Multimorbidity and Polypharmacy in Family Medicine Residency Practices

Abstract

Background: Prescription-related problems among older adults have been of great interest. However, few data are available regarding the prevalence of these problems in US family medicine residency practices (FMRPs). Objective: The aim of this research was to examine the prevalence of multimorbidity, polypharmacy, and potentially inappropriate medications (PIMs) use among older adults who visited 5 FMRPs more than once a year. Methods: A cross-sectional hospital record review for patients 65 years or older who visited 1 of the 5 university-affiliated FMRPs at least twice during January 1 to December 31, 2014, was conducted. The prevalence of multimorbidity (24 chronic index conditions), polypharmacy, and PIMs use was examined. Results: A total of 1084 patients were included in the analyses. The most common chronic conditions were hypertension (87.8%), hyperlipidemia (69.7%), and osteoarthritis (56.1%). The mean number of chronic conditions was 5.3 (SD 2.6). The prevalence of multimorbidity (≥2 chronic conditions) was 95.6%. Among these multimorbid older adults (N = 1036), the mean number of medication orders was 9.04 (SD 4.36) and 1.57 (SD 0.92) for PIMs, 86.1% met polypharmacy standards (≥5 medications), and 33.4% were prescribed one or more PIMs. The proportion of patients with fewer prescriptions at the last visit was 45.4% in the polypharmacy group and 38.0% in the PIMs group. Conclusion: Our results suggest a high level of morbidity and complexity among older adults receiving care in FMRPs. Improving the continuity of care as well as promoting interdisciplinary collaboration would have potential to reduce these prescription-related problems. Further research and education to address polypharmacy and PIMs among this population at FMRPs are required.