The relation between polypharmacy and medication non adherence in elderly patients with non-communicable diseases in primary care, Phra Nakhon Si Ayutthaya Hospital
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20250934Keywords:
Elderly, Medication adherence, PolypharmacyAbstract
Background: Most health problems in the elderly are non-communicable diseases. The elderly continuously take medication for treatment and prevent complications. This increases the chances of polypharmacy in the elderly, which may lead to medication non adherence, negatively affecting health and reducing quality of life.
Methods: This research aimed to study the relationship between polypharmacy and medication non adherence in elderly patients with non-communicable diseases in primary care services of Phra Nakhon Si Ayutthaya Hospital, compared with non-polypharmacy. This study was a cross-sectional study with participants divided into two groups: Polypharmacy and Non polypharmacy. There were 276 participants aged over 60 years and who received services at the primary care services of Phra Nakhon Si Ayutthaya Hospital, from October 2023 to April 2024. Baseline data and Medication adherence data were collected.
Results: The results of the study found that the sample group of 276 people had the most of age at 60-69 years. The most common non-communicable disease was hypertension. Most participants had a daily dose of 1-5 pills, self-managed their medication and had medication compliance. Polypharmacy was significantly associated with medication non adherence (p value 0.04) (odd ratio 2.43, 95%CI 1.06-5.58) and Polypharmacy was significantly associated with inappropriate drug use (p value <0.01) (odd ratio 6.62, 95%CI 3.47-12.61).
Conclusions: The conclusion of the study found that polypharmacy had a statistically significant effect on medication non adherence and inappropriate drug use in elderly patients with non-communicable diseases. Physicians should consider prescribing drugs for the treatment of non-communicable diseases appropriately to reduce the chance of medication non adherence and inappropriate drug use in the elderly.
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References
United Nations. World population ageing 2020 Highlights. New York: United Nations. 2020.
National Statistical Office Ministry of Digital Economy and Society Report Survey of the Older Persons in Thailand 2021 (The 2021 Survey of The Older Persons in Thailand). Bangkok. 2022.
Foundation of Thai Gerontology Research and Development institute (TGRI). The Situation of Elderly People in Thailand 2021. Nakornpathom. 2022.
Vatcharavongvan P. Elderly patients with polypharmacy: Approaches to improve medication management in an outpatient setting. Thammasat Medical J. 2016;16:50-59.
Tippayavadee Wannawichate, Panita Limpawattana, Manchumad Manjavong. Prevalence of Polypharmacy and Associated Factors among Older Patients at an Outpatient Clinic of a Tertiary Care Hospital. KKU J Med. 2022;8(2):20-9.
Ruangritchankul S, Krairit O, Putthipokin K. Polypharmacy among Older Adults in Outpatient Clinic, Internal Medicine Department, Ramathibodi Hospital. Thai J Toxicol. 2018;33(1):35-50.
Kulapatsangtong R, Khungtumneum K, Bunthan W. Factors Related to Polypharmacy Use Behaviorsamong Community-Dwelling Older Persons with Non-Communicable Diseases. J of Prachomklao College of Nurs. 2022;5(2):57-71.
Grant RW, Singer DE, Devita NG, James B. Meigs. Polypharmacy and Medication Adherence in Patients with Type 2 Diabetes. Diabetes Care. 2003;5(5):1408-12. DOI: https://doi.org/10.2337/diacare.26.5.1408
Tan YW, Suppiah S. Polypharmacy among community-dwelling elderly in Singapore: Prevalence, risk factors and association with medication non-adherence. Proceedings of Singapore Healthcare. 2019;28(4):224–31. DOI: https://doi.org/10.1177/2010105819868485
World Health Organization. Medication Safety in Polypharmacy. Geneva: World Health Organization. 2019
Sirasa Ruangritchankul. Polypharmacy in the Elderly. Ramathibodi Med J. 2018;41(1):95-104.
Rukleng S, Woradej S. Prevalence drug related problems and outcomes of polypharmacy treatment among patients: literature review. J Health Sci. 2016;25(6):1084-96.
Sabate E. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization. 2003
Jongwilaikasem K, Lerkiatbundit S. Development of the medication adherence scale for Thais (MAST). Thai J of Pharm Prac. 2021;13(1):17-30.
Vatcharavongvan P, Puttawanchai V. Polypharmacy, medication adherence and medication management at home in elderly patients with multiple non-communicable diseases in Thai primary care. Family Medicine & Primary Care Review. 2017;19(4):412-6. DOI: https://doi.org/10.5114/fmpcr.2017.70818
Pongchitsiri S. Prevalence and Associated Factors of Medication Non-adherence among Elderly Patients with Chronic Diseases in Primary Care Setting of Chachoengsao Province. The J Prapokklao Hospital Clinical Med Education Center. 2021;38(2):97-104.
Makruasi S, Makruasi N. Prevalence of Polypharmacy and Factors Affecting Medication Non-Adherence among Non-Communicable Disease Patients in Nakhon Nayok Hospital: An Aspect of General Hospital. JPMAT. 2023;13(1):165-81.
