Polypharmacy prevalence and associated factors in patients with systemic lupus erythematosus: A single-centre, cross-sectional study.

OBJECTIVES: This study aimed to clarify factors associated with polypharmacy among patients with systemic lupus erythematosus. METHODS: This single-centre cross-sectional study was conducted by reviewing the medical records and questionnaire data of 261 systemic lupus erythematosus patients at a teaching hospital in Japan from 1 September to 30 November 2020. Polypharmacy was defined as the regular administration of five or more oral medications; excessive polypharmacy consisted of the regular use of ten or more oral medications. This study investigated 1) the prevalence of polypharmacy and excessive polypharmacy, 2) the distribution of medication types, and 3) factors associated with polypharmacy and excessive polypharmacy. RESULTS: The proportions of patients that exhibited polypharmacy and excessive polypharmacy were 70% and 19%, respectively. Polypharmacy was associated with older age, long duration of systemic lupus erythematosus, high disease activity, and administration of glucocorticoids or immunosuppressive agents. Excessive polypharmacy was associated with a higher updated Charlson comorbidity index, history of visits to multiple internal medicine clinics, and presence of public assistance. CONCLUSIONS: Polypharmacy and excessive polypharmacy in patients with systemic lupus erythematosus are related to medical aspects such as disease severity and comorbidities in addition to social aspects such as hospital visitation patterns and economic status.

Pattern of in-hospital changes in drug use in the older people from 2010 to 2016.

PURPOSE: To assess the pattern of in-hospital changes in drug use in older patients from 2010 to 2016. METHODS: People aged 65 years or more acutely hospitalized in those internal medicine and geriatric wards that did continuously participate to the REgistro POliterapie Società Italiana di Medicina Interna register from 2010 to 2016 were selected. Drugs use were categorized as 0 to 1 drug (very low drug use), 2 to 4 drugs (low drug use), 5 to 9 drugs (polypharmacy), and 10 or more drugs (excessive polypharmacy). To assess whether or not prevalence of patients in relation to drug use distribution changed overtime, adjusted prevalence ratios (PRs) was estimated with log-binomial regression models. RESULTS: Among 2120 patients recruited in 27 wards continuously participating to data collection, 1882 were discharged alive and included in this analysis. The proportion of patients with very low drug use (0-1 drug) at hospital discharge increased overtime, from 2.7% in 2010 to 9.2% in 2016. Results from a log-logistic adjusted model confirmed the increasing PR of these very low drug users overtime (particularly in 2014 vs 2012, PR 1.83 95% CI 1.14-2.95). Moreover, from 2010 to 2016, there was an increasing number of patients who, on polypharmacy at hospital admission, abandoned it at hospital discharge, switching to the very low drug use group. CONCLUSION: This study shows that in internal medicine and geriatric wards continuously participating to the REgistro POliterapie Società Italiana di Medicina Interna register, the proportion of patients with a very low drug use at hospital discharge increased overtime, thus reducing the therapeutic burden in this at risk population.

Polypharmacy and Excessive Polypharmacy Among Persons Living with Chronic Pain: A Cross-Sectional Study on the Prevalence and Associated Factors.

Purpose: Polypharmacy can be defined as the concomitant use of ≥5 medications and excessive polypharmacy, as the use of ≥10 medications. Objectives were to (1) assess the prevalence of polypharmacy and excessive polypharmacy among persons living with chronic pain, and (2) identify sociodemographic and clinical factors associated with excessive polypharmacy. Patients and Methods: This cross-sectional study used data from 1342 persons from the ChrOnic Pain trEatment (COPE) Cohort (Quebec, Canada). The self-reported number of medications currently used by participants (regardless of whether they were prescribed or taken over-the-counter, or were used for treating pain or other health issues) was categorized to assess polypharmacy and excessive polypharmacy. Results: Participants reported using an average of 6 medications (median: 5). The prevalence of polypharmacy was 71.4% (95% CI: 69.0-73.8) and excessive polypharmacy was 25.9% (95% CI: 23.6-28.3). No significant differences were found across gender identity groups. Multivariable logistic regression revealed that factors associated with greater chances of reporting excessive polypharmacy (vs <10 medications) included being born in Canada, using prescribed pain medications, and reporting greater pain intensity (0-10) or pain relief from currently used pain treatments (0-100%). Factors associated with lower chances of excessive polypharmacy were using physical and psychological pain treatments, reporting better general health/physical functioning, considering pain to be terrible/feeling like it will never get better, and being employed. Conclusion: Polypharmacy is the rule rather than the exception among persons living with chronic pain. Close monitoring and evaluation of the different medications used are important for all persons, especially those with limited access to care.

Prevalence and factors associated with polypharmacy among patients with rheumatoid arthritis: a single-centre, cross-sectional study.

