Comorbidity and medication load in adult asthmatics

Ikäheimo, Pekka; Hartikainen, Sirpa; Tuuponen, T; Kiuttu, Jorma; Klaukka, Timo

doi:10.1080/02813430510018473

Cited by 13 publications

(7 citation statements)

References 13 publications

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“…The setting and methods for exploring polypharmacy vary widely. Investigations have been carried out in outpatients/ambulatory patients [6,[9][10][11][12][13], hospitalized patients [14][15][16], patients in nursing homes [17,18], elderly patients [11-13, 15, 19, 20] and patients included in prescription or other population databases [5,[21][22][23][24]. Studies have also explored polypharmacy in specific disease entities such as psychiatric diseases [8,16], rheumatic diseases [14], asthma [24] and heart failure [2].…”

Section: Introductionmentioning

confidence: 99%

Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug‐related problems

Viktil

Blix²,

Moger

et al. 2006

Brit J Clinical Pharma

440

321

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What is already known about this subject • Polypharmacy has been linked to heightened risk of occurrence of drug‐related problems (DRPs) and a detrimental health outcome. • Polypharmacy has been variously defined; in research studies a commonly applied definition has been the concomitant use of five or more drugs. • The value of using a definite number of drugs as a cut‐off to describe polypharmacy as a risk factor for the occurrence of DRPs has not been validated. What this study adds • Nearly half of the patients admitted to general hospitals used five or more drugs; during the hospital stay these patients were prescribed as many new drugs as those admitted with fewer drugs. • The presence of DRPs increased approximately linearly with the number of drugs used, for the range of one to >11 drugs. • To set a strict cut‐off to identify polypharmacy and declare that using more than this number of drugs represents a potential risk for occurrence of DRPs, is of limited value in clinical practice. Aim To investigate whether polypharmacy defined as a definite number of drugs is a suitable indicator for describing the risk of occurrence of drug‐related problems (DRPs) in a hospital setting. Methods Patients admitted to six internal medicine and two rheumatology departments in five hospitals were consecutively included and followed during the hospital stay, with particular attention to medication and DRPs. Comparisons were made between patients admitted with five or more drugs and with less than five drugs. Clinical pharmacists assessed DRPs by reviewing medical records and by participating in multidisciplinary team discussions. Results Of a total of 827 patients, 391 (47%) used five or more drugs on admission. Patients admitted with five or more and less than five drugs were prescribed the same number of drugs after admission: 4.1 vs. 3.9 drugs [P = 0.4, 95% confidence interval (CI) − 0.57, 0.23], respectively. The proportion of drugs used on admission which was associated with DRPs was similar in the patient group admitted with five or more drugs and in those admitted with less than five drugs. The number of DRPs per patient increased approximately linearly with the increase in number of drugs used; one unit increase in number of drugs yielded a 8.6% increase in the number of DRPs (95% CI 1.07, 1.10). Conclusion The number of DRPs per patient was linearly related to the number of drugs used on admission. To set a strict cut‐off to identify polypharmacy and declare that using more than this number of drugs represents a potential risk for occurrence of DRPs, is of limited value when assessing DRPs in a clinical setting.

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Section: Introductionmentioning

confidence: 99%

Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug‐related problems

Viktil

Blix²,

Moger

et al. 2006

Brit J Clinical Pharma

440

321

View full text Add to dashboard Cite

show abstract

“…In any case, it can be stated that the prevalence of patients using 5 or more drugs -the most common definition -is high, particularly among the elderly (10,25,27,(32)(33)(34)36,42,45). In general, more than half of the patients enrolled in theses studies used five or more drugs.…”

Section: Frequency Of Polypharmacymentioning

confidence: 99%

“…Studies have also been performed based on data from prescription or population databases (13,28,(40)(41)(42). Further, studies have explored polypharmacy in specific disease entities such as psychiatric diseases (16,20,35), rheumatic diseases (34), asthma (42), and heart failure (43). Due to different settings and definitions given in the various studies, the frequency of polypharmacy varies widely.…”

