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Chronicity, Multimorbidity, and Medication Appropriateness
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Chronicity, Multimorbidity, and Medication Appropriateness

A special issue of Journal of Clinical Medicine (ISSN 2077-0383).

Deadline for manuscript submissions: 31 December 2024 | Viewed by 3083

Special Issue Editors

Dr. Ignatios Ioakeim-Skoufa

E-Mail Website
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

E-Mail Website
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. Helena Coelho

E-Mail Website
Guest Editor
Portuguese Society of Health Care Pharmacists (SPFCS), PT-3030-320 Coimbra, Portugal
Interests: drug utilization; pharmacoepidemiology; pharmacovigilance; operation strategy

Special Issue Information

Dear Colleagues,

Multimorbidity is extremely common in older people. However, its prevalence continuously rises in younger adults, highlighting the need for effective interventions to prevent its development and evolution at early ages. Large-scale epidemiologic studies are needed to characterize chronicity better and exhaustively analyze multimorbidity trajectories. It is also vital to study patterns of chronic polypharmacy and other clinical and pharmacological characteristics that are common amongst chronic patients, such as inappropriate medication, low adherence to treatment, drug-related adverse events, and drug–drug and drug–disease interactions. In the era of big data and emerging technologies, addressing chronicity is a significant priority for public health systems, healthcare professionals, and patients.

This Special Issue, “Chronicity, Multimorbidity, and Medication Appropriateness”, in the Journal of Clinical Medicine aims to cover the following areas: the characterization of chronicity, multimorbidity trajectories, and risk factors in all ages; drug utilization; patterns of chronic polypharmacy; medication adherence; adverse events; potentially inappropriate medication in chronic patients; and synergistic effects of the morbidity burden and medication use on health outcomes.

Dr. Ignatios Ioakeim-Skoufa
Dr. Mercedes Aza-Pascual-Salcedo
Dr. Helena Coelho
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. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly 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 2600 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 utilization
  • polypharmacy
  • medication appropriateness
  • medication adherence
  • drug interactions
  • care models
  • chronic inflammation
  • interventions

Published Papers (4 papers)

