Prevalence Of Polypharmacy In Patients Research Articles

Prevalence and global trends of polypharmacy in patients with chronic liver disease: A systematic review and meta-analysis.

Despite its central role in drug metabolism, the exact prevalence estimates and factors affecting global trends of polypharmacy in patients with chronic liver disease (CLD) have remained unexamined. The aim of this systematic review and meta-analysis is to estimate the prevalence of polypharmacy in patients with CLD and to comprehensively synthesize the socio-demographic factors that drive this. We conducted a comprehensive search of relevant databases (PubMed, EMBASE, Science citation index, Cochrane Database of Systematic Reviews, and database of abstracts of reviews of effectiveness) for studies published from inception to May 30, 2022 that reported on prevalence estimates of polypharmacy in patients with CLD. The risk of bias was conducted utilizing Loney criteria. The primary outcome was the pooled prevalence of polypharmacy in patients with CLD. We subsequently performed a systematic review and weighted meta-analysis to ascertain the exact pooled prevalence of polypharmacy among patients with CLD. We identified approximately 50 studies from the initial literature search, of which 7 (enrolling N = 521,435 patients) with CLD met the inclusion criteria; of these, 58.7% were male, with a mean age of 53.9 (SD ± 12.2) years. The overall pooled prevalence of polypharmacy among patients with CLD was 31% (95% confidence interval [CI]: 4%-66%, I2 = 100%, τ2 ≤ 0.001, P ≤ .0001). We found higher pooled prevalence estimates among patients aged 50 years and older compared to their younger cohorts (42%, [CI 10-77]; I2 = 100%, P = <.001 vs 21%, [CI 0-70]; I2 = 100%, P = <.001). In an examination of multiple community- and hospital-based databases of patients with CLD, we found a pooled prevalence estimate of polypharmacy of approximately 31%. This represents a case burden within the range reported in the general population and will likely respond to mitigation strategies employed thus far for patients in that population.

Prevalence of Polypharmacy in Patients With Vestibular and Balance Complaints.

To determine the prevalence of polypharmacy in patients presenting with dizziness to a tertiary neurotology clinic and analyze the association between polypharmacy and clinical characteristics. Retrospective, cross-sectional review. Demographics, symptoms, diagnoses, medications, audiometry, dizziness handicap index (DHI) scores, and cognitive failure questionnaire (CFQ) scores were extracted from charts of patients seen as new patients from September 1, 2019, to March 31, 2020, with a primary complaint of dizziness. A total of 382 patients were included. More than two-thirds of the patients (n = 265, 69.4%) met criteria for polypharmacy (≥5 medications), of which most (n = 249, 94.0%) were prescribed a potentially ototoxic drug. Approximately 10% of patients were taking five or more ototoxic medications (oto-polypharmacy). Polypharmacy was correlated to age and was more common for patients with diabetes, hypertension, other cardiovascular comorbidities, and depression (odds ratio [OR], 3.73-6.67; p < 0.05). Polypharmacy was twice as likely in patients with mild to moderate hearing loss (OR 2.02 [1.24-3.29] and OR 2.13 [1.06-4.27], respectively; p < 0.05) and ~1.5× more likely in patients who had moderate to severe DHI scores (OR 1.65 [1.05-2.59] and OR 1.63 [1.00-2.65], respectively; p < 0.05). Patients with polypharmacy also had higher CFQ scores compared to those without polypharmacy (CFQ 32.5 [19.0-48.0] versus CFQ 25.0 [13.0-40.0]; p = 0.002. Oto-polypharmacy was more common for patients with lightheadedness as a dizziness descriptor (OR 3.16 [1.56-6.41]; p < 0.01). However, oto-polypharmacy was only more common for patients with mild to moderate hearing loss (OR 2.69 [1.33-5.45] and OR 2.86 [1.31-6.20], respectively; p < 0.01) and severe DHI scores (2.31 [1.12-4.77], p = 0.02). The prevalence of polypharmacy in patients with vestibular disorders is high. Some of the medications that patients are on are also potentially ototoxic at variable degrees. Polypharmacy is more common when lightheadedness is one of the dizziness descriptors and seems to be associated with worse scores on patient-reported outcome measures (DHI, CFQ). Medication reconciliation and multidisciplinary involvement could help to better address polypharmacy in this patient population. However, further investigation is needed to elucidate polypharmacy's role in symptom presentation, vestibular testing results, and therapeutic strategies.

Elderly patients with comorbid hypertension who prefer primary care have a lower rate of polypharmacy: A cross-sectional study in Shanghai, China.