Section: Frequency Of Polypharmacymentioning

confidence: 99%

The Janus face of polypharmacy – overuse versus underuse of medication

Viktil¹,

Blix²,

Reikvam³

2009

Nor J Epidemiol

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As modern guidelines may recommend several drugs for a single medical condition, it follows that many patients, especially if co-morbidity is present, use a number of medications. Also, an aging population implies more morbidity and consequently will have the result that many patients use many drugs -a situation often referred to as polypharmacy. Polypharmacy has been linked to negative health outcomes such as adverse drug reactions, interaction problems, poor patient adherence, and hospitalisations. Such experiences have led to the attitude that efforts should be made to reduce polypharmacy. However, this approach might prevent patients from obtaining optimal treatment. There is no universal definition of polypharmacy and measuring of a reduction in polypharmacy becomes problematic. Because polypharmacy is an imprecise term it should be used with caution in research as well as in patient management. Moreover, studies have shown that undertreatment occurs frequently also among patients using many drugs. This is the Janus face of polypharmacy: too many drugs should be avoided, but the individual patient should receive the appropriate drugs that have the potential to reduce morbidity and improve quality of life. It is the individual drugs themselves, along with patient specific factors, and not a fixed number of drugs, that we should pay attention to.

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“…They feel stigmatized because of their social status and perceive a lack of sensitivity among professionals with regard to their living conditions, and this has a negative impact on their use of healthcare [13,19,26,27]. Those receiving employment assistance benefits may experience a sense of devaluation when coming in contact with workers in the health and social services sector because they belong to a social group that is the subject of prejudice [28]. …”

Section: Introductionmentioning

confidence: 99%

“…Health professionals also face major challenges in dealing with poor patients who have coexisting chronic illnesses [28,29]. These persons tend to adopt a more passive style of communication, talk less, ask fewer questions, and especially, take a less active role in the process of choosing treatments, making it difficult to establish a therapeutic physician–patient alliance [30].…”

Section: Introductionmentioning

confidence: 99%

Transforming primary healthcare by including the stakeholders involved in delivering care to people living in poverty: EQUIhealThY study protocol

Loignon

Hudon

Boudreault‐Fournier

et al. 2013

BMC Health Serv Res

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BackgroundEnsuring access to timely and appropriate primary healthcare for people living in poverty is an issue facing all countries, even those with universal healthcare systems. The transformation of healthcare practices and organization could be improved by involving key stakeholders from the community and the healthcare system in the development of research interventions. The aim of this project is to stimulate changes in healthcare organizations and practices by encouraging collaboration between care teams and people living in poverty. Our objectives are twofold: 1) to identify actions required to promote the adoption of professional practices oriented toward social competence in primary care teams; and 2) to examine factors that would encourage the inclusion of people living in poverty in the process of developing social competence in healthcare organizations.Methods/designThis study will use a participatory action research design applied in healthcare organizations. Participatory research is an increasingly recognized approach that is helpful for involving the people for whom the research results are intended. Our research team consists of 19 non-academic researchers, 11 academic researchers and six partners. A steering committee composed of academic researchers and stakeholders will have a decision-making role at each step, including knowledge dissemination and recommendations for new interventions. In this project we will adopt a multiphase approach and will use a variety of methods, including photovoice, group discussions and interviews.DiscussionThe proposed study will be one of only a few using participatory research in primary care to foster changes aimed at enhancing quality and access to care for people living in poverty. To our knowledge this will be the first study to use photovoice in healthcare organizations to promote new interventions. Our project includes partners who are targeted for practice changes and improvements in delivering primary care to persons living in poverty. By involving knowledge users, including service recipients, our study is more likely to produce a transformation of professional practices and encourage healthcare organizations to take into account the needs of persons living in poverty.

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Comorbidity and medication load in adult asthmatics

Cited by 13 publications

References 13 publications

Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug‐related problems

Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug‐related problems

The Janus face of polypharmacy – overuse versus underuse of medication

Transforming primary healthcare by including the stakeholders involved in delivering care to people living in poverty: EQUIhealThY study protocol

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