (pDDIs) among patients in the geriatric outpatient department (OPD). Aims and Objectives: The aim is to conduct prescriptions analysis of patients and to evaluate the pDDIs among patients in the geriatric OPD. Materials and Methods: A retrospective observational study began after Institutional Review Board approval. Demographic details, clinical profile, and drugs prescribed were recorded. The prescription analysis was done by prespecified criteria and pDDIs were identified using various tools. Results: Prescriptions of 202 patients with a mean age of 68.76 years were collected. Mean drugs prescribed were 6.07. Total number of fixed-dose combinations (FDCs) and over-the-counter drugs were 669 (40.50%) and 430 (26.03%), respectively. 129 (63.9%) prescriptions were incomplete in terms of dose, duration, frequency, or dosage form. Maximum interactions - 367 (34.42%) were found with aspirin followed by cardiovascular drugs. Total prescriptions with pDDIs were 137 (67.82%) Out of 34 (3.82%) serious interactions, pharmacodynamic pDDIs were seen with aspirin and enalapril/ramipril and pharmacokinetic were between omeprazole/rabeprazole and clopidogrel. Consequences of common pDDIs were identified as deterioration in renal function and hyperkalemia. The number of interactions was positively correlated with number of FDCs and number of drugs prescribed (r = 0.427, P = 0.0001 and r = 0.189, P = 0.0001, respectively). Conclusion: Prespecified prescription analysis criteria were one of the most useful tools to improve prescribing patterns. Drug interactions can be reduced by prescribing minimum drugs in elderly, alteration in time of dosing and fractionation of dose along with amalgamating the use of online DDI checker in hospital information system. Training of prescribers especially in geriatric patients is the need of the hour.

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Drug utilization pattern and factors associated with polypharmacy and excessive polypharmacy in geriatric medical out-patients at a rural health training centre in India

Cited by 3 publications

References 6 publications

Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

Are there socioeconomic inequalities in polypharmacy among older people? A systematic review and meta-analysis

Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study

Prescription Analysis and Evaluation of Potential Drug–Drug Interactions among Patients Attending the Geriatric Unit at a Tertiary Care Hospital

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