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Multimorbidity, Polypharmacy, and Medication Appropriateness: Public Health Challenges and Research Priorities

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences".

Deadline for manuscript submissions: 1 December 2024 | Viewed by 15412

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Special Issue Editors

Dr. Francisca González-Rubio

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Guest Editor

Drug Utilization Work Group, Spanish Society of Family and Community Medicine (semFYC), ES-08009 Barcelona, Spain
Interests: multimorbidity; chronic diseases; drug utilisation; pharmacoepidemiology; pharmacovigilance; public health; big data

Dr. Ignatios Ioakeim-Skoufa

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Guest Editor

WHO Collaborating Centre for Drug Statistics Methodology, Department of Drug Statistics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, NO-0213 Oslo, Norway
Interests: multimorbidity; chronic diseases; public health; drug utilisation; pharmacovigilance; epidemiology; real-world evidence; AI in health
Special Issues, Collections and Topics in MDPI journals

Dr. Mercedes Aza-Pascual-Salcedo

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Guest Editor

Primary Care Pharmacy, Aragon Health Service (SALUD), ES-50017 Zaragoza, Spain
Interests: multimorbidity; chronic diseases; drug utilisation; pharmacoepidemiology; pharmacovigilance; real-world data
Special Issues, Collections and Topics in MDPI journals

Dr. Harry H. X. Wang

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Guest Editor

School of Public Health, Sun Yat-Sen University, Guangzhou 510275, China
Interests: primary health care; multimorbidity; hypertension and CVDS; health services and epidemiology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Advances in Medicine and other sciences during the last four decades have contributed to an extraordinary rise in life expectancy. Healthcare models have been improved, offering more effective diagnostic and therapeutic procedures. The clinical profile of the population also changes with time; diseases previously known as “deadly” are becoming today preventable and treatable conditions, others are diagnosed earlier in life, and new ones emerge. Several factors participate in this evolution; many of them are in our hands, such as caring for the environment, adopting healthy habits, and appropriate use of drugs. Many people live with two or more chronic conditions (multimorbidity) and are treated with multiple drugs (polypharmacy); their number increases continuously in all ages and genders. This situation is becoming more and more challenging in the clinical setting and, in the era of big data and real-world evidence, it is a major priority for epidemiologic research.

The Special Issue “Multimorbidity, polypharmacy, and medication appropriateness: public health challenges and research priorities” of the International Journal of Environmental Research and Public Health aims to cover the following important areas:

Characterisation of multimorbidity, risk factors, use of healthcare services
Drug utilisation, medication adherence, polypharmacy, potentially inappropriate medication
Multimorbidity trajectories, trends in polypharmacy
Multimorbidity, polypharmacy, potentially inappropriate medication and their (synergistic) effects on health outcomes
The role of big data, real-word evidence, and artificial intelligence in the clinical praxis and epidemiologic research regarding multimorbidity and polypharmacy

High-quality original papers and literature reviews that address one or more of the above areas are welcome for submission in this Special Issue.

Dr. Francisca González-Rubio
Dr. Ignatios Ioakeim-Skoufa
Dr. Mercedes Aza-Pascual-Salcedo
Dr. Harry H. X. Wang
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

multimorbidity
chronic diseases
drug-utilisation study
medication appropriateness
polypharmacy
potentially inappropriate medication
drug interactions
drug-related side effects and adverse reactions
medication adherence
person-centred approaches
real-world data
AI in Health

Published Papers (7 papers)

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Research

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17 pages, 1313 KiB

Open AccessArticle

Safety Concerns Related to the Simultaneous Use of Prescription or Over-the-Counter Medications and Herbal Medicinal Products: Survey Results among Latvian Citizens

by Inga Sile, Renate Teterovska, Oskars Onzevs and Elita Ardava

Int. J. Environ. Res. Public Health 2023, 20(16), 6551; https://doi.org/10.3390/ijerph20166551 - 09 Aug 2023