In 2017, the World Health Organization highlighted polypharmacy as one of the key focus areas of the Global Patient Safety Challenge on Medication Safety. According to the experience of developed countries, the provision of primary pharmaceutical care plays a very important role in the intervention of polypharmacy in the elderly. It is necessary to assess the associations between elderly polypharmacy status and primary care in developing countries. The findings of this paper provide the prevalence of polypharmacy in patients with comorbid hypertension, and the factors associated with it. A total of 19,332 elderly patients with hypertension were completed, among which the mean (SD) number of diseases was 4.83 (1.99), the mean (SD) daily maximum number of drugs was 5.13 (2.89), and the rate of polypharmacy was 50.5%. Age, living areas, total number of visits, preference for medical institutions and the number of diseases were associated with polypharmacy. Among them, advanced age, greater number of visits and diseases are the risk factors of polypharmacy for elderly patients with comorbid hypertension. The rate of polypharmacy in patients who intend to seek treatment in community healthcare centers is low. A total of 9,603 pharmaceutical workers worked in Shanghai public hospitals in 2020, among them 52.0% worked in the central city area, and more than 70% worked in secondary and tertiary hospitals. There was a large mismatch between patients' medical preference and the number of pharmaceutical personnel. As a consequence, it is necessary to strengthen the development of community pharmaceutical care in primary medical institutions for elderly polypharmacy management.

149 Polypharmacy in Patients Hospitalised With Heart Failure: Retrospective Audit

Polypharmacy is associated with adverse outcomes including falls, adverse drug reactions, increased length of stay in hospital and readmission. To evaluate the prevalence of polypharmacy in patients hospitalised with heart failure (HF) and identify opportunities to optimise medication. Consecutive patients with a primary HF diagnosis discharged from the Cardiology ward of one hospital were retrospectively identified (October 2018 - January 2019). Medications at admission and discharge were identified from medical records. Polypharmacy and hyperpolypharmacy were defined as taking ≥5 and ≥10 medications respectively (including OTC, supplements and as-needed medications). We identified 30 patients. For four patients hospitalised twice during the study period, we analysed the first hospitalisation. Mean age was 77±12 years, 70% were male, 67% had reduced ejection fraction (≤40%), 20% had a new HF diagnosis, and 79% had ≥5 comorbidities, the most common being atrial fibrillation (83%), hypertension (77%), diabetes (47%) and ischaemic heart disease (43%). Polypharmacy was present in 93% on admission and 100% on discharge, with hyperpolypharmacy in 67% on admission and 80% on discharge. Half of the patients had ≥5 medication changes at discharge compared with admission. While most medications were appropriate, the most prevalent potential targets for deprescribing identified were proton pump inhibitors (50%), magnesium supplements (30%) and antidepressants (7%). Polypharmacy is common among patients hospitalised with HF, with a further increase at discharge. Hospitalisation provides a potential opportunity for strategies to optimise and deprescribe medication.

Polypharmacy in a hospitalized psychiatric population: risk estimation and damage quantification

BackgroundPolypharmacy increases the risk of pharmacological interactions, prevalence of secondary effects and with this the lack of adherence to treatment. It is estimated that between 10 and 40% of patients hospitalized in psychiatric institutions are prescribed more than one antipsychotic. The objective of the present study was to identify the prevalence of polypharmacy, evaluate adverse effects associated to the use of psych drugs and to estimate the risk in specific groups.MethodsWe carried out a longitudinal, retrospective study that included the analysis of all discharged patients (n = 140) in the first trimester of the year in a psychiatric hospital in Mexico. The information was classified into 7 sections: sociodemographic, diagnosis, clinical follow-up information, prescribed drugs, adverse reactions, substance abuse, laboratory and complementary results.Risk estimation was obtained with Odds Ratios, to correlate continuous variables Pearson’s correlation was used. Student’s T and Mann Whitney’s U were used to compare 2 independent samples; multiple and linear regressions were carried out.ResultsThe mean number of drugs used during hospitalization was 7.8 drugs per patient. The mean prescribed psych drugs was 4.07. The mean antipsychotic dose was the risperidone equivalent of 5.08 mg. 29.2% of patients had at least one secondary effect associated to the use of drugs, 17.8% presented extrapyramidal symptoms. 81.4% of patients were prescribed 6 or more drugs (polypharmacy) and were 5 times more likely to suffer a secondary effects (OR 6.24). 14.2% had polypharmacy while receiving antipsychotics and had more than twice the risk of presenting extrapyramidal symptoms (OR 3.05). For each added psych drug, hospital stay increased by 6.56 days.ConclusionsDespite international guideline recommendations where reasoned and conciliatory prescription of psych drugs is advised, there is still a high prevalence of polypharmacy in patients hospitalized in psychiatric institutions. In the present study 4 out of 5 patients received polypharmacy decreasing tolerability, treatment adherence and increasing the risk and costs secondary to an increased hospital stay.