Paisansirikul A, Ketprayoon A,Ittiwattanakul W,Petchlorlian A. Prevalence and associated factors of drug‑related problems among older people: a cross‑sectional study at king Chulalongkorn Memorial Hospital in Bangkok. Drugs-Real World Outcomes. 2021;8(1):73-84. DOI: https://doi.org/10.1007/s40801-020-00219-2
Muangpaisan W, Pisalsalakij D, Intalapaporn S, Chattanawaree W. Medical nonadherence in elderly patients in a Thai geriatric clinic. Asian Biomedicine. 2014;8(4):541-5. DOI: https://doi.org/10.5372/1905-7415.0804.325
Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A, et al. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC Fam Pract. 2019;20(1):132. DOI: https://doi.org/10.1186/s12875-019-1019-3
Napolitano F, Napolitano P, Angelillo IF. Medication adherence among patients with chronic conditions in Italy. Eur J Public Health. 2016;26:48-52.
Pattanajak C. Medication adherence in elderly patients with chronic disease at Lad Pattana Health Promoting Hospital, Muang District, Mahasarakham Province. Mahasarakham Hospital J. 2019;16(3):13-22.
Smaje A, Weston-Clark M, Raj R, Orlu M, Davis D, Rawle M. Factors associated with medication adherence in older patients: a systematic review. Aging Med (Milton). 2018;1:254-66. DOI: https://doi.org/10.1002/agm2.12045
Jongwilaikasem K. Development of the Medication Adherence Scale for Thais (MAST). Thai J of Pharm Pract. 2021;13(1):17-30.
Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51. DOI: https://doi.org/10.1016/j.amjopharm.2007.12.002
Sorensen L, Stokes JA, Purdie DM. Medication management at home: medication-related risk factors associated with poor health outcomes. Age Ageing. 2005;34(6):626–32. DOI: https://doi.org/10.1093/ageing/afi202
Zelko E, Klemenc-Ketis Z, Tusek-Bunc K. Medication adherence in elderly with polypharmacy living at home: a systematic review of existing studies. Master Sociomed. 2016;28:129-32. DOI: https://doi.org/10.5455/msm.2016.28.129-132
Napolitano F, Napolitano P and Angelillo IF. Medication adherence among patients with chronic conditions in Italy. Eur J Public Health. 2016;26:48-52. DOI: https://doi.org/10.1093/eurpub/ckv147
Roy NT, Sajith M, Bansode MP. Assessment of Factors Associated with Low Adherence to Pharmacotherapy in Elderly Patients. J Young Pharm. 2017;9(2):272-6. DOI: https://doi.org/10.5530/jyp.2017.9.53
Patterson SM, Cadogan CA, Kerse N, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2012;5:8165. DOI: https://doi.org/10.1002/14651858.CD008165.pub2
Thorell K, Midlöv P. Use of potentially inappropriate medication and polypharmacy in older adults: a repeated cross-sectional study. BMC Geriatr. 2020;19;20:73. DOI: https://doi.org/10.1186/s12877-020-1476-5
Sangaleti I, Lentsck I. Polypharmacy, potentially inappropriate medications and associated factors among older adults with hypertension in primary care. Rev Bras Enferm. 2023;76(2):20785. DOI: https://doi.org/10.1590/0034-7167-2022-0785
Hagiwara S, Komiyama J. Polypharmacy and potentially inappropriate medications in older adults who use long-term care services: a cross-sectional study. BMC Geriatr. 2024;24(1):696. DOI: https://doi.org/10.1186/s12877-024-05296-4
Lenander C, Bondesson A, Viberg N. Effects of an intervention (SAKLAK) on prescription of potentially inappropriate medication in elderly patients. Fam Pract. 2017;34(2):213–8. DOI: https://doi.org/10.1093/fampra/cmw121
Lenander C, Bondesson A, Midlov P. Healthcare system intervention for safer use of medicines in elderly patients in primary care qualitative study of the participants’ perceptions of self-assessment, peer review, feedback and agreement for change. BMC Fam Pract. 2015;16:117. DOI: https://doi.org/10.1186/s12875-015-0334-6
Tamblyn R, Huang A, Perreault R. The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. CMAJ. 2003;169(6):549–6.
Taylor CT, Byrd DC, Krueger K. Improving primary care in rural Alabama with a pharmacy initiative. Am J Health Syst Pharm. 2003;60(11):1123–9. DOI: https://doi.org/10.1093/ajhp/60.11.1123
Osterberg L, Blaschke T. Adherence to Medication. N Engl J Med. 2005;353:487-97. DOI: https://doi.org/10.1056/NEJMra050100
Sychev DA, Cherniaeva MS, Rozhkova MA, Vorobyova AE. Potentially Inappropriate Medications for Use in Older Adults: Beers Criteria (2023 American Geriatrics Society Guidelines). Safety and Risk of Pharmacotherapy. 2024;3:254. DOI: https://doi.org/10.30895/2312-7821-2024-420
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