Abstract
Clinical practice guidelines are useful to suggest pharmacological therapies for the treatment of single chronic diseases. However, there is little guidance for multimorbidity, and specific quality measures for people with multimorbidity that can be used at a population level are lacking. To describe what pharmacists and geriatricians consider to be an optimal basic pharmacological therapy for an older individual with type 2 diabetes (DM), chronic obstructive pulmonary disease (COPD) and heart failure (HF). An online cross-sectional survey among 162 pharmacists and geriatricians, in Quebec, Canada, was performed. Participants were invited to choose, from a list of 32 medications or classes, the optimal basic therapy for an individual aged 65-75 years with the 3 chronic diseases. Descriptive statistics were used to calculate the median number of medications chosen and the proportions of participants who chose each medication, according to the participant's specialty. A Kruskall-Wallis test was performed to detect whether there were differences in the median number of medications recommended according to speciality. There was little consensus on the optimal basic pharmacological therapy for this hypothetical multimorbid individual, with 157 different combinations provided by the 162 participants. Nevertheless, 5 classes were chosen by at least 75% of the participants: metformin, long-acting anticholinergic agents, angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs), beta-blockers, and short-acting beta-agonists. The median number of recommended medications was 10 (interquartile range [IQR]: 6-13). There was a statistically significant difference between specialties (p = 0.0396). Geriatricians recommended the lower median number of medications, 7 (IQR: 5-10). At least half of the participants considered polypharmacy (≥10 medications) inevitable for an optimal basic treatment of DM, COPD and HF. The heterogeneity of responses raises issues when considering quality indicators in population-based studies.
Highlights
Aging is almost unavoidably associated with the presence of multimorbidity,[1] defined as the co-occurrence of two or more diseases in a single person.[2]
It has been reported that 62% of U.S Medicare individuals aged 65–74 years live with two or more chronic diseases, while multimorbidity rises to 81.5% for individuals 85 years old and older.[3]
The objective of this study was to investigate what pharmacists and geriatricians consider to be an optimal basic pharmacological therapy of a multimorbid person—that is, the basic therapy most individuals would need in a population-based point of view
Summary
Aging is almost unavoidably associated with the presence of multimorbidity,[1] defined as the co-occurrence of two or more diseases in a single person.[2]. While clinical practice guidelines are extremely useful tools for the treatment of single chronic diseases, there is little guidance for evidence-based pharmacological therapies in multimorbidity.[6] for the treatment of individuals with complex comorbid diseases, clinicians tend to follow clinical practice guidelines for each disease. This behaviour can lead to competing or conflicting situations and increase the risk for the individuals to be exposed to an unnecessary number of medications.[6]. The heterogeneity of responses raises issues when considering quality indicators in population-based studies
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