The impact of number of drugs prescribed on the risk of potentially inappropriate medication among outpatient older adults with chronic diseases

Weng, Mao-Chung; Tsai, Chin‐Feng; Sheu, Kai‐Lun; Lee, Y.-T.; Lee, H.-C.; Tzeng, Shu‐Ling; Ueng, Kwo‐Chang; Chen, C.-C.; Chen, S.-C.

doi:10.1093/qjmed/hct141

Cited by 80 publications

(94 citation statements)

References 33 publications

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“…In our analysis, inverse relationships were found between age and PIM use when the PIM-Taiwan and PRISCUS criteria were applied. In line with other studies [4], [18], [22], [27]–[29], we also demonstrated a relationship between higher disease burden, higher number of medications prescribed, and higher healthcare utilization with PIM use. Although these recipients had been regularly visited by home healthcare providers, these results suggested lack of continuity of care.…”

Section: Discussionsupporting

confidence: 92%

Patient- and Clinic Visit-Related Factors Associated with Potentially Inappropriate Medication Use among Older Home Healthcare Service Recipients

et al. 2014

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ObjectivesTaiwanese National Health Insurance (TNHI) provides home healthcare services to patients with skilled nursing needs who were homebound or lived in nursing homes. Studies on potentially inappropriate medications (PIMs) for older home healthcare service recipients (HHSRs) are growing, but comparisons among newer criteria of PIMs have not been applied. The aim of this study was to explore the prevalence and correlates of PIMs based on three different instruments published after 2010 among older HHSRs.Materials and MethodsWe performed cross-sectional analysis of the TNHI Research Database. A total of 25,187 HHSRs aged more than 65 years in 2009 were included. Medication lists independent of chronic conditions from the 2012 Beers criteria, PIM-Taiwan criteria, and the PRISCUS (Latin for “old and venerable”) criteria were used. Analysis was performed separately at patient and clinic-visit level. T-tests, chi-square analysis, and multivariate logistic regressions were used where appropriate.ResultsThe prevalence of having at least one PIM at patient and clinic-visit level was highest with the Beers (82.67%, 36.14% respectively), followed by the PRISCUS (68.49%, 25.13%) and PIM-Taiwan (63.04%, 19.21%) criteria. At patient level, polypharmacy (odds ratio (OR) 2.53 to 4.90), higher number of clinic (OR 1.15 to 1.41), hospital (OR 1.24 to 1.64), and physician (OR 1.15 to 1.41) visits were associated with PIM use for all 3 sets of criteria. At clinic-visit level, internist/family physicians (OR 1.26 to 1.72) and neurologists/psychiatrists (OR 1.73 to 5.87) were more likely to prescribe PIMs than others. Psychotropic drugs and first generation antihistamines accounted for most of the top ten PIMs.ConclusionThe prevalence of PIMs was high among older Taiwanese HHSRs. Polypharmacy and certain medical specialties were associated with a higher likelihood of PIM prescriptions. Provider education and medication review and reconciliation should be considered.

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Section: Discussionsupporting

confidence: 92%

Patient- and Clinic Visit-Related Factors Associated with Potentially Inappropriate Medication Use among Older Home Healthcare Service Recipients

et al. 2014

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“…In the multivariate analysis, it was found that increasing medication use (prescribed, non-prescribed and supplement use) was associated with PDDIs and PIMS after adjusting for age, sex, ethnicity and the number of comorbidities, as previously described [9, 72, 73]. In the present study, only drug interactions which were considered clinically significant and could potentially lead to serious consequences were assessed while PIMS identified the use of medications that had a high propensity to cause adverse events in the elderly population.…”

