Polypharmacy and specific comorbidities in university primary care settings

Area of Science:

• Gerontology and Primary Care Medicine
• Clinical Pharmacology
• Epidemiology

Background:

• Polypharmacy (≥5 long-term prescribed drugs) is prevalent in older adults.
• Limited data exist on polypharmacy's association with specific comorbidities in primary care.
• Multimorbidity (≥2 comorbidities) is common in patients experiencing polypharmacy.

Purpose of the Study:

• To measure the prevalence of polypharmacy and inappropriate prescribing in primary care.
• To assess the association between polypharmacy and specific comorbidities.
• To evaluate the link between polypharmacy and potentially inappropriate prescribing (PIP) and potential prescribing omission (PPO).

Main Methods:

• Cross-sectional analysis of 1002 patients aged 50-80 years in Swiss university primary care settings.
• Defined polypharmacy as ≥5 drugs and multimorbidity as ≥2 comorbidities.
• Used logistic mixed-effects regression and multilevel mixed-effects Poisson regression to analyze associations.

Main Results:

• Polypharmacy was associated with age, BMI, multimorbidity, hypertension, diabetes mellitus, chronic kidney disease, and cardiovascular diseases.
• Hypertension (OR 8.49), multimorbidity (OR 6.14), and older age showed the strongest associations with polypharmacy.
• Prevalence of PPO was 32.2%, and PIP was significantly more frequent in patients with polypharmacy (9.3% vs. 3.2%).

Conclusions:

• Polypharmacy is common in primary care and significantly associated with major chronic diseases.
• Polypharmacy increases the likelihood of inappropriate prescribing.
• Future research should focus on developing guidelines for multimorbid patients to avoid inappropriate prescribing.