Healthcare Statistics Unit, National Clinical Research Centre, 3rd floor, MMA House, 124, Jalan Pahang, 53000, Kuala Lumpur, Malaysia.
Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
BMC Geriatr. 2018 Feb 23;18(1):59. doi: 10.1186/s12877-018-0750-2.
Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public and private primary care clinics, and its association with patient, prescriber and practice characteristics.
We used data from The National Medical Care Survey (NMCS), a national cross-sectional survey of patients' visits to primary care clinics in Malaysia. A weighted total of 22,832 encounters of patients aged ≥65 years were analysed. Polypharmacy was defined as concomitant use of five medications and above. Multilevel logistic regression was performed to examine the association of polypharmacy with patient, prescriber and practice characteristics.
A total of 20.3% of the older primary care attenders experienced polypharmacy (26.7%% in public and 11.0% in private practice). The adjusted odds ratio (OR) of polypharmacy were 6.37 times greater in public practices. Polypharmacy was associated with patients of female gender (OR 1.49), primary education level (OR 1.61) and multimorbidity (OR 14.21). The variation in rate of polypharmacy was mainly found at prescriber level.
Polypharmacy is common among older persons visiting primary care practices. Given the possible adverse outcomes, interventions to reduce the burden of polypharmacy are best to be directed at individual prescribers.
与其他人群相比，老年人更有可能经历不良反应，因此，多药治疗在老年人中尤为重要。尽管多药治疗很重要，但目前关于患者、医生和实践特征与多药治疗之间可能存在关联的研究较少。因此，本研究旨在确定在参加公立和私立初级保健诊所的老年人中多药治疗的发生率，并探讨其与患者、医生和实践特征的关系。
我们使用了来自马来西亚全国医疗保健调查（NMCS）的数据，该调查是对初级保健诊所患者就诊情况的全国性横断面调查。对 22832 名年龄≥65 岁的患者进行了加权分析。多药治疗定义为同时使用五种及以上药物。采用多水平逻辑回归分析多药治疗与患者、医生和实践特征的关系。
共有 20.3%的老年初级保健就诊者经历了多药治疗（公立诊所为 26.7%，私立诊所为 11.0%）。在公立诊所中，多药治疗的调整后比值比（OR）是 6.37 倍。多药治疗与女性（OR 1.49）、小学教育程度（OR 1.61）和多种合并症（OR 14.21）的患者相关。多药治疗率的差异主要存在于医生层面。
多药治疗在老年患者中很常见。鉴于多药治疗可能产生的不良后果，减少多药治疗负担的干预措施最好针对个体医生。
