Polypharmacy Use Research Articles

Treatment patterns and appropriateness of antipsychotic prescriptions in patients with schizophrenia

Schizophrenia is a chronic mental condition presenting a wide range of symptoms. Although it has a low prevalence compared to other mental conditions, it has a negative impact on social and occupational functions. This study aimed to assess the appropriateness of antipsychotic medications administered to schizophrenic patients and describe current treatment patterns for schizophrenia. A retrospective cohort study was conducted in all patients over the age of 15 with an active diagnosis of schizophrenia and treated with antipsychotics between 2008 and 2013 in the Valencia region. A total of 19,718 patients were eligible for inclusion. The main outcome assessed was inappropriateness of the pharmacotherapeutic management, including polypharmacy use. Altogether, 30.4% of patients received antipsychotic polypharmacy, and 6.8% were prescribed three or more antipsychotics. Overdosage affected 318 individuals (1.6%), and 21.5% used concomitant psychotropics without an associated psychiatric diagnosis. Women and people with a comorbid condition like anxiety or depression were less likely to receive antipsychotic polypharmacy. In contrast, increased polypharmacy was associated with concomitant treatment with other psychoactive drugs, and only in user on maintenance therapy, with more visits to the mental health hospital. Overall, we observed a high level of inappropriateness in antipsychotic prescriptions. Greater adherence to guidelines could maximize the benefits of antipsychotic medications while minimizing risk of adverse effects.

High-level psychotropic polypharmacy: a retrospective comparison of children in foster care to their peers on Medicaid

BackgroundThe use of antipsychotic medication and psychotropic polypharmacy has increased in the United States over the last two decades especially for children from low-income families and those in foster care. Although attention has been paid to providing greater insight, prescribing patterns remain concerning since there is a lack of evidence related to safety and efficacy. High-level psychotropic polypharmacy has not been described. We aim to compare the use of HLPP for children receiving Medicaid services and those in foster care and identify factors associated with the duration of use of high-level psychotropic polypharmacy. Additionally, we will examine the frequency of laboratory metabolic screening and emergency department, inpatient, and outpatient visits.MethodsA cross-sectional, secondary analysis of statewide data describes trends in high-level psychotropic polypharmacy from 2012 to 2017 and the prevalence and predictors of high-level psychotropic polypharmacy duration and resource use in 2017 for all children on Medicaid and those in foster care. High-level psychotropic polypharmacy included concurrent use, at least four classes of medications including an antipsychotic, and at least 30 days duration.ResultsHigh-level psychotropic polypharmacy increased from 2012 to 2014 for both groups but stabilized in 2015–2016. Children in foster care showed a slight increase compared to their peers in 2017. There was no association between duration and demographic characteristics or foster care status. Diagnoses predicted duration. Neither group received metabolic monitoring at an acceptable rate.ConclusionsConcerning patterns of high-level psychotropic polypharmacy and metabolic monitoring were identified. Cautious use of high-level psychotropic polypharmacy and greater oversight to ensure that these children are receiving comprehensive services like behavioral health, primary care, and primary prevention.

The use of antipsychotic polypharmacy at Ravenswood House Medium Secure Unit: the extent of use and reporting of outcomes