Prevalence of polypharmacy in patients of the emergency hospital in East Kazakhstan

Background Polypharmacy i.e. administration of more medications than are clinically indicated is common among the elderly in many countries and is associated with negative health outcomes. European studies have reported the prevalence of polypharmacy ranging from 30.4% and 84.5%, but the evidence from Central Asian countries of the European WHO region is almost non-existent. The aim of this pilot study is to assess the prevalence of polypharmacy in a …

E35. Prevalence of Polypharmacy in Patients with Rheumatoid Arthritis and Association with Disease Characteristics

E35. Prevalence of Polypharmacy in Patients with Rheumatoid Arthritis and Association with Disease Characteristics

Perfil de prescripción farmacológica en pacientes con enfermedades crónicas no neoplásicas en fase avanzada

ObjectivesTo analyze the prescription profile and the factors associated with multiple medications (polypharmacy) and non-adherence in patients with advanced chronic diseases. Material and methodsLongitudinal cross-sectional study including 41 Spanish hospitals (PALIAR project). Polypharmacy was defined as a prescribed treatment with five or more drugs, and excessive polypharmacy when the number was ten or more. The adherence was evaluated using a questionnaire completed by the patients or their caregivers. Description of drug prescription profile and analysis was performed on the risk factors associated with multiple medications and non-adherence. ResultsThe study included 1847 patients, and 1778 (96.2%) completed the questionnaire. Mean age was 78.74±10 years. Antihypertensives (82.6%), gastroprotectives (73.8%), anti-platelets/anticoagulants (70.3%), and psychotropic drugs (51.8%) were the most frequently prescribed drugs. Prevalence of polypharmacy/excessive polypharmacy was 86.2%/31.3%, with a mean of 8±3.5 drugs per patient. Errors in treatment compliance were detected in 48.2% of patients, but 38.5% and 9.6% referred to an occasional or almost daily failure, respectively. Factors associated with non-adherence were: to be a patient with multiple diseases, cognitive impairment, three or more 3 hospital admissions in the last three months, and having polypharmacy. Factors associated with polypharmacy were: to be a patient with multiple diseases, an ECOG score <3, age <85 years, and 3 or more hospital admissions. Factors associated with excessive polypharmacy were: to be a patient with multiple diseases and previous frequent hospital admissions. ConclusionsThe prevalence of polypharmacy in patients with advanced chronic diseases is high, and mistakes in treatment compliance are frequent. Further studies with better defined objectives and more specific therapeutic limits are needed.

POLYPHARMACY IN ELDERLY STROKE PATIENTS: AN OBSERVATIONAL AND INTERVENTIONAL STUDY IN A PORTUGUESE STROKE UNIT

Background: Portugal’s population is ageing. High comorbidity and polypharmacy are associated to increased age. Although controversial, most authors define polypharmacy as 6 or more prescribed drugs. Polypharmacy represents increased risk of interaction and side-effects. Stroke is a critical event that demands review of long-term medication. To our knowledge, this is the first study to analyze the profile of highly medicated stroke patients. Methods: Observational study of routinely collected data over a 6-month period in a Stroke Unit of an Internal Medicine Department. Statistical analysis with T-test and chi-square test was performed. Results: 89 consecutive acute stroke patients reported during this period. Mean age 75.5±11.5 years, 59.6% women and 55.1% of patients had 6 or more drugs before admission. We found that polypharmacy patients were older (80.3±8.8 vs 69.7±11.9, p<0.001); had more established diagnosis (9.8 vs 7.7, p=0.01); higher Charlson Comorbidity Index (7.3 vs 4.0, p<0.001) and a higher prevalence of Dementia (34.7% vs 5.0%, p=0.001), Ischemic Heart Disease (86.7% vs 13.3%, p=0.007), Heart Failure (44.9 vs 10.0%, p<0.001) and Diabetes mellitus (46.9% vs 20.0%, p=0.008). At discharge, a reduction of 19.1% on the total amount of drugs was achieved. Conclusion: There is a high prevalence of polypharmacy in patients with acute stroke and an association to high comorbidity. Evidence-based guidelines may increase the total number of recommended drugs in stroke patients but, meanwhile, a reduction is observed. Criteria should be used to screen and stop potentially inappropriate medication (PIM). An interventional study on PIM is warranted in our unit.

Estudio de pacientes polimedicados mayores de 65 años en un centro de asistencia primaria urbano

Objective To identify and characterise the polymedicated population over 65 years-old; and to determine the prevalence of drugs and the diseases in this population subgroup. Design Cross-sectional study. Setting A primary care centre Zaidín-Centro in Granada. Andalusian Public Health Service. Participants A total of 305 patients over 65 years-old taking polypharmacy (defined as use of five or more drugs, during a period equal to or greater than six months by any route) selected by stratified sampling by sex, age and number of drugs consumed. Principal measurements The analysed variables were sex, age, number of diseases, number of drugs and medical doctor. Results The prevalence of polypharmacy in patients over 65 years-old was 33.77%. These patients were using an average number of drugs of 8.7 ± 2.5 and had an average number of diseases of 5.56 ± 1.89. The prevalence of polypharmacy was greater among women, but differences decreased in people more than 85 years old. The antihypertensive pharmacological group was the most commonly used, in accordance with the most frequent disease, arterial hypertension. We found a strong relationship between the number of drugs and the number of diseases (p = 0.05). Conclusions Chronic use of drugs in the elderly is of considerable magnitude, affecting one out of every three. Polypharmacy in the elderly is a common and serious problem that needs to be reviewed and evaluated continuously.