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Research

15 pages, 556 KiB  
Article
Validation of an Inhaled Therapy Beliefs Questionnaire in Patients with Chronic Obstructive Pulmonary Disease
by Francisca Muñoz-Cobos, Virginia P. Aguiar-Leiva, Carmen Argüello-Suárez, Paula Colacicchi, Luis Antonio Calleja-Cartón and Francisca Leiva-Fernández
J. Clin. Med. 2024, 13(8), 2281; https://doi.org/10.3390/jcm13082281 - 15 Apr 2024
Viewed by 463
Abstract
Background: To carry out a validation questionnaire that assesses beliefs about inhaled treatments in patients with chronic obstructive pulmonary disease (COPD), as knowing patients’ beliefs could help to improve medication adherence and health outcomes. Methods: We evaluated data from 260 COPD [...] Read more.
Background: To carry out a validation questionnaire that assesses beliefs about inhaled treatments in patients with chronic obstructive pulmonary disease (COPD), as knowing patients’ beliefs could help to improve medication adherence and health outcomes. Methods: We evaluated data from 260 COPD patients from electronic medical record databases from five primary healthcare centers, in a descriptive, cross-sectional study with a sample size calculated for a 10-item questionnaire, with an estimated Cronbach’s alpha of 0.70 and a 95% confidence level. Study participants were selected via systematic random sampling. Variables: Ten-item Inhaled Therapy Beliefs Questionnaire, CCTI-Questionnaire v.2.0, time for completion, age, sex, educational level, spirometry severity (GOLD criteria), exacerbations (previous year), characteristics of inhaled treatment, and smoking habit. A two-year follow-up in a subsample of 77 patients from one health center was utilized. The Morisky–Green test, pharmacy dispensing data, test–retest (kappa coefficient), and an exploratory analysis of the adherence–belief relationship (ji-squared) were measured. Results: The 10-item questionnaire showed good viability (3 min completion time) when performed face-to-face or telephonically; its psychometric properties were acceptable, with an internal consistency (Cronbach’s alpha) score of 0.613. Three factors explained 47.58% of the total variance (p < 0.0001): use (factor 1), effects (factor 2), and objectives (factor 3) of inhalers. The two-year follow-up ultimately considered 58 out of the 77 patients (10 deceased, 4 unlocated, 2 mistakes, 2 no inhaled treatment, and 1 withdrawal). Non-adherence was 48.3% in terms of the Morisky–Green test; 31% in terms of pharmacy dispensing data; and 40.4% considering both methods. There was low test–retest reliability, indicated by items 4, 8, and 9 of the CCTI-Questionnaire (Kappa = 0.4, 0.26, and 0.34; p-value < 0.0001, 0.008, and 0.001, respectively). There was mild correlation between beliefs and adherence. Conclusions: The ten-item CCTI-Questionnaire v.2.0 demonstrated acceptable psychometric properties regarding feasibility, reliability, and content validity. Full article
(This article belongs to the Special Issue Chronicity, Multimorbidity, and Medication Appropriateness)
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23 pages, 794 KiB  
Article
Drug Related Problems among Older Inpatients at a Tertiary Care Setting
by Porrawee Pramotesiri, Krongtong Putthipokin and Sirasa Ruangritchankul
J. Clin. Med. 2024, 13(6), 1638; https://doi.org/10.3390/jcm13061638 - 13 Mar 2024
Viewed by 585
Abstract
Background: Older persons are more likely to have multiple chronic diseases, leading to the simultaneous use of many medications. This situation results in increased drug-related problems (DRPs), which are the causes of adverse health outcomes. Therefore, we aimed to evaluate the prevalence of [...] Read more.
Background: Older persons are more likely to have multiple chronic diseases, leading to the simultaneous use of many medications. This situation results in increased drug-related problems (DRPs), which are the causes of adverse health outcomes. Therefore, we aimed to evaluate the prevalence of and associated risk factors for exposure to >1 criterion of DRPs among older adults admitted to a tertiary care hospital. Methods: We conducted a cross-sectional study involving 357 participants aged ≥60 years admitted to Ramathibodi Hospital from 1 February 2022 to 30 November 2022. The participants were evaluated for baseline characteristics, medications and DRPs and were classified into two groups, according to their exposure to DRPs: patients with exposure to ≤1 criteria and patients with exposure to >1 criterion of DRPs. Multivariate logistic regression analysis was performed to determine the independent risk factors for exposure to >1 criterion of DRPs. Results: Overall, 205 (57.4%) patients experienced >1 criterion of DRPs. Approximately 67.8%, 71.7% and 7.6% of the participants were exposed to at least one potentially inappropriate medication (PIM), drug–drug interaction (DDI) and adverse drug events (ADE), respectively. The most frequently prescribed PIMs were proton pump inhibitors (PPIs) (17.3%). Antineoplastics (48.1%) were the most frequently drug class related to ADEs. Overall, 37% of the ADEs in the current study were considered preventable ADEs. After adjustment for potential confounders, polypharmacy and the use of proton pump inhibitors, hypoglycemics, diuretics, psycholeptics, psychoanaleptics and cardiac therapy medications were correlated with a higher risk of exposure to > 1 criterion of PIMs, DDIs or ADEs. Conclusions: Therefore, comprehensive medication reviews and careful medication prescriptions are recommended in the geriatric population. Full article
