Excessive polypharmacy and potentially inappropriate prescribing in 147 care homes: a cross-sectional study

MacRae, C., Henderson, D. A.G., Mercer, S. W. , Burton, J. , De Sousa, N., Grill, P., Marwick, C. and Guthrie, B. (2021) Excessive polypharmacy and potentially inappropriate prescribing in 147 care homes: a cross-sectional study. BJGP Open, 5(6), BJGPO.2021.0167. (doi: 10.3399/BJGPO.2021.0167) (PMID:34620596)

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Abstract

Background: Care-home residents often have multiple cognitive and physical impairments and are at high risk of adverse drug events (ADEs). Aim: Describe excessive polypharmacy and potentially inappropriate prescribing predisposing care-home residents to ADEs. Design and Setting: Cross-sectional analysis of all dispensed prescriptions for residents of 147 care-homes. Method: Prevalence of excessive polypharmacy was examined using multilevel logistic regression, by modelling associations between individual and care-home predictors with excessive polypharmacy (≥10 drugs). Prescribing of drugs known to increase the risk of eight clinically important ADE categories was examined. Drugs prescribed within each ADE category, for each resident, were counted. Results: 32.3% of residents had excessive polypharmacy, which was more common in residents aged 70–74 years (aOR =1.86 [1.04–3.34]) and 80–84 years (aOR =1.75 [1.01–3.02]), living in a residential care-home (aOR =1.50 [95%CI 1.19–1.88]), and located in Fife (aOR =1.37 [1.09–1.71]). Excessive polypharmacy was less common in residents with dementia (aOR =0.73 [0.64–0.84]). 8.9% (5.9%–11.6%) of the variation was attributable to care-home predictors. Potentially inappropriate prescribing of ≥2 drugs was seen across all ADE categories with highest prevalence seen in drugs predisposing to constipation (35.8%), sedation (27.7%), and renal injury (18.0%). Conclusions: Excessive polypharmacy is common in care-home residents and is associated with both individual and care-home predictors. Potentially inappropriate prescribing of drugs that predisposed residents to all included ADEs categories is common. Research is needed to support and evaluate safe care-home prescribing practices.

Item Type:Articles
Additional Information:PG was funded by Medical Research Scotland as part of a vacation scholarship (MRS grant number: 1198–2018). NDS was funded by an Economic and Social Research Council award from the Antimicrobial Resistance Cross Council Initiative supported by the seven research councils in partnership with other funders, with CAM and BG as grant holders (ESRC grant number: ES/P008224/1).
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Burton, Dr Jenni and Mercer, Professor Stewart
Authors: MacRae, C., Henderson, D. A.G., Mercer, S. W., Burton, J., De Sousa, N., Grill, P., Marwick, C., and Guthrie, B.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
Journal Name:BJGP Open
Publisher:Royal College of General Practitioners
ISSN:2398-3795
ISSN (Online):2398-3795
Published Online:07 October 2021
Copyright Holders:Copyright © 2021 The Author(s).
First Published:First published in BJGP Open 5(6): BJGPO.2021.0167
Publisher Policy:Reproduced under a Creative Commons Licence

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