Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study.

Autor: Barrio-Cortes J; Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Ave. Reina Victoria, 21, 6Th Floor, 28003, Madrid, Spain.; Faculty of Health, Camilo José Cela University, Madrid, Spain.; Gregorio Marañón Health Research Institute, Madrid, Spain.; Research Network On Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain., Benito-Sánchez B; Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Ave. Reina Victoria, 21, 6Th Floor, 28003, Madrid, Spain. beatrizbenitosanch@salud.madrid.org., Villimar-Rodriguez AI; Primary Care Pharmacy, Care Management of the Central Territorial Area, Madrid Health Service, Madrid, Spain., Rujas M; Technical University of Madrid (UPM), Madrid, Spain., Arroyo-Gallego P; Technical University of Madrid (UPM), Madrid, Spain., Carlson J; Predictby, Barcelona, Spain., Merino-Barbancho B; Technical University of Madrid (UPM), Madrid, Spain., Roca-Umbert A; Predictby, Barcelona, Spain., Castillo-Sanz A; Foundation for Research of Hospital Infantil Niño Jesús, Madrid, Spain., Lupiáñez-Villanueva F; Predictby, Barcelona, Spain., Fico G; Technical University of Madrid (UPM), Madrid, Spain., Gómez-Gascón T; Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), Ave. Reina Victoria, 21, 6Th Floor, 28003, Madrid, Spain.; Research Network On Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain.; Research Institute Hospital, 12 de Octubre (imas12), Primary Care Management, Madrid, Spain.; Faculty of Medicine, Complutense University of Madrid, Madrid, Spain.
Jazyk: angličtina
Zdroj: Journal of pharmaceutical policy and practice [J Pharm Policy Pract] 2023 Nov 28; Vol. 16 (1), pp. 161. Date of Electronic Publication: 2023 Nov 28.
DOI: 10.1186/s40545-023-00665-7
Abstrakt: Background: Patients with polypharmacy suffer from complex medical conditions involving a large healthcare burden. This study aimed to describe the characteristics and utilization of primary care (PC) and hospital care (HC) and factors associated in chronic patients with polypharmacy, stratifying by adjusted morbidity groups (AMG) risk level, sex and age, and comparing with non-polypharmacy.
Methods: Cross-sectional study conducted in a Spanish basic healthcare area. Studied patients were those over 18 years with chronic diseases identified by the AMG tool from Madrid electronic clinical record, which was the data source. Sociodemographic, sociofunctional, clinical and healthcare utilization variables were described and compared by risk level, sex, age and having or not polypharmacy. Factors associated with healthcare utilization in polypharmacy patients were determined by a negative binomial regression model.
Results: In the area studied, 61.3% patients had chronic diseases, of which 16.9% had polypharmacy vs. 83.1% without polypharmacy. Patients with polypharmacy (vs. non-polypharmacy) mean age was 82.7 (vs. 52.7), 68.9% (vs. 60.7%) were women, and 22.0% (vs. 1.2%) high risk. Their average number of chronic diseases was 4.8 (vs. 2.2), and 95.6% (vs. 56.9%) had multimorbidity. Their mean number of annual healthcare contacts was 30.3 (vs. 10.5), 25.9 (vs. 8.8) with PC and 4.4 (vs. 1.7) with HC. Factors associated with a greater PC utilization in patients with polypharmacy were elevated complexity, high risk level and dysrhythmia. Variables associated with a higher HC utilization were also increased complexity and high risk, in addition to male sex, being in palliative care, having a primary caregiver, suffering from neoplasia (specifically lymphoma or leukaemia) and arthritis, whereas older age and immobilization were negatively associated.
Conclusions: Polypharmacy population compared to non-polypharmacy was characterized by a more advanced age, predominance of women, high-risk, complexity, numerous comorbidities, dependency and remarkable healthcare utilization. These findings could help healthcare policy makers to optimize the distribution of resources and professionals within PC and HC systems, aiming for the improvement of polypharmacy management and rational use of medicines while reducing costs attributed to healthcare utilization by these patients.
(© 2023. The Author(s).)
Databáze: MEDLINE
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