Section: Discussionmentioning

confidence: 57%

Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

et al. 2017

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BackgroundPolypharmacy has been associated with increased morbidity and mortality in the older population.ObjectivesThe aim of this study was to determine the prevalence, risk factors and health outcomes associated with polypharmacy in a cohort of urban community-dwelling older adults receiving chronic medications in Malaysia.MethodsThis was a baseline study in the Malaysian Elders Longitudinal Research cohort. The inclusion criteria were individuals aged ≥55years and taking at least one medication chronically (≥3 months). Participants were interviewed using a structured questionnaire during home visits where medications taken were reviewed. Health outcomes assessed were frequency of falls, functional disability, potential inappropriate medication use (PIMs), potential drug-drug interactions (PDDIs), healthcare utilisation and quality of life (QoL). Risk factors and health outcomes associated with polypharmacy (≥5 medications including dietary supplements) were determined using multivariate regression models.ResultsA total of 1256 participants were included with a median (interquartile range) age of 69(63–74) years. The prevalence of polypharmacy was 45.9% while supplement users made up 56.9% of the cohort. The risk factors associated with increasing medication use were increasing age, Indian ethnicity, male, having a higher number of comorbidities specifically those diagnosed with cardiovascular, endocrine and gastrointestinal disorders, as well as supplement use. Health outcomes significantly associated with polypharmacy were PIMS, PDDIs and increased healthcare utilisation.ConclusionA significant proportion of older adults on chronic medications were exposed to polypharmacy and use of dietary supplements contributed significantly to this. Medication reviews are warranted to reduce significant polypharmacy related issues in the older population.

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“…Other studies have demonstrated a clear relationship between an increasing number of medications and increase in unintended ADEs (6,8). This relationship is not linear; in fact, one Italian study demonstrated a fourfold increase in the risk of an ADE as the medication burden increased by only three individual medications, from five to eight (17).…”

Section: Discussionmentioning

confidence: 88%

“…We recognize that even one medication inappropriately prescribed can be burdensome to the patient. For the purposes of our analysis, we used the more common definition of five or more medications (8,16). Close to 94% of patients in our cohort experienced polypharmacy using this definition.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the complex interplay of concomitantly managing life-threatening illnesses (e.g., heart failure), non-life threatening comorbid conditions (e.g., hypertension, atrial fibrillation), and symptoms (e.g., dyspnea, pain) creates challenges for both the clinicians and patients. Also, as medication lists grow, the risk for drug-drug interactions (DDIs), drug-food interactions and other adverse drug events (ADEs) increases (6–8). Naturally, it becomes difficult for even experienced and attentive clinicians to not become overwhelmed with simultaneously managing multiple medications during brief clinical visits.…”

Section: Introductionmentioning

confidence: 99%

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The Burden of Polypharmacy in Patients Near the End of Life

McNeil

Kamal

Kutner

et al. 2016

Journal of Pain and Symptom Management

107

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Context Patients with advanced illness are prescribed multiple medications in the last year of life, intensifying the risk of negative consequences related to polypharmacy. Objectives To describe the medication burden of patients near the end of life and identify potential areas for improvement in clinician prescribing practices. Methods This was a pre-specified secondary analysis of data from a prospective trial. Eligible participants were adults with less than 12 months estimated prognosis taking a statin medication for primary prevention of cardiovascular disease. Participants were enrolled from 15 sites, randomized to continue or discontinue statin medications, and followed for up to a year. Concomitant medications were recorded at least monthly from study enrollment through death. Prescribed medications were categorized by class and subclass. Descriptive statistics were calculated. Results On average, participants (N=244) were 74.3 years old (SD 11.5) and lived 264 days (SD 128); 47.5% of the patients had a primary diagnosis of malignant tumor. This population was exposed to medications across 51 classes, 192 subclasses and 423 individual medications. Patients took an average of 11.5 (SD 5) medications at the time of enrollment and 10.7 (SD 5) medications at death or study termination. The five most common classes of medications prescribed near the end of life were, anti-hypertensives, broncholytics/bronchodilators, laxatives, antidepressants, and gastric protection agents. Conclusion There is a significant medication burden placed on patients with advanced illness. Although most medications were prescribed for supportive care, we observed a high prevalence of medications for managing non-life threatening comorbidities.

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The impact of number of drugs prescribed on the risk of potentially inappropriate medication among outpatient older adults with chronic diseases

Abstract: The number of prescribed medications can be an index of PIM risk in older patients with chronic diseases. Clinicians should suspect high PIM risk in older outpatients with ≥ 5 prescriptions.

Cited by 80 publications

References 33 publications

Patient- and Clinic Visit-Related Factors Associated with Potentially Inappropriate Medication Use among Older Home Healthcare Service Recipients

Patient- and Clinic Visit-Related Factors Associated with Potentially Inappropriate Medication Use among Older Home Healthcare Service Recipients

Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multi-ethnic Malaysia

The Burden of Polypharmacy in Patients Near the End of Life

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