Cited by 2 | Viewed by 1831

Abstract

The use of herbal medicines is increasing worldwide. While the safety profile of many herbal medicines is promising, the data in the literature show important interactions with conventional drugs that can expose individual patients to high risk. The aim of this study was to investigate the experience of the use of herbal medicines and preparations and the risks of interactions between herbal and conventional medicines among Latvian citizens. Data were collected between 2019 and 2021 using a structured questionnaire designed for pharmacy customers in Latvia. Electronic databases such as Drugs.com, Medscape, and European Union herbal monographs were reviewed for the risk of drug interactions and potential side effects when herbal medicines were involved. The survey included 504 respondents. Of all the participants, 77.8% used herbal preparations. Most of the participants interviewed used herbal remedies based on the recommendation of the pharmacist or their own initiative. A total of 38.3% found the use of herbal remedies safe and harmless, while 57.3% of respondents regarded the combination of herbal and regular drugs as unsafe. The identified herbal medicines implicated in the potential risk of serious interactions were grapefruit, St. John’s wort, and valerian. As the risks of herb–drug interactions were identified among the respondents, in the future, both pharmacy customers and healthcare specialists should pay more attention to possible herb–drug interactions of over-the-counter and prescription medications. Full article

(This article belongs to the Special Issue Multimorbidity, Polypharmacy, and Medication Appropriateness: Public Health Challenges and Research Priorities)

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15 pages, 1215 KiB

Open AccessArticle

Sex Differences in Multimorbidity, Inappropriate Medication and Adverse Outcomes of Inpatient Care: MoPIM Cohort Study

by Marisa Baré, Marina Lleal, Daniel Sevilla-Sánchez, Sara Ortonobes, Susana Herranz, Olivia Ferrandez, Celia Corral-Vázquez, Núria Molist, Gloria Julia Nazco, Candelaria Martín-González, Miguel Ángel Márquez and on behalf of the MoPIM Study Group

Int. J. Environ. Res. Public Health 2023, 20(4), 3639; https://doi.org/10.3390/ijerph20043639 - 18 Feb 2023

Cited by 1 | Viewed by 2186

Abstract

There is no published evidence on the possible differences in multimorbidity, inappropriate prescribing, and adverse outcomes of care, simultaneously, from a sex perspective in older patients. We aimed to identify those possible differences in patients hospitalized because of a chronic disease exacerbation. A multicenter, prospective cohort study of 740 older hospitalized patients (≥65 years) was designed, registering sociodemographic variables, frailty, Barthel index, chronic conditions (CCs), geriatric syndromes (GSs), polypharmacy, potentially inappropriate prescribing (PIP) according to STOPP/START criteria, and adverse drug reactions (ADRs). Outcomes were length of stay (LOS), discharge to nursing home, in-hospital mortality, cause of mortality, and existence of any ADR and its worst consequence. Bivariate analyses between sex and all variables were performed, and a network graph was created for each sex using CC and GS. A total of 740 patients were included (53.2% females, 53.5% ≥85 years old). Women presented higher prevalence of frailty, and more were living in a nursing home or alone, and had a higher percentage of PIP related to anxiolytics or pain management drugs. Moreover, they presented significant pairwise associations between CC, such as asthma, vertigo, thyroid diseases, osteoarticular diseases, and sleep disorders, and with GS, such as chronic pain, constipation, and anxiety/depression. No significant differences in immediate adverse outcomes of care were observed between men and women in the exacerbation episode. Full article

(This article belongs to the Special Issue Multimorbidity, Polypharmacy, and Medication Appropriateness: Public Health Challenges and Research Priorities)

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16 pages, 877 KiB

Open AccessArticle

Comprehensive Multimorbidity Patterns in Older Patients Are Associated with Quality Indicators of Medication—MoPIM Cohort Study

by Marina Lleal, Marisa Baré, Sara Ortonobes, Daniel Sevilla-Sánchez, Rosa Jordana, Susana Herranz, Maria Queralt Gorgas, Mariona Espaulella-Ferrer, Marta Arellano, Marta de Antonio, Gloria Julia Nazco, Rubén Hernández-Luis and on behalf of the MoPIM Study Group

Int. J. Environ. Res. Public Health 2022, 19(23), 15902; https://doi.org/10.3390/ijerph192315902 - 29 Nov 2022

