Medication before and after a spinal cord lesion

Abstract

Objective: To map the impact of spinal cord lesion (SCL) on medication. Study design: Registration of medication for 72 patients before SCL and at discharge from the Department for Spinal Cord Injuries. Setting: Department for Spinal Cord Injuries, East Denmark. Methods: The changes in medication for each Anatomical Therapeutic Chemical (ATC) Classification System group were registered for all patients, who were discharged from Department for Spinal Cord Injuries during 2010. The changes in medication per se were calculated for different parts of the population: non-traumatic, traumatic patients, men, women, paraplegia, tetraplegia, American Spinal Injury Association Impairment Scale (AIS) A, B or C, AIS D, age 0-45, 46-60 and 60 þ . In addition, comparisons of changes in medication were made between complementary parts of the population. Results: The overall increase in medication after SCL was 3.29 times (Po0.001). Statistically significant increases were seen for most medicine categories. When studying subgroups of the population, the increase was most constantly seen for the medicine in the groups 'Alimentary tract and metabolism' and 'Nervous system'. The highest overall increases were seen in patients with AIS A, B and C compared with AIS D (Po0.05). There was no difference between traumatic and non-traumatic SCL, men and women, and younger compared with older patients. Conclusion: SCL elicits a general massive need for medicine. The relative increase is most pronounced for the more severely injured (AIS A, B and C). The increase in medication may have implications for side effects and for the economy of all involved.

Medication-related problems in individuals with spinal cord injury in a primary care-based clinic

“…Polypharmacy in patients with SCI is common, as was observed in our study as well as in a prospective study conducted among 72 patients with spinal cord lesion 5 and a retrospective case-control analysis of 13,160 individuals with SCI. 6 However, in comparison to the retrospective case-control study, we found a higher rate of polypharmacy (74%) when all products were considered, as well as when polypharmacy was limited to prescribed and over-the-counter medications (63% vs 56%).…”

“…Jensen and colleagues 5 have documented an increase in medication intake by patients recently diagnosed with SCI in an acute care environment and Kitzman and colleagues 6 have demonstrated significantly higher rates of polypharmacy, use of high-risk medications, and occurrence of adverse drug events in patients with SCI on polypharmacy. However, neither study described the prevalence of pharmacotherapy, polypharmacy, or types of medication use among the SCI populations served by a primary care-based clinic.…”

“…A prospective study in Denmark that investigated medication use among 72 patients admitted with a spinal cord lesion found that medication consumption increased 3.29-fold relative to that before SCI. 5 Similarly, a retrospective case-control analysis of claims datasets from 4,800 hospitals between 2007 and 2009 found that patients with SCI were prescribed significantly more medications than those who did not have SCI. 6 Polypharmacy, defined as use of five or more concomitant prescribed medications, was twice as common among patients with SCI than in a control population (56% vs 27%).…”

Medication adherence for persons with spinal cord injury and dysfunction from the perspectives of healthcare providers: A qualitative study

“…1,2 Persons with SCI/D may experience multiple secondary health complications [3][4][5] and comorbid conditions. [6][7][8] As a result, treatment plans are often complex, 9,10 involving the concomitant use of multiple medications (i.e. polypharmacy), [11][12][13][14] which often include high-risk prescription drugs (e.g.…”

“…27 Although medication adherence is a primary determinant for the successful treatment of chronic conditions, 27,28 approximately half of all persons with chronic conditions in developed countries do not take their medications as prescribed. 27,29 The high instances of polypharmacy 9,13 and health and social complexities 1 in the SCI/D population underscore the need for further research into medication adherence. Through effective communication and patient-centered care, healthcare providers can play a pivotal role in improving medication adherence and self-management behaviors of patients experiencing polypharmacy.…”