(This article belongs to the Special Issue Chronicity, Multimorbidity, and Medication Appropriateness)
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14 pages, 1411 KiB  
Article
Morbidity among Adolescent Hypnotic Drug Users in Norway: An Observational Population-Based Study
by Mohammad Nouri Sharikabad, Svetlana Skurtveit, Hilchen Thode Sommerschild, Kristine Olsen, Ingeborg Hartz, Rikke Wesselhoeft, Vidar Hjellvik, Lars Johan Hauge and Marte Handal
J. Clin. Med. 2024, 13(4), 1075; https://doi.org/10.3390/jcm13041075 - 14 Feb 2024
Viewed by 723
Abstract
We have previously shown that the use of hypnotic drugs increased among young Scandinavians during 2012–2018. This study aimed to explore psychiatric and somatic morbidity among adolescent hypnotic drug users in a cohort study of 13–17-year-old individuals during 2008–2018 in Norway. Data sources [...] Read more.
We have previously shown that the use of hypnotic drugs increased among young Scandinavians during 2012–2018. This study aimed to explore psychiatric and somatic morbidity among adolescent hypnotic drug users in a cohort study of 13–17-year-old individuals during 2008–2018 in Norway. Data sources were (i) prescription data from the Norwegian Prescription Database linked to specialist health care diagnoses from the Norwegian Patient Registry and (ii) sleep disorder diagnoses from the Primary Health Care Database. Hypnotic drugs were defined as the sedative antihistamine alimemazine and the ATC group “Hypnotics and Sedatives” (N05C), excluding midazolam. In 2017, 2519 girls (16.5/1000) and 1718 boys (10.7/1000) were incident (new) users of hypnotic drugs. Most of these new users (82% of girls, 77% of boys) were referred to secondary health care, where the most frequent diagnoses were mental and behavioral disorders (51.8% of girls, 46.2% of boys), while only 3.2% received a specific sleep disorder diagnosis. The most common mental and behavioral disorders were “Neurotic stress-related disorders” among girls (27.4%) and “Behavioral and emotional disorders” among boys (23.6%). In conclusion, the trend of increasing hypnotic drug use among adolescents reflects the initiation of hypnotic drugs in a subgroup of the population with a higher disease burden, mainly due to psychiatric disorders, than the general population. Full article
(This article belongs to the Special Issue Chronicity, Multimorbidity, and Medication Appropriateness)
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11 pages, 244 KiB  
Article
Potentially Inappropriate Prescribing and Potential Prescribing Omissions and Their Association with Adverse Drug Reaction-Related Hospital Admissions
by Ross Brannigan, John E. Hughes, Frank Moriarty, Emma Wallace, Ciara Kirke, David Williams, Kathleen Bennett and Caitriona Cahir
J. Clin. Med. 2024, 13(2), 323; https://doi.org/10.3390/jcm13020323 - 06 Jan 2024
Viewed by 890
Abstract
Background: This study aimed to determine the prevalence of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) and their association with ADR-related hospital admissions in patients aged ≥ 65 years admitted acutely to the hospital. Methods: Information on medications and morbidities was [...] Read more.
Background: This study aimed to determine the prevalence of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) and their association with ADR-related hospital admissions in patients aged ≥ 65 years admitted acutely to the hospital. Methods: Information on medications and morbidities was extracted from the Adverse Drug Reactions in an Ageing Population (ADAPT) cohort (N = 798: N = 361 ADR-related admissions; 437 non-ADR-related admissions). PIP and PPOs were assessed using Beers Criteria 2019 and STOPP/START version 2. Multivariable logistic regression (adjusted odds ratios (aOR), 95%CI) was used to examine the association between PIP, PPOs and ADR-related admissions, adjusting for covariates (age, gender, comorbidity, polypharmacy). Results: In total, 715 (90%; 95% CI 87–92%) patients had ≥1 Beers Criteria, 555 (70%; 95% CI 66–73%) had ≥ 1 STOPP criteria and 666 patients (83%; 95% CI 81–86%) had ≥ 1 START criteria. Being prescribed at least one Beers (aOR = 1.66, 95% CI = 1.00–2.77), or meeting STOPP (aOR = 1.07, 95% CI = 0.79–1.45) or START (aOR = 0.72; 95%CI = 0.50–1.06) criteria or the number of PIP/PPO criteria met was not significantly associated with ADR-related admissions. Patients prescribed certain drug classes (e.g., antiplatelet agents, diuretics) per individual PIP criteria were more likely to have an ADR-related admission. Conclusion: There was a high prevalence of PIP and PPOs in this cohort but no association with ADR-related admissions. Full article
(This article belongs to the Special Issue Chronicity, Multimorbidity, and Medication Appropriateness)
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