Department of Clinical Pharmacy and Pharmacy Practice, Yarmouk University, Irbid, Jordan.
Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
Int J Pharm Pract. 2021 Dec 4;29(6):580-586. doi: 10.1093/ijpp/riab067.
Polypharmacy is usually associated with duplication of therapy, unnecessary medications and adverse drug reactions. Therefore, it is crucial to study the factors that increase the risk of polypharmacy. The objective of this study was to assess the risk factors for polypharmacy (i.e. the concomitant use of at least five medications) with a special focus on comorbidity in Jordan.
Using a retrospective cross-sectional study design, medical records of patients (age ≥55 years), which covered slightly over one-fourth of the population, found in a national electronic healthcare database from 2018 to 2019 were retrieved. Polypharmacy, the main outcome, was defined as the current use of at least five medications (the patient should have at least one chronic condition, one medication refill and continuous use of the medication for at least 30 days). Comorbidity, the main exposure, was summarized using the Charlson Comorbidity Index (CCI). Potential predictors of polypharmacy were examined using a multivariable logistic regression analysis.
An eligible sample of 113 834 individuals (mean age 68 years, 51.5% female) were included in the analysis, of whom 38% met the polypharmacy definition (28% were categorized as having major [5-9 medications] and 10.2% exhibited excessive polypharmacy [≥10 medications]). Approximately, 20% of the patients had a CCI of ≥1. The most significant predictors of polypharmacy were a CCI score between 3 and 4 (adjusted odds ratio [AOR] = 5.89; 95% CI, 5.10 to 6.80; P < 0.001), gender (AOR = 0.86; 95% CI, 0.82 to 0.86; P < 0.001), and age ≥75 years (AOR = 1.62; 95% CI, 1.57 to 1.67; P < 0.001).
Polypharmacy is common among patients in Jordan. Comorbidity is positively, independently and strongly related to polypharmacy. Identifying groups who are at the greatest risk for polypharmacy can help optimize patients' treatment, which can lead to better outcomes and improved quality of life.
多种药物疗法通常与治疗重复、不必要的药物和药物不良反应有关。因此，研究增加多种药物疗法风险的因素至关重要。本研究的目的是评估与合并症相关的多种药物疗法（即同时使用至少五种药物）的风险因素，重点关注约旦的合并症。
使用回顾性横断面研究设计，从 2018 年至 2019 年从国家电子医疗保健数据库中检索了年龄≥55 岁患者的病历，这些病历略超过人口的四分之一。多种药物疗法是主要结局，定义为当前使用至少五种药物（患者应至少有一种慢性疾病、一种药物续药且药物连续使用至少 30 天）。合并症，主要暴露，使用 Charlson 合并症指数（CCI）进行总结。使用多变量逻辑回归分析检查多种药物疗法的潜在预测因素。
对 113834 名符合条件的个体（平均年龄 68 岁，51.5%为女性）进行了分析，其中 38%符合多种药物疗法的定义（28%被归类为使用大剂量[5-9 种药物]，10.2%表现出过度多种药物疗法[≥10 种药物]）。大约 20%的患者 CCI 评分≥1。多种药物疗法的最重要预测因素是 CCI 评分为 3 至 4（调整后的优势比[OR]为 5.89；95%置信区间，5.10 至 6.80；P < 0.001）、性别（OR=0.86；95%置信区间，0.82 至 0.86；P < 0.001）和年龄≥75 岁（OR=1.62；95%置信区间，1.57 至 1.67；P < 0.001）。
约旦患者中多种药物疗法很常见。合并症与多种药物疗法呈正相关、独立且强相关。确定最容易发生多种药物疗法的风险群体可以帮助优化患者的治疗，从而改善治疗效果和生活质量。
