Prescription drug claims following a traumatic spinal cord injury for older adults: a retrospective population-based study in Ontario, Canada

Abstract

Study designRetrospective cohort study.ObjectivesThe objectives for this study were to examine the prevalence of polypharmacy for people with traumatic spinal cord injury (SCI) following injury and to determine risk factors.SettingOntario, CanadaMethodsWe used provincial-level administrative health services data of publicly funded healthcare encounters housed at the Institute for Clinical Evaluative Sciences, Toronto, Ontario. We examined prescription medications dispensed over a 1 year period post injury for persons 66+ years with an index traumatic SCI between 2004 and 2014. Polypharmacy was defined as being on 10 or more drug classes. Descriptive and analytical statistics were conducted. Relative risks and 95% confidence limits for factors related to polypharmacy were calculated using a robust Poisson multivariate regression model.ResultsWe identified 418 cases of persons with traumatic SCI during the observation window. A total of 233 patients (56%) were taking at least 10 drug classes in the year following discharge from care for traumatic SCI. The mean number of drug classes taken post injury was 11 (SD = 6). Continuity of care was significantly associated with polypharmacy, with a higher continuity of care (having at least 75% of visits with the same doctor) reducing the risk of polypharmacy. The most common drugs prescribed were laxatives, opioids and cardiovascular-related drugs.ConclusionFindings suggest that polypharmacy is extensive among older adults with traumatic SCI. Persons with better continuity of care are less likely to have polypharmacy compared to those with less continuity.SponsorshipThis project was funded by a Connaught New Investigator Award (University of Toronto), and the Craig H. Neilsen Foundation Psychosocial Research Pilot Grant (Grant #441259).

Managing Medication Cost Burden: A Qualitative Study Exploring Experiences of People with Disabilities in Canada

“…The estimated lifetime economic burden associated with a traumatic SCI in Canada ranges from $1.47 million for a person with incomplete paraplegia to $3.03 million for one with complete tetraplegia [17]. People with SCI are high users of medications, taking between 5–14 different medications concurrently, often with complex regimens [18]. Therefore, individuals with SCI represented an ideal population of high users of medications for this study due to the chronic nature of their condition, the presence of multiple consequences of injury and the level of disability associated with an SCI [19,20].…”

Medication adherence for persons with spinal cord injury and dysfunction from the perspectives of healthcare providers: A qualitative study

“…[6][7][8] As a result, treatment plans are often complex, 9,10 involving the concomitant use of multiple medications (i.e. polypharmacy), [11][12][13][14] which often include high-risk prescription drugs (e.g. opioids, benzodiazepines).…”

Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients

“… 26–28 Although few SCI-specific studies have investigated continuity of care on health outcomes, one contemporary study found that persons with continuity of care were less likely to partake in polypharmacy. 29 30 To this effect, to improve survival outcomes, regular, life-long specialised care is critical for the long-term management of secondary health conditions (eg, cardiovascular disease, urinary tract infections, respiratory infections and pressure ulcers) associated with premature mortality. 13 However, current evidence suggests inadequate management and support of secondary health conditions.…”