OBJECTIVE: This study aimed to identify factors associated with polypharmacy, including social aspects, among patients with rheumatoid arthritis. METHODS: We conducted this single-centre, cross-sectional study at a 715-bed regional tertiary care teaching hospital in Japan from 1 September to 30 November 2020. Polypharmacy was defined as having five or more medications administered orally regularly, and excessive polypharmacy was defined as having 10 or more medications administered orally regularly. The prevalence of polypharmacy and excessive polypharmacy, distribution of medication types, and factors associated with polypharmacy and excessive polypharmacy were investigated among patients with rheumatoid arthritis. RESULTS: The proportions of polypharmacy and excessive polypharmacy were 61% and 15%, respectively, in 991 patients. Polypharmacy and excessive polypharmacy were associated with older age (odds ratio, 1.03 and 1.03, respectively), high Health Assessment Questionnaire Disability Index (odds ratio, 1.45 and 2.03, respectively), medication with glucocorticoids (odds ratio, 5.57 and 2.42, respectively), high Charlson comorbidity index (odds ratio, 1.28 and 1.36, respectively), and a history of hospitalisation in internal medicine (odds ratio, 1.92 and 1.87, respectively) and visits to other internal medicine clinics (odds ratio, 2.93 and 2.03, respectively). Moreover, excessive polypharmacy was associated with the presence of public assistance (odds ratio, 3.80). CONCLUSIONS: Considering that polypharmacy and excessive polypharmacy are associated with a history of hospitalisation and glucocorticoid medication in patients with rheumatoid arthritis, medications during hospitalisation should be monitored, and glucocorticoids should be discontinued. Key points • The proportion of polypharmacy (five or more medications administered orally regularly) was 61%. • The proportion of excessive polypharmacy (10 or more medications administered orally regularly) was 15%. • Medications during hospitalisation should be reviewed and examined, and glucocorticoids should be discontinued.

Polypharmacy in Polish Older Adult Population-A Cross-Sectional Study: Results of the PolSenior Project.

Polypharmacy is a challenging issue in geriatrics. The aim of the study was to characterize correlates of polypharmacy in the PolSenior project. The PolSenior project, was a comprehensive survey in a large and longitudinal representative sample of thePolish older population. The project was conducted by the International Institute of Molecular and Cell Biology in Warsaw between 2008 and 2011. All medications consumed during the week preceding the survey were evaluated for each participant (n = 4793, including 2314 females (48.3%)). Thereafter, the percentage of those with polypharmacy (at least 5 medications) and excessive polypharmacy (at least 10 medications) was calculated, and their correlates were determined. The average number of medications used by participants was 5.1 ± 3.6, and was higher in females than in males (5.5 ± 3.5 vs. 4.8 ± 3.5; p < 0.001). Polypharmacy characterized 2650 participants (55.3%) and excessive polypharmacy-532 of them (11.1%). The independent correlates associated withpolypharmacy were: age over 70 years, female sex, higher than primary education, living in an urban area, comorbidities, any hospitalization during past five years, and visiting general practicioners at least yearly. As for correlates with excessive polypharmacy, they were: age 80-84 years, female sex, living in an urban area, diagnosis of at least four chronic diseases, and at least two hospitalizations in the last five years. This study serves as a starting place to understand patient characteristics associated with polypharmacy, excessive polypharmacy, and identify targeted interventions.

Relation between drug therapy-based comorbidity indices, Charlson's comorbidity index, polypharmacy and mortality in three samples of older adults.

BACKGROUND: Comorbidity indexes were designed in order to measure how the disease burden of a patient is related to different clinical outcomes such as mortality, especially in older and intensively treated people. Charlson's Comorbidity Index (CCI) is the most widely used rating system, based on diagnoses, but when this information is not available therapy-based comorbidity indices (TBCI) are an alternative: among them, Drug Derived Complexity Index (DDCI), Medicines Comorbidity Index (MCI), and Chronic Disease Score (CDS) are available. AIMS: This study assessed the predictive power for 1-year mortality of these comorbidity indices and polypharmacy. METHODS: Survival analysis and Receiver Operating Characteristic (ROC) analysis were conducted on three Italian cohorts: 2,389 nursing home residents (Korian), 4,765 and 633 older adults admitted acutely to geriatric or internal medicine wards (REPOSI and ELICADHE). RESULTS: Cox's regression indicated that the highest levels of the CCI are associated with an increment of 1-year mortality risk as compared to null score for all the three samples. DDCI and excessive polypharmacy gave similar results but MCI and CDS were not always statistically significant. The predictive power with the ROC curve of each comorbidity index was poor and similar in all settings. CONCLUSION: On the whole, comorbidity indices did not perform well in our three settings, although the highest level of each index was associated with higher mortality.

Avaliação de polifarmácia excessiva e interações medicamentosas de fármacos de ação central em pacientes de uma unidade de terapia intensiva (UTI) / Evaluation of excessive polypharmacy and interactions of central-acting drugs in patients of an intensive care unit (ICU)

