Factors related to excessive polypharmacy (≥15 medications) in an outpatient population from Colombia

Abstract

Summary Aims To determine the frequency of excessive polypharmacy (≥15 medications) in an outpatient population from Colombia and the variables associated with this condition. Methods A cross‐sectional study using a systematised database of 6.2 million affiliates of the Colombian Health System. All patients treated uninterruptedly with 15 or more medications for 3 months (January‐March 2017) were included. Sociodemographic, pharmacological, potential drug interactions, and prescribers' variables were identified. Results A total of 264 patients with prescriptions of ≥15 medications were identified; with an estimated prevalence of excessive polypharmacy of 108.4 per 100 000 people. The mean age was 67.7 ± 17.8 years and 60.6% were females. The mean number of medications per patient was 20.1 ± 4.5 and 48.9% (n = 129) had 20 or more. The most used were antiulcer medications (89.0%; n = 235), antihypertensives (85.6%; n = 226), analgesic/antipyretic (80.3%; n = 212), psychiatric/neurologic medications (78.5%; n = 207), statins (67.4%; n = 178), acetylsalicylic acid (59.5%; n = 157), and vitamins (57.2%; n = 151). On average, each patient had 21.0 ± 11.4 drug‐drug interactions and were attended by 6.2 ± 3.1 physicians. Being treated by seven or more physicians (OR: 5.09; 95% CI: 1.64‐15.79) increased the probability of receiving more than 20 medications. Conclusions Drugs for treatment of chronic conditions prevailed, especially in elderly patients with multiple chronic conditions; however, some groups of medications without clear indications, such as antiulcer medications or vitamin supplements, also had extensive use. A main factor that increases the probability of polypharmacy greater than 20 drugs is care by seven or more physicians, which shows a fragmentation in patient care by the country's health system, without achieving co‐ordination and integration between the different agents involved in medical care, also influenced by different physicians′ practice patterns.

Polypharmacy and excessive polypharmacy in community‐dwelling middle aged and aged adults between 2011 and 2015

“…But patients already taking minimum five medications in 2014 were not excluded from the analysis. Furthermore, a recent study on factors related to the intake of minimum 15 medications found that a large majority of prescriptions was provided by the GP 34 . While this might only concern a reflection of the current primary healthcare organisation, it also supports our findings regarding GP contacts being associated with polypharmacy, bearing in mind the potential bidirectional nature of this association.…”

Extreme polypharmacy: The need to mint a new term

“…In studies conducted by this research group, we found a prevalence of excessive polypharmacy of approximately 108.4 per 100 000 people. It was also found that many patients were receiving 20 or more medications monthly (average 20.1 ± 4.5 drugs per patient), which lead us to propose that there is a new category of polypharmacy that we have decided to call “extreme polypharmacy.” This category deserves special attention because there are many consequences that can be derived from polypharmacy; it has been observed that polypharmacy raises the risk of adverse reactions (up to 82% for those patients who receive seven or more medications vs 13% in those who receive only two), the potential for interactions, a lack of adherence to treatment and decreased functional status in elderly patients …”

“…In all cases, extreme polypharmacy is aggravated by therapeutic duplications (more than one antiulcer, antidepressant, or hypnotic medication, among others) from the care provided by multiple physicians in different specialties who do not adjust their medications according to those already prescribed by others. This leads to a greater number of possible drug‐drug interactions and an increased risk of adverse events, which may go unnoticed by all of the prescribers . In addition, the costs of care become very expensive (average: U.S. $272.5 per month, range U.S. $34.9‐3840.2 per month), which impacts health systems and deserves special care from physicians and decision makers.…”

Availability of secondary healthcare data for conducting pharmacoepidemiology studies in Colombia: A systematic review

“…A pharmacy dispensing company (Audifarma SA) was identified in the SLR as the most commonly used database for RWE 34,42,61,63,72,73,94‐98,100‐109,111‐115,117,118,120,122‐131,134‐141,163,168,242,301,310 . It contains demographic data, diagnosis by ICD‐10, and drug dispensation records coded by the Anatomical Therapeutic Chemical (ATC) classification, which can be used to identify comorbidities, drug‐to‐drug interactions, medication errors, adverse events, and calculate adherence rates.…”