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Optimizing elderly pharmacotherapy: polypharmacy vs. undertreatment. Are these two concepts related?

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to estimate the prevalence of polypharmacy and potential prescribing omissions (PPO) and their related factors in community-dwelling elderly patients and to examine any possible relationship between these two concepts.

Methods

A cross-sectional study was carried out including patients 65 years of age or over living on the island of Lanzarote (Spain). Sociodemographic, clinical and functional variables were collected, together with full data on drug therapy. The percentage of patients receiving ≥5 medications (polypharmacy) and the percentage of patients receiving at least one PPO according to Screening Tool to Alert doctors to Right Treatment (START) criteria (underprescription) were the two primary endpoints.

Results

A total of 1844 medications were prescribed to the 407 patients included in our study. The overall prevalence of polypharmacy was 45 %. The risk factors associated with polypharmacy were comorbidity (OR 1.98, 95 % CI 1.63–2.44), limitations in activities of daily living (ADL; OR 3.0, 95 % CI 1.51–6.11), and being prescribed a drug in the Anatomical Therapeutic Chemical classification (ATC) C group (OR 7.92, 95 % CI 4.10–16.25) or in the N group (OR 3.80, 95 % CI 2.25–6.55). START criteria identified a total of 303 PPO in 170 (41.8 %) subjects. The risk of PPO increased by 60 % for every additional point in the Charlson Comorbidity Index (OR 1.60, 95 % CI 1.35–1.91). Polypharmacy also independently predicted the odds of at least one PPO according to START criteria (OR 2.19, 95 % CI 1.36–3.55).

Conclusion

Our findings show high rates of polypharmacy and PPO, as well as a clear relationship between these two concepts.

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Acknowledgments

We would like to thank the Primary Care Management Team on Lanzarote for providing permission to access and consult the clinical records and patient lists.

Sponsor/funding

This research received no specific funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Authors’ contributions

The proposed paragraph repeats some sentences. It could be changed by the following: EBR and GAZ were responsible for the concept and design of the study, application of START criteria and evaluation of prescriptions, analysis and interpretation of results, preparation of the manuscript and final approval of the version for publication. GAZ was also responsible for the data collection. Preparation of manuscript was also a responsability of ROR. MLO was also responsible for the application of START criteria and evaluation of prescriptions. ROR, MLO and IBE were also responsible for the analysis and interpretation of results and final approval of the version for publication.

Ethical standards

The authors declare that this clinical research was devised in line with the ethical standards laid down in the Helsinki Declaration (Fortaleza 2013) and that special attention was paid to ensuring informed consent from all patients prior to their inclusion, as well as to the confidentiality of all personal data. This study was classified as a post-authorization, epidemiological study by the Spanish Medications and Healthcare Products Agency. The study was also approved by the Clinical Research Ethics Committee (Dr. Negrín Gran Canaria Universitary Hospital, code 120279).

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Correspondence to Encarnación Blanco-Reina.

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Blanco-Reina, E., Ariza-Zafra, G., Ocaña-Riola, R. et al. Optimizing elderly pharmacotherapy: polypharmacy vs. undertreatment. Are these two concepts related?. Eur J Clin Pharmacol 71, 199–207 (2015). https://doi.org/10.1007/s00228-014-1780-0

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