AimsTo evaluate the use of antipsychotic polypharmacy in Ravenswood House Medium Secure Hospital. We also aimed to review the reporting of the outcomes of their use.BackgroundThe use of antipsychotic polypharmacy (APP) continues to be practised within forensic psychiatric inpatient settings yet there is a lack of robust evidence for the benefits of doing so. The practice is also associated with the use of higher total antipsychotic doses beyond the recommended BNF maximum. Such prescribing is associated with an increased side effect burden. Doctors have a duty to justify the ongoing use of antipsychotic polypharmacy and to avoid potentially ineffective and/or harmful use.MethodA cross-sectional review of the medication cards for 51 in-patients at Ravenswood House Hospital was completed. Demographic data and data pertaining to diagnoses and medication was also gathered from the electronic patient records.Result23 patients (45%) in Ravenswood House Hospital were prescribed antipsychotic polypharmacy. 87% of those prescribed antipsychotic polypharmacy had a primary diagnosis of either schizophrenia or schizoaffective disorder. 19 patients (37%) had two regular antipsychotics prescribed. 74% of these prescriptions were above the recommended BNF maximum. 62% were also prescribed a regular benzodiazepine. The vast majority of indications documented for APP were chronic behavioural disturbance and treatment resistant schizophrenia. The majority of these patients were on a T3. There was a significant under reporting of the rationale of prescribing APP. It could be surmised that at least 11 combinations were in part to mitigate side effects, but only 3 had this documented. There was also a lack of documentation or use of rating scales regarding the clinical outcomes and side effects of APP.ConclusionPrescription of antipsychotic polypharmacy is an important issue in secure forensic hospital settings. The lack of clear documentation of clinical effectiveness and side effect burden remains a concern. Wider study is required to establish the benefits of such prescribing to justify its ongoing use.

A Systematic Review of Complex Polypharmacy in Bipolar Disorder: Prevalence, Clinical Features, Adherence, and Preliminary Recommendations for Practitioners.

Objective: Extensive combination pharmacotherapy regimens for bipolar disorder have gained increasing use in routine practice in ways that outpace data from evidence-based clinical trials. The present review examined the prevalence of complex pharmacotherapy regimens in bipolar disorder patients and sought to characterize factors that most influence polypharmacy prescribing patterns. Data Sources: The authors independently systematically searched the MEDLINE, PsycINFO, and Embase databases for English-language observational/naturalistic or randomized controlled polypharmacy trials, using the keywords bipolar and polypharmacy or bipolar and combination treatment and pharmacotherapy. Study Selection: From among 3,566 publications, 49 ultimately met study inclusion criteria. Data Extraction: Information was obtained regarding prevalence rates of extensive polypharmacy as well as clinical characteristics and naturalistic outcomes for patients with simple (≤ 2) or complex (≥ 3) regimens of psychotropic agents. Results: A weighted mean percentage of 32.7% of bipolar outpatients (4,535/13,863) taking ≥ 3 psychotropic medications was identified. Factors associated with complex polypharmacy use include female sex, White race, age > 50 years, history of psychosis, greater burden of depressive illness, subtherapeutic dosing, lower treatment adherence, more extensive psychiatric comorbidity, and a greater history of suicide attempts. Conclusions: Extensive or complex combination pharmacotherapy regimens are common in many patients with bipolar disorder and often reflect greater overall illness severity. Naturalistic studies do not point to better outcomes for patients receiving more complex drug regimens, suggesting likely confounding by indication, high severity, or comorbid conditions. Formal clinical trials are needed to identify optimal drug combinations and durations when using ≥ 3 psychotropic medications to treat patients with bipolar disorder.

Patient factors associated with the use of psychotropic polypharmacy in patients under the care of a community mental health team in the West of Ireland

AimsPsychiatric polypharmacy refers to the prescription of two or more psychotropic medications to any one patient. This definition is purely quantitative and does not take into account whether such a prescription is detrimental, or unnecessary. In many cases, polypharmacy has been implemented in challenging illnesses, and some studies have shown that it can improve overall outcomes for certain patients. Evidence suggests that the prevalence of psychotropic polypharmacy is increasing, despite advances in psychosocial interventions. The aim of this study was to assess the current prevalence of polypharmacy among patients being treated by a community mental health team (CMHT), and the patient factors associated with its use.MethodWe performed a cross-sectional study of all patients registered with a CMHT in a mixed urban/rural area on a single date. Case records were examined to determine the most recently prescribed drug regimen for each patient. Clinical chart diagnoses were recorded and each one independently verified by the team consultant using ICD-10. A number other sociodemographic variables were recorded. Using Microsoft Excel, we analysed the medications prescribed as well as rates and levels of polypharmacy based on multiple different patient characteristics.ResultOf the 245 patients, the mean age was 56.3 and 51.2% (n = 126) were female. Psychotropic polypharmacy was seen in 62% (n = 152) of patients. 33% (n = 82) of patients were on two psychotropic medications, and of this subset, a combination of one antipsychotic and one antidepressant was the most common drug regimen, seen in 16.7% (n = 41) of all patients. Polypharmacy was more prevalent in females, with 68% (n = 85) being on two or more psychotropics, in comparison to 58% of male patients. In relation to age, patients aged between 51 to 65 years had the highest prevalence of polypharmacy, at a rate of 71% (n = 49). Among all primary diagnoses, polypharmacy was most common in patients with affective disorders, with 80% (n = 40) of this patient cohort on two or more medications. Second to this was psychotic disorders, with polypharmacy seen in 65% (n = 62) of this group.ConclusionWe found that psychotropic polypharmacy is highly prevalent in psychiatric patients being treated in a community setting. Certain demographics and patient factors, such as age, gender and psychiatric diagnosis influenced the rate of polypharmacy and certain drug combinations were more commonly prescribed than others.

