Factors associated with polypharmacy in elderly home‐care patients

Komiya, Hitoshi; Umegaki, Hiroyuki; Asai, Atsushi; Kanda, Shigeru; Maeda, Kayaho; Shimojima, Takuya; Nomura, Hideki; Kuzuya, Masafumi

doi:10.1111/ggi.13132

Cited by 56 publications

(58 citation statements)

References 25 publications

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“…a patient factor such as frailty) led to patients in that group experiencing negative implications for their patient safety thereby leading authors to conclude that the characteristic itself was a contributing/associated factor to the patient safety issue of interest. Four studies reported no discernible/neutral effect [36,59,84,92], two indicated a positive effect on patient safety [55,88] and one mixed effects as two outcomes were measured and had different directions [93]. This study defined culturally unsafe practice as any actions that diminish, demean, or disempower the cultural identity and well-being of an individual and applied this concept to health care.…”

Section: Description Of Contributory/associated Factorsmentioning

confidence: 99%

Patient safety in marginalised groups: a narrative scoping review

Cheraghi-Sohi

Panagioti

Daker‐White

et al. 2020

Int J Equity Health

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Background: Marginalised groups ('populations outside of mainstream society') experience severe health inequities, as well as increased risk of experiencing patient safety incidents. To date however no review exists to identify, map and analyse the literature in this area in order to understand 1) which marginalised groups have been studied in terms of patient safety research, 2) what the particular patient safety issues are for such groups and 3) what contributes to or is associated with these safety issues arising.Methods: Scoping review. Systematic searches were performed across six electronic databases in September 2019. The time frame for searches of the respective databases was from the year 2000 until present day.Results: The searches yielded 3346 articles, and 67 articles were included. Patient safety issues were identified for fourteen different marginalised patient groups across all studies, with 69% (n = 46) of the studies focused on four patient groups: ethnic minority groups, frail elderly populations, care home residents and low socio-economic status. Twelve separate patient safety issues were classified. Just over half of the studies focused on three issues represented in the patient safety literature, and in order of frequency were: medication safety, adverse outcomes and near misses. In total, 157 individual contributing or associated factors were identified and mapped to one of seven different factor types from the Framework of Contributory Factors Influencing Clinical Practice within the London Protocol. Patient safety issues were mostly multifactorial in origin including patient factors, health provider factors and health care system factors.Conclusions: This review highlights that marginalised patient groups are vulnerable to experiencing a variety patient safety issues and points to a number of gaps. The findings indicate the need for further research to understand the intersectional nature of marginalisation and the multi-dimensional nature of patient safety issues, for groups that have been under-researched, including those with mental health problems, communication and cognitive impairments. Such understanding provides a basis for working collaboratively to co-design training, services and/or interventions designed to remove or at the very least minimise these increased risks.Trial registration: Not applicable for a scoping review.

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Section: Description Of Contributory/associated Factorsmentioning

confidence: 99%

Patient safety in marginalised groups: a narrative scoping review

Cheraghi-Sohi

Panagioti

Daker‐White

et al. 2020

Int J Equity Health

View full text Add to dashboard Cite

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“…As potential confounders, according to a directed acyclic graph (Additional file 1), we considered age, sex, household economy, and the number and type of comorbidities [7][8][9][10]. The household economy was based on responses to the subjective self-administered question, "How do you feel about your current daily situation economically?"…”

Section: Independent Variable Outcome and Covariatesmentioning

confidence: 99%

“…Previous studies have reported that the number and type of comorbidities experienced were associated with polypharmacy [7][8][9][10]. However, to the best of our knowledge, no studies have examined the association between the number of consulting medical institutions and the risk of polypharmacy, within the free access system, in older people living in the community.…”

Section: Introductionmentioning

confidence: 97%

Number of consulting medical institutions and risk of polypharmacy in community-dwelling older people under a healthcare system with free access: a cross-sectional study in Japan