Cited by 2 | Viewed by 1896

Abstract

Multimorbidity is increasing and poses a challenge to the clinical management of patients with multiple conditions and drug prescriptions. The objectives of this work are to evaluate if multimorbidity patterns are associated with quality indicators of medication: potentially inappropriate prescribing (PIP) or adverse drug reactions (ADRs). A multicentre prospective cohort study was conducted including 740 older (≥65 years) patients hospitalised due to chronic pathology exacerbation. Sociodemographic, clinical and medication related variables (polypharmacy, PIP according to STOPP/START criteria, ADRs) were collected. Bivariate analyses were performed comparing previously identified multimorbidity clusters (osteoarticular, psychogeriatric, minor chronic disease, cardiorespiratory) to presence, number or specific types of PIP or ADRs. Significant associations were found in all clusters. The osteoarticular cluster presented the highest prevalence of PIP (94.9%) and ADRs (48.2%), mostly related to anxiolytics and antihypertensives, followed by the minor chronic disease cluster, associated with ADRs caused by antihypertensives and insulin. The psychogeriatric cluster presented PIP and ADRs of neuroleptics and the cardiorespiratory cluster indicators were better overall. In conclusion, the associations that were found reinforce the existence of multimorbidity patterns and support specific medication review actions according to each patient profile. Thus, determining the relationship between multimorbidity profiles and quality indicators of medication could help optimise healthcare processes. Trial registration number: NCT02830425. Full article

(This article belongs to the Special Issue Multimorbidity, Polypharmacy, and Medication Appropriateness: Public Health Challenges and Research Priorities)

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10 pages, 714 KiB

Open AccessArticle

LESS-PHARMA Study: Identifying and Deprescribing Potentially Inappropriate Medication in the Elderly Population with Excessive Polypharmacy in Primary Care

by Xisco Reus, Maria Lluisa Sastre, Alfonso Leiva, Belén Sánchez, Cristina García-Serra, Ignatios Ioakeim-Skoufa and Caterina Vicens

Int. J. Environ. Res. Public Health 2022, 19(20), 13241; https://doi.org/10.3390/ijerph192013241 - 14 Oct 2022

Cited by 1 | Viewed by 2388

Abstract

Potentially inappropriate medication (PIM) increases adverse drug reactions and mortality, especially in excessively polymedicated patients. General practitioners are often in charge of this process. Some tools have been created to support them in this matter. This study aimed to measure the amount of potentially inappropriate medication among excessively polymedicated patients using several supporting tools and assess the feasibility of these tools in primary care. Several explicit deprescribing criteria were used to identify potentially inappropriate medications. The level of agreement between all the criteria and the acceptance by the general practitioner (GP) was also measured. We analysed whether the drugs proposed for deprescribing were eventually withdrawn after twelve months. The total number of drugs prescribed was 2038. Six hundred and forty-nine drugs (31.8%) were considered potentially inappropriate by at least one of the tools. GPs agreed with the tools in 56.7% of the cases. In a 12-month period, 109 drugs, representing 29.6% of the drugs that GPs agreed to deprescribe, were withdrawn. Elderly excessively polymedicated patients accumulated a great number of PIMs. The use of deprescribing supporting tools, such as explicit criteria, is feasible in primary care, and these tools are well accepted by the GPs. However, eventual withdrawal was carried out in less than half of the cases. Full article

(This article belongs to the Special Issue Multimorbidity, Polypharmacy, and Medication Appropriateness: Public Health Challenges and Research Priorities)

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15 pages, 413 KiB

Open AccessArticle

Multimorbidity Clusters in the Oldest Old: Results from the EpiChron Cohort

by Ignatios Ioakeim-Skoufa, Mercedes Clerencia-Sierra, Aida Moreno-Juste, Carmen Elías de Molins Peña, Beatriz Poblador-Plou, Mercedes Aza-Pascual-Salcedo, Francisca González-Rubio, Alexandra Prados-Torres and Antonio Gimeno-Miguel

Int. J. Environ. Res. Public Health 2022, 19(16), 10180; https://doi.org/10.3390/ijerph191610180 - 17 Aug 2022

Cited by 9 | Viewed by 2176

Abstract

Multimorbidity is challenging for both patients and healthcare systems due to its increasing prevalence and high impact on people’s health and well-being. The risk of multimorbidity increases with age, but there is still more to discover regarding the clinical profile of the oldest old. In this study, we used information from the EpiChron Cohort Study to identify multimorbidity patterns in individuals who died during the period 2010–2019 at the ages of 80–89, 90–99, and ≥100. This cohort links the demographic, clinical, and drug dispensation information of public health system users in Aragón, Spain. We saw a significantly lower number of chronic diseases and drugs and a lower prevalence of polypharmacy in centenarians compared to those aged 80–99. K-means clustering revealed different multimorbidity clusters by sex and age group. We observed clusters of cardiovascular and metabolic diseases, obstructive pulmonary conditions, and neoplasms, amongst other profiles. One in three octogenarian women had a metabolic pattern (diabetes, dyslipidaemia, and other endocrine–metabolic disorders) with the highest number of diseases (up to seven) and prevalence of polypharmacy (64%). We observed clusters of dementia and genitourinary disorders in individuals on medication with anticholinergic activity. Our study offers an opportunity to better understand the urgency of adequately addressing multimorbidity in our older adults. Full article

