Feng Xue, Tan Xi, Riley Brittany, Zheng Tianyu, Bias Thomas, Sambamoorthi Usha
1 Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University , Morgantown, West Virginia.
2 Department of Pharmacy Practice, Administration and Research, School of Pharmacy, Marshall University , Huntington, West Virginia.
Popul Health Manag. 2018 Apr;21(2):123-129. doi: 10.1089/pop.2017.0065. Epub 2017 Jul 6.
The purpose of this study is to explore the associations between polypharmacy and multimorbidity using conventional and novel measures of polypharmacy. In this cross-sectional study, data on fee-for-service (FFS) Medicaid enrollees with at least 1 chronic condition and aged 18-64 years (N = 38,329) were derived from the 2010 Medicaid Analytic eXtract (MAX) files of Maryland and West Virginia. Polypharmacy, by the authors' novel definition, was determined as simultaneous use of ≥5 drugs for a consecutive period of 60 days. Multimorbidity was defined as having ≥2 chronic conditions based on the US Department of Health and Human Services framework. The association between multimorbidity and polypharmacy was examined with chi-square tests and logistic regression. Polypharmacy prevalence was estimated at 50.9% using the novel definition, as compared to 16.7% and 64.9% for the 2 commonly used conventional measures, respectively. For all 3 definitions, individuals with multimorbidity were more likely to have polypharmacy than those without multimorbidity (P < 0.001). The authors also consistently found, using all definitions, that those who were older, female, white, and eligible for Medicaid because of cash assistance were more likely to have polypharmacy (all P < 0.001). Polypharmacy was highly prevalent and significantly associated with multimorbidity among Medicaid FFS enrollees irrespective of the definitions used. The new measure may provide a more comprehensive and accurate estimation of polypharmacy than the conventional measures. These findings suggest the need for a paradigm shift from disease-specific care to patient-centered collaborative care to manage patients with multimorbidity and polypharmacy.
本研究的目的是使用传统和新颖的多重用药衡量方法，探索多重用药与多种疾病并存之间的关联。在这项横断面研究中，有关患有至少1种慢性病且年龄在18 - 64岁的按服务付费（FFS）医疗补助参保者的数据（N = 38329）来自马里兰州和西弗吉尼亚州2010年的医疗补助分析提取物（MAX）文件。根据作者的新颖定义，多重用药被确定为连续60天同时使用≥5种药物。多种疾病并存被定义为根据美国卫生与公众服务部的框架患有≥2种慢性病。使用卡方检验和逻辑回归来检验多种疾病并存与多重用药之间的关联。使用新颖定义估计多重用药患病率为50.9%，而两种常用的传统衡量方法的患病率分别为16.7%和64.9%。对于所有这3种定义，患有多种疾病的个体比未患有多种疾病的个体更有可能出现多重用药情况（P < 0.001）。作者还始终发现，无论采用哪种定义，年龄较大、女性、白人以及因现金援助而符合医疗补助资格的人更有可能出现多重用药情况（所有P < 0.001）。无论使用何种定义，多重用药在医疗补助FFS参保者中都非常普遍，并且与多种疾病并存显著相关。与传统衡量方法相比，新的衡量方法可能会对多重用药提供更全面、准确的估计。这些发现表明，需要从以疾病为导向的护理模式转向以患者为中心的协作护理模式，以管理患有多种疾病和多重用药的患者。