Polypharmacy as maintenance treatment in bipolar illness: A systematic review.

ABSTRACTObjectivesPolypharmacy is common in maintenance treatment of bipolar illness, but proof of greater efficacy compared to monotherapy is assumed rather than well known. We systematically reviewed the evidence from the literature to provide recommendations for clinical management and future research.MethodA systematic review was conducted on the use of polypharmacy in bipolar prophylaxis. Relevant papers published in English through 31 December 2019 were identified searching the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library.ResultsTwelve studies matched inclusion criteria, including 10 randomized controlled trials (RCTs). The best drug combination in prevention is represented by lithium + valproic acid which showed a significant effect on time to mood relapses (HR = 0.57) compared to valproic acid monotherapy, especially for manic episodes (HR = 0.51). The effect was significant in terms of time to new drug treatment (HR = 0.51) and time to hospitalization (HR = 0.57). A significant reduction in the frequency of mood relapses was also reported for lithium + valproic acid vs. lithium monotherapy (RR=0.12); however, the trial had a small sample size. Lamotrigine + valproic acid reported significant efficacy in prevention of depressive episodes compared to lamotrigine alone.ConclusionsThe literature to support a generally greater efficacy with polypharmacy in bipolar illness is scant and heterogeneous. Within that limited evidence base, the best drug combination in bipolar prevention is represented by lithium + valproic acid for manic, but not depressive episodes. Clinical practice should focus more on adequate monotherapy before considering polypharmacy.

Associated factors with the prescription of potentially inappropriate medication for older adult in a public hospital

Objective: To evaluate the factors associated with the prescription of potentially inappropriate medications for the older adult (PIM) in a public hospital. Methods: A prospective cross-sectional study was carried out, whose data were collected from the medical records of older adult patients, admitted to the medical clinic of a public hospital, by a trained researcher, not a member of the staff. The collection took place between November 2018 and January 2019. The medical records of patients aged over 60 years, who were using at least one allopathic in-hospital medication, with a minimum of 48 hours of hospitalization, were included. Illegible prescriptions, or those containing only herbal medicines and / or vitamin supplements, were excluded. The PIMs were classified according to the Beers Criteria, 2019 update. Descriptive analysis of the data was performed using frequencies, means and standard deviation and bivariate analysis using the Chi-square and Fisher’s Exact tests, with a level of significance. p <0.05, using the software and SPSS® v.21.0. Results: 42 medical records of the older adult were analyzed, where a 100% prevalence of use of PIM and polypharmacy was identified. The number of PIMs per patient was significantly associated with females (p = 0.020), with a higher prevalence of older adult women who used between 1 and 4 PIMs (64.1%); diagnosis (p = 0.006), with a higher prevalence of older adult people with circulatory tract diseases (54.5% using 1-4 PIM), endocrine, nutritional and metabolic diseases (85.7% using 1-4 PIM) ) and diseases of the circulatory system (83.5% in use ≥5 PIM); polypharmacy (p = 0.002) with higher prevalence of older adult people who used ≥10 medications (52%, in use ≥ 5 PIM). The main therapeutic classes of PIM were of the alimentary tract and metabolism (46%) and nervous system (22%). Conclusion: It is concluded that the prescription of PIM was very high, where all the older adult in this study were exposed, being significantly associated with the female gender, polypharmacy, and diagnoses related to chronic comorbidities. It is necessary to raise the awareness of the team to adopt safer strategies and practices in the use of these drugs in order to minimize the exposure of the older adult to possible risks.

