The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010

Abstract

BackgroundThe escalating use of prescribed drugs has increasingly raised concerns about polypharmacy. This study aims to examine changes in rates of polypharmacy and potentially serious drug-drug interactions in a stable geographical population between 1995 and 2010.MethodsThis is a repeated cross-sectional analysis of community-dispensed prescribing data for all 310,000 adults resident in the Tayside region of Scotland in 1995 and 2010. The number of drug classes dispensed and the number of potentially serious drug-drug interactions (DDIs) in the previous 84 days were calculated, and age-sex standardised rates in 1995 and 2010 compared. Patient characteristics associated with receipt of ≥10 drugs and with the presence of one or more DDIs were examined using multilevel logistic regression to account for clustering of patients within primary care practices.ResultsBetween 1995 and 2010, the proportion of adults dispensed ≥5 drugs doubled to 20.8%, and the proportion dispensed ≥10 tripled to 5.8%. Receipt of ≥10 drugs was strongly associated with increasing age (20–29 years, 0.3%; ≥80 years, 24.0%; adjusted OR, 118.3; 95% CI, 99.5–140.7) but was also independently more common in people living in more deprived areas (adjusted OR most vs. least deprived quintile, 2.36; 95% CI, 2.22–2.51), and in people resident in a care home (adjusted OR, 2.88; 95% CI, 2.65–3.13). The proportion with potentially serious drug-drug interactions more than doubled to 13% of adults in 2010, and the number of drugs dispensed was the characteristic most strongly associated with this (10.9% if dispensed 2–4 drugs vs. 80.8% if dispensed ≥15 drugs; adjusted OR, 26.8; 95% CI 24.5–29.3).ConclusionsDrug regimens are increasingly complex and potentially harmful, and people with polypharmacy need regular review and prescribing optimisation. Research is needed to better understand the impact of multiple interacting drugs as used in real-world practice and to evaluate the effect of medicine optimisation interventions on quality of life and mortality.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-015-0322-7) contains supplementary material, which is available to authorized users.

Profile of elderly persons with metabolic syndrome and factors associated with possible drug interactions

“…The association between the presence of possible DI and age found in the present study diverged from an investigation of elderly persons living in the community in the city of Rio de Janeiro 11 . The relationship between increasing age and the occurrence of DI deserves further investigation 10,11 , as the aging process may contribute to the increase in the prevalence of chronic diseases, which causes the elderly to use more drugs 7 , resulting in a greater possibility of DI 10,27 .…”

“…In a survey conducted in Scotland, the prevalence among the elderly was 34.1% 10 . These percentages indicate that DI among the elderly is a public health problem and must be carefully monitored.…”

Descripción del uso de medicamentos gastroprotectores en pacientes con polifarmacia en una población colombiana, a partir de bases de datos transaccionales

“…Comorbilidad grave: septicemia, cáncer, hepatitis, insuficiencia renal crónica, traumatismos y quemaduras graves; Diabetes: diabetes mellitus tipo 1 y 2; HTA: hipertensión arterial; Otros diagnósticos: otros diagnósticos que no justifican el uso de antiulcerosos; Riesgo GIS: gastritis, duodenitis, esofagitis, ulceras gástrica, duodenal, péptica y gastroyeyunal, enfermedad de reflujo gastroesofágico, varices esofágicas, gástricas y duodenales y cánceres del tracto gastrointestinal superior. Guthrie B. y colaboradores evaluaron la asociación entre el número de medicamentos y la probabilidad de presentar interacciones farmacológicas serias (IFS); 80,8% pacientes con ≥15 medicamentos tuvo potenciales IFS (18). Otros estudios encontraron asociación entre la polifarmacia y riesgo de hospitalizaciones (2,(23)(24)(25), sin obtener mayor tasa de supervivencia, en comparación de los pacientes con menor número de medicamentos (25); por lo tanto, los 49 pacientes de nuestro estudio con ≥20 medicamentos tuvieron alta probabilidad de IFS y hospitalización.…”

Guidelines in the Era of Realistic Medicine

“…If the recommended course of action would only provide a small or perhaps considerably delayed benefit, it may be perfectly acceptable to not follow the guidance for reasons of life expectancy if there was little chance of achieving the benefits of the treatment. 10 It would be surprising if a management plan agreed between a patient and a clinician followed every recommendation and it is for this reason that SIGN has always opposed arbitrary targets for guideline adherence. However, it would be more concerning if a guideline does not influence a management plan because many of the recommendations are uncontroversial and cover only current practice in investigation, management and follow up.…”