Suzuki

Iwagami

Hamada

et al. 2020

BMC Health Serv Res

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Background: Under the Japanese free access healthcare system, patients are allowed to consult multiple medical institutions (including clinics and hospitals for general or specialist consultation) without primary care referral. This potentially increases the risk of polypharmacy. We examined the association between the number of consulting medical institutions and polypharmacy under a healthcare system with free access. Methods: Via a self-administered questionnaire, we identified people aged ≥65 years with ≥1 disease and ≥1 consulting medical institution in a Japanese city in 2016. The exposure of interest was the number of consulting medical institutions (1, 2, or ≥3) and the outcome was polypharmacy (use of ≥6 types of drugs). We performed a multivariate logistic regression analysis, adjusting for age, sex, household economy, and the number and type of comorbidities. To minimize confounding effects, we also performed propensity-score-matched analysis, categorizing patients into two groups: 1 and ≥2 consulting medical institutions. Results: Of 993 eligible individuals (mean (standard deviation) age: 75.1 (6.5) years, men: 52.6%), 15.7% (156/993) showed polypharmacy. Proportions of polypharmacy were 9.7% (50/516), 16.6% (55/332), and 35.2% (51/145) for people who consulted 1, 2, and ≥3 medical institutions, respectively. Relative to people who consulted 1 medical institution, adjusted odds ratios (95% confidence intervals) for polypharmacy were 1.50 (0.94-2.37) and 3.34 (1.98-5.65) for those who consulted 2 and ≥3 medical institutions, respectively. In propensity score matching, of 516 and 477 patients who consulted 1 and ≥2 medical institutions, 307 pairs were generated. The proportion of polypharmacy was 10.8% (33/307) and 17.3% (53/307), respectively (P = 0.020). The odds ratio for polypharmacy (≥2 vs. 1 consulting medical institution) was 1.73 (95% confidence interval 1.09-2.76).

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“…As an alternative to medication lists, polypharmacy might also be identified by extracting patient records from insurance claims data and other datasets, and ascertaining the numbers and types of prescribed drugs for each patient. Although several studies in other countries have analyzed the prevalence and risk factors of polypharmacy, no community‐based studies who participated in all residents have examined these issues in Japan . The aims of the present study were to determine the patterns of concomitant drug use for chronic diseases and to examine the factors associated with polypharmacy in older outpatients aged ≥75 years in Tokyo, Japan, using health insurance claims data.…”

Section: Introductionmentioning

confidence: 99%

“…Although several studies in other countries have analyzed the prevalence and risk factors of polypharmacy, [9][10][11][12][13] no community-based studies who participated in all residents have examined these issues in Japan. 14,15 The aims of the present study were to determine the patterns of concomitant drug use for chronic diseases and to examine the factors associated with polypharmacy in older outpatients aged ≥75 years in Tokyo, Japan, using health insurance claims data.…”

Section: Introductionmentioning

confidence: 99%

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

Ishizaki

Mitsutake

Hamada

et al. 2020

Geriatrics Gerontology Int

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Aim To determine the patterns of concomitant drug use for chronic diseases and examine the risk factors of polypharmacy in older outpatients. Methods Data were extracted from an anonymized health insurance claims database of a public insurance program for older adults in Tokyo, Japan. We analyzed individuals aged ≥75 years who had visited an outpatient clinic, and were regularly prescribed orally administered drugs for chronic diseases for ≥14 days between May and August 2014. The prescription patterns for 16 main drug types were studied using exploratory factor analysis, and the risk factors of polypharmacy, defined as the concomitant prescription of five or more drugs, were identified using multivariate logistic regression models. Results A total of 1 094 199 outpatients were analyzed (mean age 81.8 years, 38.4% men). We identified five prescription patterns that explained almost 40% of all observed variance: edema/heart failure/atrial fibrillation‐related drugs, insomnia/anxiety‐related drugs, pain‐related drugs, lifestyle disease‐related drugs and dementia‐related drugs. The significant risk factors of polypharmacy included men, octogenarians and nonagenarians, higher number of medical institutions visited, use of physician home visits, and hospitalization during the study period. The main drug types most strongly associated with polypharmacy were analgesics, diuretics and antidiabetics. Conclusions Polypharmacy was found to be prevalent in older outpatients aged ≥75 years in Tokyo. These findings might provide useful evidence that can contribute to the development of practical countermeasures against adverse events associated with polypharmacy in clinical practice. Geriatr Gerontol Int 2020; 20: 304–311.

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Factors associated with polypharmacy in elderly home‐care patients

Cited by 56 publications

References 25 publications

Patient safety in marginalised groups: a narrative scoping review

Patient safety in marginalised groups: a narrative scoping review

Number of consulting medical institutions and risk of polypharmacy in community-dwelling older people under a healthcare system with free access: a cross-sectional study in Japan

Drug prescription patterns and factors associated with polypharmacy in >1 million older adults in Tokyo

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