(This article belongs to the Special Issue Multimorbidity, Polypharmacy, and Medication Appropriateness: Public Health Challenges and Research Priorities)

10 pages, 1753 KiB

Open AccessArticle

Use of Statins in Kidney Transplant Recipients in Norway

by Marit Rønning, Vidar Hjellvik, Solveig Sakshaug, Hege Salvesen Blix, Karsten Midtvedt, Anna Varberg Reisæter, Hallvard Holdaas and Anders Åsberg

Int. J. Environ. Res. Public Health 2022, 19(3), 1370; https://doi.org/10.3390/ijerph19031370 - 26 Jan 2022

Cited by 1 | Viewed by 2049

Abstract

Kidney transplant recipients (KTRs) experience increased risk of cardiovascular disease. Guidelines recommend HMG-CoA reductase inhibitor (statin) therapy when tolerated. We aimed to study changes in the prescription of statins and patients’ adherence to treatment over time. A population-based observational study utilizing linked data from the Norwegian Renal Registry (national coverage of 99.9%) and the Norwegian Prescription Database was performed. Data from a total of 2250 first KTRs were included (mean age—54 years, 69% men). Dispensed prescriptions of statins and immunosuppressants for the period 2004–2016 for all first KTRs engrafted in the period 2005–2015 were analyzed. Seventy-two percent received statins the first year after kidney transplantation and the proportion increased with age. The proportion receiving a statin varied according to the time frame of transplantation (77% in 2005–2010 vs. 66% in 2012–2015). Among new users of statins, 82% of the patients were adherent both the second and third year after kidney transplantation, while the corresponding figure for those already receiving statins before transplantation was 97%. Statin continuation rates in KTRs were high. In conclusion, our findings show a slightly lower overall proportion of patients receiving statins after kidney transplants than the national target level of 80%. The proportion of statin users increased with the age of the KTRs but showed a decreasing trend as time progressed. Full article

(This article belongs to the Special Issue Multimorbidity, Polypharmacy, and Medication Appropriateness: Public Health Challenges and Research Priorities)

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Review

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19 pages, 673 KiB

Open AccessReview

The Effectiveness of Interventions to Evaluate and Reduce Healthcare Costs of Potentially Inappropriate Prescriptions among the Older Adults: A Systematic Review

by Sara Mucherino, Manuela Casula, Federica Galimberti, Ilaria Guarino, Elena Olmastroni, Elena Tragni, Valentina Orlando, Enrica Menditto and on behalf of the EDU.RE.DRUG Group

Int. J. Environ. Res. Public Health 2022, 19(11), 6724; https://doi.org/10.3390/ijerph19116724 - 31 May 2022

Cited by 6 | Viewed by 1780

Abstract

Potentially inappropriate prescribing (PIP) is associated with an increased risk of adverse drug reactions, recognized as a determinant of adherence and increased healthcare costs. The study’s aim was to explore and compare the results of interventions to reduce PIP and its impact on avoidable healthcare costs. A systematic literature review was conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement guidelines. PubMed and Embase were queried until February 2021. Inclusion criteria followed the PICO model: older patients receiving PIP; Interventions aimed at health professionals, structures, and patients; no/any intervention as a comparator; postintervention costs variations as outcomes. The search strategy produced 274 potentially relevant publications, of which 18 articles met inclusion criteria. Two subgroups were analyzed according to the study design: observational studies assessing PIP frequency and related-avoidable costs (n = 10) and trials, including specific intervention and related outcomes in terms of postintervention effectiveness and avoided costs (n = 8). PIP prevalence ranged from 21 to 79%. Few educational interventions carried out to reduce PIP prevalence and avoidable costs resulted in a slowly improving prescribing practice but not cost effective. Implementing cost-effective strategies for reducing PIP and clinical and economic implications is fundamental to reducing health systems’ PIP burden. Full article

(This article belongs to the Special Issue Multimorbidity, Polypharmacy, and Medication Appropriateness: Public Health Challenges and Research Priorities)

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