MEDICATION, COMORBIDITY AND POLYPHARMACY BURDEN IN ROMANIAN PATIENTS WITH CHRONIC KIDNEY DISEASE

Objective: Polypharmacy (prescription of minimum 5 drugs/day) is often encountered in chronic kidney disease (CKD) patients due to their high number of comorbidities. Thus, a vicious cycle is born: the prescription of more drugs can lead to drug-drug (DDI) or food-drug interactions (FDI) and adverse effects mistakenly considered new comorbidities and treated with new medications. We evaluated polypharmacy use and the potential risk of DDI/FDI in Romanian CKD patients. Design and method: Retrospective, observational study in an internal medicine clinic. Data were extracted from medical records of patients attending the clinic in a two-month period in 2018. Patients were divided into CKD patients and controls (patients diagnosed with a different disease other than CKD). DDI/FDI were checked via the Drug Interactions Checker. The hospital's ethics council approved the study (approval 4263/13.05.2019). Written informed consent was collected from all patients. Regulations imposed by the national law/Declaration of Helsinki [1975&2008(5) revised] were respected. We presented categorical variables as frequencies/percentages and continuous variables as mean±standard deviation. Continuous variables were compared via independent samples t-tests. Categorical variables were compared using Fisher's exact test. The level of significance was set at 5% and presented as p-values. The analysis was performed using GraphPadQuickCalcs. Results: Study group: 22 CKD patients, 72.72 ± 10.37 years, range 54–93 years, 54.55% males. Controls: 144 patients, 67.90 ± 13.31 years, range 22–92 years, 52.77% females. CKD patients had more comorbidities (P = 0.0001) and drug prescriptions at discharge (P = 0.005) versus controls. Polypharmacy was noted in 95.45% (N = 21) of CKD patients versus 74.30% (N = 107) of controls (P = 0.02). CKD patients were at a higher risk of DDI (P = 0.01) and especially major and moderate DDI (P = 0.005 and P = 0.02, respectively) versus controls. CKD patients had a similar risk of potential FDI and DDI to controls (Table 1). The most frequent potential DDI and FDI interactions in CKD patients are depicted in Table 2. Conclusions: Polypharmacy is a serious reason for concern in CKD patients. Their management should be targeted at reducing medication burden and revised to include only drugs with low DDI/FDI risks. Patients should be carefully monitored and informed regarding the risks posed by polypharmacy.

The challenges in schizophrenia treatment in real-life: The uncomfortable truth

Certain percentage of the first-episode schizophrenia patients presents with negative symptoms, which persists over the year and influence treatment outcomes (Galderisi et al. 2013). Treatment of negative symptoms has been a significant continuous clinical challenge. Majority of recently published guidelines recommend antipsychotic monotherapy as the standard of care, recommending antipsychotic combination therapy only after a failed trial with clozapine (George A. Keepers et al. 2020; Faden et al. 2020). However, real-life forces clinicians to look for possible combinations of medications early on, especially to tackle negative symptoms. The systematic review of global prescribing practices covering four decades found the pooled median rate of antipsychotic combination therapy approximately 20% (Gallego et al. 2012). One of the largest retrospective studies every conducted (n = 62,250) assessed rehospitalisation rates and the long-term use of antipsychotic polypharmacy in schizophrenia. Antipsychotic combination treatment was associated with an approximate 10% lower relative risk of psychiatric rehospitalisation compared with antipsychotic monotherapy (Tiihonen et al. 2019). Real-world effectiveness study of antipsychotic monotherapy vs. polypharmacy in schizophrenia from Eastern Europe is also supporting this approach (Katona, Czobor, and Bitter 2014). At the same time antipsychotic combination therapy can increase the total antipsychotic dose burden, frequency of adverse effects, potential drug-drug interactions and incur additional costs. In our recent naturalistic study in schizophrenia outpatients (n=120) with insufficient effectiveness of previous antipsychotics therapy on negative symptoms, we were able successfully switch therapy form several different antipsychotic combinations to monotherapy and gain clinical benefits (Rancans et al, 2020).DisclosureNo significant relationships.

