Polypharmacy among Nursing Home Geriatric Medicaid Recipients

Gupta, Sanjay; Rappaport, Harvey M.; Bennett, Lonnie T.

doi:10.1177/106002809603000905

Cited by 17 publications

(7 citation statements)

References 11 publications

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“…29 Additionally, Gupta et al noted intrastate geographic variation with prescription count in Louisiana geriatric Medicaid beneficiaries. 30 Other researchers have investigated different dimensions of medication use geographic variation (e.g., inter- and intra-regional variation abroad and urban/rural variation). supp ref Moreover, although not a composite pharmacological assessment like polypharmacy, some United States data on the spatial distributions of use of specific medication classes are available.…”

Section: Discussionmentioning

confidence: 99%

Geographic region and racial variations in polypharmacy in the United States

Cashion

McClellan

Howard

et al. 2015

Annals of Epidemiology

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Purpose Medications can have unintended effects. High medication use populations may benefit from increased regimen oversight. Limited knowledge exists concerning racial and regional polypharmacy variation. We estimated total medication distributions (excluding supplements) of American black and white adults and assessed racial and regional polypharmacy variation. Methods REasons for Geographic And Racial Differences in Stroke (REGARDS) cohort data (N=30,239 U.S. blacks/whites ages ≥45 years) were analyzed. Home pill-bottle inspections assessed the last two weeks’ medications. Polypharmacy (≥ 8 medications) was determined by summing prescription and/or OTC ingredients. Population-weighted logistic regression assessed polypharmacy’s association with census region, race, and gender. Results The mean ingredient number was 4.12 (SE = 0.039), with 15.7% of REGARDS using ≥8 ingredients. In crude comparisons, women used more medications than men, and blacks and whites reported similar mean ingredients. A cross-sectional, logistic model adjusting for demographics, socioeconomics, and comorbidities showed increased polypharmacy prevalence in whites vs. blacks (OR, [95% CI]: 0.63, [0.55–0.72]), women (1.94, [1.68–2.23]), and Southerners {broadly Southeasterners and Texans} (1.48, [1.17–1.87]) vs. Northeasterners {broadly New England and upper Mid-Atlantic}. Possible limitations include polypharmacy misclassification and model mis-specification. Conclusion Polypharmacy is common. Race and geography are associated with polypharmacy variation. Further study of underlying factors explaining these differences is warranted.

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Section: Discussionmentioning

confidence: 99%

Geographic region and racial variations in polypharmacy in the United States

Cashion

McClellan

Howard

et al. 2015

Annals of Epidemiology

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“…It has been demonstrated that the number of prescribed drugs increases along with the number of prescribing physicians and with the number of pharmacies visited [75]. Minimizing these numbers may decrease the risk of potentially inappropriate DDIs [76].…”

Section: Main Risk Factors For Adverse Drug Interactionsmentioning

confidence: 99%

Epidemiology and characteristics of adverse drug reactions caused by drug–drug interactions

Magro

Moretti²,

Leone³

2011

Expert Opinion on Drug Safety

221

159

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Potential DDIs far outnumber actual drug interactions. The potential for an adverse interaction to occur is often theoretical, and clinically important adverse effects occur only in the presence of specific risk factors. Several studies have shown the efficacy of computers in early detection of DDIs. However, a correct risk-benefit evaluation by the prescribing physician, together with a careful clinical, physiological and biochemical monitoring of patients, is essential. Future directions of drug interaction research include the increasing importance of pharmacogenetics in preventing DDIs and the evaluation of interactions with biological drugs.

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“…The presence of multiple medical illnesses contributes to the problem of polypharmacy in the growing older population. Polypharmacy is defined as the regular daily consumption of multiple medications as well as the use of high‐risk medications and questionable dosing 3 . Polypharmacy is known to be a significant risk factor for adverse drug reactions (ADR), failed patient compliance, and increased health‐care costs 4 – 7 .…”

Section: Inappropriate Medications In Older People (Independent Of DImentioning

confidence: 99%