Barrio-Cortes Jaime, Benito-Sánchez Beatriz, Villimar-Rodriguez Ana Isabel, Rujas Miguel, Arroyo-Gallego Peña, Carlson Jim, Merino-Barbancho Beatriz, Roca-Umbert Ana, Castillo-Sanz Andrés, Lupiáñez-Villanueva Francisco, Fico Giuseppe, Gómez-Gascón Tomás
Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Ave. Reina Victoria, 21, 6Th Floor, 28003, Madrid, Spain.
Faculty of Health, Camilo José Cela University, Madrid, Spain.
J Pharm Policy Pract. 2023 Nov 28;16(1):161. doi: 10.1186/s40545-023-00665-7.
Patients with polypharmacy suffer from complex medical conditions involving a large healthcare burden. This study aimed to describe the characteristics and utilization of primary care (PC) and hospital care (HC) and factors associated in chronic patients with polypharmacy, stratifying by adjusted morbidity groups (AMG) risk level, sex and age, and comparing with non-polypharmacy.
Cross-sectional study conducted in a Spanish basic healthcare area. Studied patients were those over 18 years with chronic diseases identified by the AMG tool from Madrid electronic clinical record, which was the data source. Sociodemographic, sociofunctional, clinical and healthcare utilization variables were described and compared by risk level, sex, age and having or not polypharmacy. Factors associated with healthcare utilization in polypharmacy patients were determined by a negative binomial regression model.
In the area studied, 61.3% patients had chronic diseases, of which 16.9% had polypharmacy vs. 83.1% without polypharmacy. Patients with polypharmacy (vs. non-polypharmacy) mean age was 82.7 (vs. 52.7), 68.9% (vs. 60.7%) were women, and 22.0% (vs. 1.2%) high risk. Their average number of chronic diseases was 4.8 (vs. 2.2), and 95.6% (vs. 56.9%) had multimorbidity. Their mean number of annual healthcare contacts was 30.3 (vs. 10.5), 25.9 (vs. 8.8) with PC and 4.4 (vs. 1.7) with HC. Factors associated with a greater PC utilization in patients with polypharmacy were elevated complexity, high risk level and dysrhythmia. Variables associated with a higher HC utilization were also increased complexity and high risk, in addition to male sex, being in palliative care, having a primary caregiver, suffering from neoplasia (specifically lymphoma or leukaemia) and arthritis, whereas older age and immobilization were negatively associated.
Polypharmacy population compared to non-polypharmacy was characterized by a more advanced age, predominance of women, high-risk, complexity, numerous comorbidities, dependency and remarkable healthcare utilization. These findings could help healthcare policy makers to optimize the distribution of resources and professionals within PC and HC systems, aiming for the improvement of polypharmacy management and rational use of medicines while reducing costs attributed to healthcare utilization by these patients.
使用多种药物的患者患有复杂的医疗状况，涉及巨大的医疗负担。本研究旨在描述初级保健（PC）和医院护理（HC）的特征及利用情况，以及与患有多种药物治疗慢性病患者相关的因素，按调整后的发病组（AMG）风险水平、性别和年龄进行分层，并与非多种药物治疗情况进行比较。
在西班牙一个基本医疗保健区域进行横断面研究。研究对象为18岁以上通过马德里电子临床记录中的AMG工具识别出患有慢性病的患者，该记录为数据源。描述并比较了社会人口统计学、社会功能、临床和医疗保健利用变量，按风险水平、性别、年龄以及是否使用多种药物进行分类。通过负二项回归模型确定与使用多种药物患者的医疗保健利用相关的因素。
在所研究的区域，61.3%的患者患有慢性病，其中16.9%使用多种药物，而83.1%未使用多种药物。使用多种药物的患者（与未使用多种药物的患者相比）平均年龄为82.7岁（与52.7岁相比），女性占68.9%（与60.7%相比），高风险患者占22.0%（与1.2%相比）。他们的慢性病平均数量为4.8种（与2.2种相比），95.6%（与56.9%相比）患有多种疾病。他们每年的医疗接触平均次数为30.3次（与10.5次相比），与初级保健接触25.9次（与8.8次相比），与医院护理接触4.4次（与1.7次相比）。与使用多种药物患者更多地利用初级保健相关的因素包括病情复杂性增加、高风险水平和心律失常。与更高的医院护理利用率相关的变量除了病情复杂性增加和高风险外，还包括男性、处于姑息治疗、有主要照顾者、患有肿瘤（特别是淋巴瘤或白血病）和关节炎，而年龄较大和行动不便则呈负相关。
与非多种药物治疗人群相比，使用多种药物的人群具有年龄更大、女性占主导、高风险、病情复杂、多种合并症、依赖他人以及显著的医疗保健利用等特征。这些发现有助于医疗保健政策制定者优化初级保健和医院护理系统内的资源和专业人员分配，旨在改善多种药物治疗的管理和合理用药，同时降低这些患者的医疗保健利用成本。