Predictors of glycosylated haemoglobin A1C trend among type 2 diabetes patients in a multi-ethnic country

Good control of glycosylated haemoglobin A1C in diabetes patients prevents cardiovascular complications. We aim to describe the A1C trend and determine the predictors of the trend among type 2 diabetes patients in Malaysia. Longitudinal data in the National Diabetes Registry from 2013 to 2017 were analysed using linear mixed-effects modelling. Among 17,592 patients, 56.3% were females, 64.9% Malays, and the baseline mean age was 59.1 years. The U-shaped A1C trend changed marginally from 7.89% in 2013 to 8.07% in 2017. The A1C excess of 1.07% as reported in 2017 represented about 22% higher risk of diabetes-related death, myocardial infarction, and stroke, which are potentially preventable. The predictors for higher baseline A1C were non-Chinese ethnicity, younger age groups, longer diabetes duration, patients on insulin treatment, polypharmacy use, patients without hypertension, and patients who were not on antihypertensive agents. Younger age groups predicted a linear increase in the A1C trend, whereas patients on insulin treatment predicted a linear decrease in the A1C trend. Specifically, the younger adults and patients of Indian and Malay ethnicities had the poorest A1C trends. Targeted interventions should be directed at these high-risk groups to improve their A1C control.

Using a machine learning approach to investigate factors associated with treatment-resistant depression among adults with chronic non-cancer pain conditions and major depressive disorder

Objective Presence of chronic non-cancer pain conditions (CNPC) among adults with major depressive disorder (MDD) may reduce benefits of antidepressant therapy, thereby increasing the possibility of treatment resistance. This study sought to investigate factors associated with treatment-resistant depression (TRD) among adults with MDD and CNPC using machine learning approaches. Methods This retrospective cohort study was conducted using a US claims database which included adults with newly diagnosed MDD and CNPC (January 2007–June 2017). TRD was identified using a clinical staging algorithm for claims data. Random forest (RF), a machine learning method, and logistic regression was used to identify factors associated with TRD. Initial model development included 42 known and/or probable factors that may be associated with TRD. The final refined model included 20 factors. Results Included in the sample were 23,645 patients (73% female mean age: 55 years; 78% with ≥2 CNPC, and 91% with joint pain/arthritis). Overall, 11.4% adults (N = 2684) met selected criteria for TRD. The five leading factors associated with TRD were the following: mental health specialist visits, polypharmacy (≥5 medications), psychotherapy use, anxiety, and age. Cross-validated logistic regression model indicated that those with TRD were younger, more likely to have anxiety, mental health specialist visits, polypharmacy, and psychotherapy use with adjusted odds ratios (AORs) ranging from 1.93 to 1.27 (all ps < .001). Conclusion Machine learning identified several factors that warrant further investigation and may serve as potential targets for clinical intervention to improve treatment outcomes in patients with TRD and CNPC.

Polypharmacy, potentially inappropriate medication and pharmacogenomics drug exposure in the Rhineland Study.

High medication use may contribute to the efficiency of drug therapy in general, but it could also increase the burden of adverse drug reactions. We aimed to assess medication use and the prevalence of three risk factors for adverse drug reactions: the use of polypharmacy, potentially inappropriate medication in the elderly and pharmacogenomic polymorphisms affecting the metabolism of drugs. Cross-sectional interview-based medication data (including over-the-counter drugs) was collected in a large population-based cohort (≥30years of age) in Bonn, Germany. Analyses were based on the first 5000 participants of the Rhineland Study (mean age 55years, 57% women). Of our participants, 66.0% reported the use of a drug regularly, which increased to 87.4% in participants aged ≥65years (n=1301). The rates of use of polypharmacy, potentially inappropriate medication and pharmacogenomic drugs were 15.9%, 6.4% and 20.5%, respectively. In participants <65years, 16.0% (95% CI 14.8, 17.3) had at least one risk factor. In participants aged ≥65years, 54.1% (95% CI 51.4, 56.8) had at least one and 27.4% (95% CI 25.0, 29.9) had at least two risk factors. Extrapolating these numbers to the German population implies that around 9 million of the 17 million individuals aged 65years or older are potentially at an elevated risk for adverse drug reactions, of which 4.6 million are at a potentially highly elevated risk for adverse drug reactions. Our study shows that drug use is common and the individual risk for an adverse drug reaction in our population is high. This suggests room for improvement in general medication use.