A unidade de terapia intensiva (UTI) é um setor hospitalar destinado a prestar atendimento a pacientes graves e de risco. Em UTI diversos medicamentos de ação central são utilizados. O uso de múltiplos medicamentos se torna um desafio em pacientes em UTI. Nesse contexto, o termo polifarmácia é amplamente utilizado para descrever o uso simultâneo de cinco ou mais medicamentos e, quando há uso de dez ou mais medicamentos, é utilizado o termo polifarmácia excessiva. O risco de efeitos adversos aumenta na proporção em que há aumento do número de medicamentos assim como elevado risco de interação medicamentosa (IM), ou seja, influência (sinérgica ou antagônica) que um fármaco exerce na ação de outro. A função renal de pacientes internados em UTI é outro aspecto relevante, já que os rins desempenham papel fundamental na eliminação de fármacos. Assim, o conhecimento técnico científico do enfermeiro e da equipe multidisciplinar é de extrema importância para garantir a segurança do paciente. O objetivo do estudo foi analisar e classificar a polifarmácia excessiva, interações medicamentosas potenciais e condição metabólica e de excreção (função renal) de pacientes internados em UTI que fazem uso de fármacos de ação central e demais fármacos. Trata-se de um estudo descritivo, observacional e transversal. Foi utilizado análise descritiva e de regressão logística. Foi identificado polifarmácia excessiva em grande parte da prescrição médica no primeiro dia de internação e houve associação com o desfecho alta e óbito, assim como com níveis glicêmicos elevados no primeiro dia de internação. Os fármacos prescritos que apresentaram maior frequeencia de IM foram para o sistema digestivo e agentes anti-infecciosos. Pacientes que utilizaram fármacos para o sistema cardiovascular, que interagem com outros fármacos, tiveram mais chance de ir a óbito. A via endovenosa foi a mais utilizada para administração dos medicamentos no primeiro dia de internação tendo diminuído no último dia. As chances de polifarmácia excessiva para o sexo masculino diminuíram quando não houve IM grave com medicação por via endovenosa. Houve correlação positiva entre IM com polifarmácia excessiva no último dia de internação. IM grave foi a mais encontrada, assim como evidência científica regular e tempo de início não especificado, seguido de tardio. Houve associação entre IM moderada com aumento dos níveis plasmáticos de ureia, creatinina e potássio. A regressão logística mostrou que pacientes entre 40 e 59 anos tem mais chance de evoluir à óbito do que pacientes entre 18 a 39 anos, e que os do sexo masculino tem menor chance de polifarmácia excessiva. Concluímos que, em UTI, há elevada ocorrência de IM potencial e polifarmácia excessiva em pacientes que fazem uso de fármacos de ação central. A correlação de polifarmácia excessiva e hiperglicemia indica que a associação de vários fármacos pode causar alterações metabólicas que estão associadas à danos ao organismo. A polifarmácia associada com aumento das concentrações plasmáticas de ureia e creatinina sugere que ela pode ser causadora da disfunção renal ou pode colocar o paciente em risco, visto que a eliminação não adequada de fármacos pode elevar suas concentrações plasmáticas sendo potencialmente perigosa.

Intensive care units (ICU) are the hospital sector intended for the care of patients in a critical state and at risk. In ICU, several central-acting pharmaceuticals are administered. The use of multiple drugs becomes a challenge to ICU patients. In this context, the term polypharmacy is widely used to describe the simultaneous use of five or more drugs. When ten or more drugs are used, the term excessive polypharmacy is preferred. The risk of side effects increases with the number of drugs administered. The higher the number, the higher the risk of drugs interaction (DI), that is, the influence (that could be beneficial or harmful) that a drug exerts in the effect of others. The renal function of ICU patients is another relevant aspect, given that kidneys play a central role in the elimination of drugs. Therefore, it is extremely important that nurses and the multi-disciplinary team have the necessary technical-scientific knowledge to safeguard the patient's health. The aim of this study was to analyze and classify excessive polypharmacy, potential drugs interactions, and the excretion conditions (renal function) of ICU patients who were administered central-acting drugs and other pharmaceuticals. It is a descriptive, observational, and transversal study. Descriptive and logistic regression analyses were carried out. Excessive polypharmacy was identified in a large proportion of the medical prescriptions on the first day of ICU stay, and there was an association between the outcomes hospital discharge and death, as well as with the glucose levels on the first day. The most commonly prescribed drugs were those for the digestive and central nervous systems. Patients who were administered drugs for the cardiovascular system, which interact with other drugs, had higher chances of death. Intravenous route was the most common method of drug administration on the first day of ICU stay; it was less used on the last day. The chances of excessive polypharmacy for males decreased when there were no severe DI with intravenous medication. There was a positive correlation between DI with excessive polypharmacy on the last day of ICU stay. Severe DI was the most common form found, as well as regular scientific evidence and unspecified starting time, followed by late starting time. There was an association between moderate DI and the increase of urea, creatinine, and potassium plasma levels. The logistic regression has shown that 40-59 years old patients are more likely to die when compared to patients who are 18-39 years old; it has also shown that males are less frequently subject to excessive polypharmacy. We have concluded that there is a high incidence of potential DI and excessive polypharmacy in patients that are administered central-acting drugs in the ICU. The correlation between excessive polypharmacy and hyperglycemia indicates that the association of several pharmaceuticals may cause metabolic changes associated with body damage. Polypharmacy associated with the increase of plasmatic concentrations of urea and creatinine suggests that it could be the cause of renal dysfunction or that it could put the patient at risk, given that the inadequate elimination of pharmaceuticals may raise their plasmatic concentration, which is potentially dangerous