Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada

Abstract

ObjectivesDescribe nursing home polypharmacy prevalence in the context of prescribing for diabetes and hypertension and determine possible associations between lower surrogate markers for treated hypertension and diabetes (overtreatment) and polypharmacy.DesignCross-sectional study.Setting6 nursing homes in British Columbia, Canada.Participants214 patients residing in one of the selected facilities during data collection period.Primary and secondary outcome measuresPolypharmacy was defined as ≥9 regular medications. Overtreatment of diabetes was defined as being prescribed at least one hypoglycaemic medication and a glycosylated haemoglobin (HbA1c) ≤7.5%. Overtreatment of hypertension required being prescribed at least one hypertension medication and having a systolic blood pressure ≤128 mm Hg. Polypharmacy prescribing, independent of overtreatment, was calculated by subtracting condition-specific medications from total medications prescribed.ResultsData gathering was completed for 214 patients, 104 (48%) of whom were prescribed ≥9 medications. All patients were very frail. Patients with polypharmacy were more likely to have a diagnosis of hypertension (p=0.04) or congestive heart failure (p=0.003) and less likely to have a diagnosis of dementia (p=0.03). Patients with overtreated hypertension were more likely to also experience polypharmacy (Relative Risk (RR))1.77 (1.07 to 2.96), p=0.027). Patients with overtreated diabetes were prescribed more non-diabetic medications than those with a higher HbA1c (11.0±3.7vs 7.2±3.1, p=0.01).ConclusionOvertreated diabetes and hypertension appear to be prevalent in nursing home patients, and the presence of polypharmacy is associated with more aggressive treatment of these risk factors. The present study was limited by its small sample size and cross-sectional design. Further study of interventions designed to reduce overtreatment of hypertension and diabetes is needed to fully understand the potential links between polypharmacy and potential of harms of condition-specific overtreatment.

Prevalence and predictors of polypharmacy prescription among type 2 diabetes patients at a tertiary care department in Ningbo, China: A retrospective database study

“…In similar studies conducted among diabetes patients in Brazil and Saudi Arabia, it was 57% and 78%, respectively [16,18]. 48% of patients with diabetes and hypertension in Canada were prescribed �9 medicines [19]. The average number of medicines prescribed to T2DM patients in India and Germany was five and 12, respectively [15,20].…”

“…In patients, it can adversely affect their adherence to medicines, quality of life and life expectancy, can lead to suboptimal blood glucose control and hospital admissions, and can increase severe hypoglycaemia risk and healthcare costs [10][11][12][13][14]. Studies conducted in different diabetes (including T2DM) populations and settings have reported a range of polypharmacy prevalence figures (6-85%) [15][16][17][18][19][20][21][22][23][24].…”

“…This study was conducted among T2DM patients who were discharged from the tertiary care department and thus, the generalisability of study findings is limited to similar populations and settings. As mentioned before, studies conducted in other diabetes (including T2DM) populations and settings have reported a range of prevalence figures [15][16][17][18][19][20][21]. In China, studies conducted in community settings have reported a much lower prevalence of polypharmacy (6-18%) [22][23][24].…”

Cardiometabolic diseases and active aging - polypharmacy in control

“…A study of 214 elderly people in Canada also found an association between polypharmacy and more intensive pharmacological treatments to treat hypertension and diabetes. However, in this study, the sample consisted of very fragile and institutionalized elderly people (17) .…”

Frequency of Polypharmacy and Risk Factors in the Elderly in Burdur

“…The frequency of polypharmacy also varies between the elderly living in the community and the elderly living in the nursing home. Among the patients living in the community, the incidence rates of 41%, 43.4%, 35.8% and 46.8% were reported from Iceland, USA, Australia and Italy, respectively (10)(11)(12). In a recent study conducted among nursing homes as a report of shelter work in eight European countries, the incidence rate was reported to be 49.7% (13).…”