Functionality During the First Five Years After the Diagnosis of Schizophrenia. A Cohort Study in a Colombian Population

ObjectiveThere is a lack of studies on the natural history of the initial stages of schizophrenia in Colombia. This study aims to assess functionality in the first five years after the diagnosis of schizophrenia. MethodsNaturalistic longitudinal study of 50 patients with early schizophrenia evaluated between 2011 and 2014. Data about demographic background, symptoms, introspection, treatment and adverse reactions were collected in all patients every 3 months for at least 3-5 years. Functionality was measured with the Global Assessment of Functioning (GAF) and Personal and Social Performance (PSP) scales. ResultsPatients were followed up for a mean of 174±62.5 weeks and showed moderate difficulties in overall functioning. This functioning was modified by polypharmacy, degree of introspection, changes in antipsychotic regimens, and the number of episodes, relapses and hospitalisations. ConclusionsThe results suggest that functional outcomes seem to be related to the use of polypharmacy, degree of insight, changes in antipsychotic regimens, and number of episodes, relapses and hospitalisations during the first years of schizophrenia.

Drug utilization pattern and factors associated with polypharmacy and excessive polypharmacy in geriatric medical out-patients at a rural health training centre in India.

Context:Multiple chronic illnesses associated with ageing population demands the role of polypharmacy. Drug utilization study in terms of description of drug use pattern in the geriatric patients aids in monitoring polypharmacy as well as to determine the factors contributing to it.Objectives:To analyse the drug utilization pattern in geriatric patients at a rural health training centre.Subjects and Methods:A cross-sectional study was conducted in a rural health centre to assess the drug utilization pattern using the WHO core drug prescribing indicators. Polypharmacy was defined as usage of 5-8 drugs and excessive polypharmacy as intake of 10 or more drugs. The drugs were coded using Anatomical Therapeutical Chemical classification. Univariate and bivariate analysis were done using SPSS to present the data.Results:Among 207 patients, 29.5% were on polypharmacy and 1.5% patients on excessive polypharmacy. About 75% of patients had one or more comorbid medical condition. A total number of 829 drugs were prescribed and the average number of drugs per prescription was 4.02.Conclusion:The drug utilization pattern analysis in the geriatric patients reveals deviation of the average number of drugs per prescription from the WHO standard recommendation. The most common comorbid condition among the geriatric patients was diabetes mellitus. This drug utilization study imparts knowledge about the use of polypharmacy, comorbidities and the pattern of commonly used drugs among the geriatric patients in rural area. Periodic assessment of the pattern of drug utilization in the elderly aids to improve the prescribing pattern and minimize patient harm.

Factors associated with perceived social support in older people with cancer

OBJECTIVE: To analyze factors associated with perceived social support in older people with cancer. METHODOLOGY: This is a cross-sectional, analytical study conducted with a convenience sample of 134 older people seen at a specialist cancer treatment unit in a hospital located in a municipal district in the South of Minas Gerais state, Brazil. Data collection was conducted by interview and analysis of medical records. Social support was analyzed using the Medical Outcomes Study social support scale. The Mann-Whitney and Kruskal-Wallis tests were used to analyze differences between means. Linear regression was used for analysis of associations. RESULTS: The majority of the sample of older people with cancer analyzed were male, aged from 60 to 74 years, and reported high mean scores for material support; affective support; positive social interaction; and emotional/informational support. Factors with positive associations with social support were: not living alone; income one to three times the minimum wage; having a partner; rating health as good/very good; and presence of comorbidity. Factors with negative associations were: poor/very poor perceived income and polypharmacy use. CONCLUSIONS: This sample of older people reported high mean scores for material support; affective support; positive social interaction; and emotional/informational support. Factors associated with perceived social support were: living arrangements; family income; perceived sufficiency of income; marital status; health self-assessment; comorbidity; and polypharmacy.

