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BMC primary care
05 26, 2023;24 (1): 120.

The effect of polypharmacy on healthcare services utilization in older adults with comorbidities: a retrospective cohort study.

George Doumat, Darine Daher, Mira Itani, Lina Abdouni, Khalil El Asmar, Georges Assaf
Author Information
  1. George Doumat: Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
  2. Darine Daher: Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
  3. Mira Itani: Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
  4. Lina Abdouni: Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
  5. Khalil El Asmar: Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
  6. Georges Assaf: Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon. ga62@aub.edu.lb.
PMID: 37237338 DOI: 10.1186/s12875-023-02070-0

Abstract

BACKGROUND: Older adults are more prone to increasing comorbidities and polypharmacy. Polypharmacy is associated with inappropriate prescribing and an increased risk of adverse effects. This study examined the effect of polypharmacy in older adults on healthcare services utilization (HSU). It also explored the impact of different drug classes of polypharmacy including psychotropic, antihypertensive, and antidiabetic polypharmacy on HSU.
METHODS: This is a retrospective cohort study. Community-dwelling older adults aged ≥ 65 years were selected from the primary care patient cohort database of the ambulatory clinics of the Department of Family Medicine at the American University of Beirut Medical Center. Concomitant use of 5 or more prescription medications was considered polypharmacy. Demographics, Charlson Comorbidity index (CCI), and HSU outcomes, including the rate of all-cause emergency department (ED) visits, rate of all-cause hospitalization, rate of ED visits for pneumonia, rate of hospitalization for pneumonia, and mortality were collected. Binomial logistic regression models were used to predict the rates of HSU outcomes.
RESULTS: A total of 496 patients were analyzed. Comorbidities were present in all patients, with 22.8% (113) of patients having mild to moderate comorbidity and 77.2% (383) of patients having severe comorbidity. Patients with polypharmacy were more likely to have severe comorbidity compared to patients with no polypharmacy (72.3% vs. 27.7%, p = 0.001). Patients with polypharmacy were more likely to visit the ED for all causes as compared to patients without polypharmacy (40.6% vs. 31.4%, p = 0.05), and had a significantly higher rate of all-cause hospitalization (adjusted odds ratio aOR 1.66, 95 CI = 1.08-2.56, p = 0.022). Patients with psychotropic polypharmacy were more likely to be hospitalized due to pneumonia (crude odds ratio cOR 2.37, 95 CI = 1.03-5.46, p = 0.043), and to visit ED for Pneumonia (cOR 2.31, 95 CI = 1.00-5.31, p = 0.049). The association lost significance after adjustment.
CONCLUSIONS: The increasing prevalence of polypharmacy amongst the geriatric population with comorbidity is associated with an increase in HSU outcomes. As such, frequent medication revisions in a holistic, multi-disciplinary approach are needed.

Keywords

Aged Outcome Assessment, Health Care Polypharmacy

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MeSH Term

Humans
Aged
United States
Retrospective Studies
Facilities and Services Utilization
Comorbidity
Hospitalization
Delivery of Health Care
Journal Article
Article has an altmetric score of 49

Word Cloud

Created with Highcharts 10.0.0polypharmacypatientsHSUratep = 0adultsEDcomorbiditystudyoldercohortoutcomesall-causehospitalizationpneumoniaPatientslikely3195CI = 1increasingPolypharmacyassociatedeffecthealthcareservicesutilizationincludingpsychotropicretrospectivevisitsseverecomparedvsvisitoddsratiocOR2BACKGROUND:OlderpronecomorbiditiesinappropriateprescribingincreasedriskadverseeffectsexaminedalsoexploredimpactdifferentdrugclassesantihypertensiveantidiabeticMETHODS:Community-dwellingaged ≥ 65yearsselectedprimarycarepatientdatabaseambulatoryclinicsDepartmentFamilyMedicineAmericanUniversityBeirutMedicalCenterConcomitantuse5prescriptionmedicationsconsideredDemographicsCharlsonComorbidityindexCCIemergencydepartmentmortalitycollectedBinomiallogisticregressionmodelsusedpredictratesRESULTS:total496analyzedComorbiditiespresent228%113mildmoderate772%383723%277%001causeswithout406%4%05significantlyhigheradjustedaOR16608-256022hospitalizedduecrude3703-546043Pneumonia00-5049associationlostsignificanceadjustmentCONCLUSIONS:prevalenceamongstgeriatricpopulationincreasefrequentmedicationrevisionsholisticmulti-disciplinaryapproachneededcomorbidities:AgedOutcomeAssessmentHealthCare

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