背景:多重用药的患者患有复杂的医疗状况,涉及巨大的医疗保健负担。这项研究旨在描述初级保健(PC)和医院护理(HC)的特点和利用以及与多种药物慢性患者相关的因素。按调整发病率组(AMG)风险水平分层,性别和年龄,并与非复方药物进行比较。
方法:在西班牙基础医疗保健领域进行的横断面研究。研究的患者是那些18岁以上的慢性病患者,由马德里电子临床记录的AMG工具确定,这是数据源。社会人口统计学,社会功能,根据风险水平描述和比较临床和医疗保健利用变量,性别,年龄和是否有多重用药。通过负二项回归模型确定与多药房患者医疗保健利用相关的因素。
结果:在研究领域,61.3%的患者有慢性病,其中16.9%的人有多重用药。83.1%没有多重用药。多重用药患者(vs.非多重用药)平均年龄为82.7岁(vs.52.7),68.9%(与60.7%)是女性,和22.0%(与1.2%)高风险。他们的慢性病平均数量为4.8(与2.2),和95.6%(与56.9%)具有多发病率。他们的平均年度医疗保健接触人数为30.3(与10.5),25.9(vs.8.8)与PC和4.4(与1.7)与HC。与多药房患者PC利用率更高相关的因素是复杂性升高,高风险水平和心律失常。与更高的HC利用率相关的变量也增加了复杂性和高风险,除了男性,在姑息治疗中,有一个主要的照顾者,患有肿瘤(特别是淋巴瘤或白血病)和关节炎,而年龄和固定是负相关的。
结论:与非多重用药相比,多重用药人群的特征是年龄更高,女性占主导地位,高风险,复杂性,许多合并症,依赖性和显著的医疗保健利用率。这些发现可以帮助医疗保健政策制定者优化PC和HC系统中资源和专业人员的分配,旨在改善多重药物管理和合理使用药物,同时降低这些患者的医疗保健利用成本。
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.