Cerebral vasculitis associated with drug abuse.

To review understand the epidemiology, background, neuropharmacology, and histopathology of literature verified cases, and likely etiopathogenic mechanisms. There are only a handful of histologically confirmed patients in the literature with cerebral vasculitis because of drug abuse. There is little justification for invasive laboratory investigation given the ready availability of highly accurate vascular neuroimaging techniques to dictate management, which usually rests upon avoidance of further exposure and minimizing the secondary neurotoxic effects of the abused substances and polypharmacy use.

Polypharmacy and Potentially Inappropriate Medications in Patients With Dementia

INTRODUCTION: The use of polypharmacy and potentially inappropriate medication (PIM) is a critical issue in geriatrics. Furthermore, the number of patients with dementia is dramatically increasing worldwide. In this study, we investigated: (1) if the states of polypharmacy and PIM differed in patients with and without dementia; (2) the types of medicine that were commonly prescribed; (3) the types of dementia that resulted in the prescription of multiple medicines; (4) if there was a correlation between the number of medicines and the number of medical institutions (hospitals and clinics) that the patients attended. METHODS: In total, 216 patients who were 65 years of age and older were analyzed. The number of medicines prescribed and the medical institutions they attended were counted through the electronic medical charts of Tohoku Medical and Pharmaceutical University Hospital. We employed the Beers 2019 criteria for the definition of PIM. RESULTS: (1) The number of prescribed medicines was not significantly different between patients with dementia and those without dementia. (2) Anti-hypertensives and gastro-intestinal medicines were the most commonly prescribed medicines in patients with and without dementia. (3) Patients with “dementia with Lewy bodies” and “mixed dementia” were prescribed the highest number of medicines. (4) The number of medicines and PIM use were significantly and positively correlated with the number of medical institutions. CONCLUSIONS: The number of medical institutions strongly affected the number of medicines prescribed and PIM use. Efforts should be made to organize and reduce the number of medical institutions that a patient attends.

Fatores associados à baixa adesão ao tratamento farmacológico de pacientes atendidos por um Centro Integrado de Saúde

Introdução: O problema com a adesão a farmacoterapia é influenciada por diversos fatores que afetam significativamente os pacientes, tornando assim um desafio a ser solucionado e que continua por anos como um dos maiores problemas de saúde, para este estudo os dados foram coletados nos atendimentos realizados pelos alunos do curso de farmácia no Centro Integrado de Saúde da Universidade Anhembi Morumbi. Objetivo: Expor os principais motivos que levaram os pacientes atendidos pelo Centro Integrado de Saúde a não continuar com a farmacoterapia. Métodos: Os dados foram coletados em consulta médica, com o formulário estruturado partir do método Dáder. Cada caso foi estudado e classificado conforme o Problema Relacionado ao Medicamento (PRM) e se necessário aplicada a intervenção farmacêutica. Desta forma, construiu-se um perfil para análise, com base em problemas que levaram a não adesão, prescritor, sexo, faixa etária e escolaridade. Resultados: O maior problema em relação à adesão está relacionado a aquisição, seguido por reações adversas a medicamentos. Do total de prescrições feitas, 72% se referem a prescrições feitas por neurologistas e reumatologistas. 71% dos pacientes são do sexo feminino, demonstraram maiores abandonos a adesão farmacoterapêutica, e 60% dos pacientes com faixa etária acima de 50 anos, são os que mais abandonam o tratamento farmacoterápico, devido o uso de polifarmacia, esquecendo de tomar os medicamentos. Conclusão: O problema com adesão ao tratamento medicamentoso é prevalente na sociedade e um grande desafio a se enfrentar, devido a influência de fatores de diversas esferas, tornando o assunto difícil de se compreender, desta forma é necessário mais estudo e analises profundas para conseguir chegar a um denominador em comum para, então, desenvolver um plano de ação, porém concluímos que os mais relevantes problemas estão relacionados com a difícil aquisição do medicamento, sendo este o problema que possui interferência direta na farmacoterapia.

APOE genotype and multimorbidity in the FINGER multidomain lifestyle trial

AbstractBackgroundA growing burden on healthcare systems is the increasing amount of chronic diseases in single person (multimorbidity), especially in the elderly population. Multimorbidity leads to many problems, such as higher use and cost of healthcare, polypharmacy and poorer quality of life. The present study reports exploratory analyses of APOE genotype and multimorbidity in the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER, ClinicalTrials.gov NCT01041989).MethodFINGER was a 2‐year randomized controlled trial with 1260 participants at risk for dementia from the general Finnish population, aged 60‐77 years. Beneficial effects of the multidomain intervention (diet, exercise, cognitive training and monitoring of vascular risk factors) versus control (regular health advice) have been previously reported on the primary cognitive outcome and several secondary outcomes. APOE and multimorbidity data at baseline and the 2‐year follow‐up were available for 532 participants in the intervention group and 527 in the control group. Multimorbidity was assessed through a standardized questionnaire, and an interview by the study physicians. The questionnaire entailed 17 diseases. Associations between APOE genotype (carrier vs non‐carrier of the ε4 allele) and multimorbidity after 2 years were assessed using logistic regression analyses, adjusted for randomization group, age, sex, education, smoking, alcohol consumption and baseline multimorbidity.ResultAt baseline APOE was not related to multimorbidity. However, in longitudinal analyses carriers of the APOE4 allele were more likely to develop 3 or more new chronic diseases during follow‐up, with OR (95%CI) 2.2 (1.04‐4.87), p=0.04. No significant associations were found between APOE and multimorbidity defined as one or more new chronic diseases (p=0.21) or 2 or more new chronic diseases (p=0.59).ConclusionPreliminary findings from the FINGER trial suggest that in this at‐risk general older population the APOE4 allele was related to multimorbidity defined as 3 or more new chronic diseases. To our knowledge this is the first study to link APOE to multimorbidity in the context of a lifestyle intervention to prevent cognitive decline. This is in line with previous findings linking APOE4 to cardiovascular and metabolic conditions.

Pharmacotherapy prescribing patterns in the treatment of bipolar disorder in a South African outpatient population

Objectives To describe the range and frequency of psychotropics used in the management of bipolar disorder in a specific setting as well as describe the nature and frequency of monotherapy versus polypharmacy use. Specifically to determine congruence with recommended standard of care that might inform a review and refinement of prescribing within this context. Methods The study was a retrospective file review for patients with bipolar disorder (ICD 10 and or DSM IV TR diagnostic criteria) attending the outpatient clinic of a specialised psychiatric hospital (Tara Hospital) affiliated to the Department of Psychiatry (University of the Witwatersrand) in Johannesburg, South Africa. Data were presented both descriptively (continuous, discrete and categorical data) and with a range of appropriate statistical tests used for associations between categorical data (Chi Square; Fisher’s exact test; Cramer’s V and the phi coefficient). Results The majority of patients (93.8%) were prescribed polypharmacy, with 3.2 as the mean number of psychotropic medications prescribed per patient (as determined from the last prescription written during the period of review, i.e. one year). There was a notable variety in the combinations used with no particular combination being prescribed in the majority of patients, noting, however, that 47% of the combinations used included a standard mood stabiliser prescribed together with an antipsychotic. Conclusions The current study provides data on the prescribing patterns for bipolar disorder in a specialist psychiatric clinic within an academic complex in South Africa. The findings reflect international studies and highlight polypharmacy and combination treatment as common in such settings. Where polypharmacy is prescribed, the variation in combinations prescribed indicate that whilst treatment guidelines may provide a best practice approach, studies determining the most useful combinations are few and ultimately clinical requirements for individual patients will dictate treatment.