Multimorbidity and polypharmacy

Multimorbidity

Multimorbidity – usually defined as the presence of more than one long-term disorder within an individual – is becoming the norm rather than the exception as populations age. It has been shown that the majority of people aged 65 years or over are multimorbid, with number of comorbidities rising with increasing age, although multimorbidity is not confined to the elderly. Multimorbidity is associated with a range of adverse outcomes, including impaired physical, social, and psychological quality of life, and increased health service utilisation and mortality.

Health services are largely organised to provide care for single diseases. Researchers in CCHSR are trying to better understand how multimorbidity affects individuals and impacts on health services. We have examined issues such as quality of care, patient experience, quality of life and service use, and have explored the impact of factors such as socioeconomic deprivation and mental health.

Polypharmacy

One particular consequence of multimorbidity is polypharmacy – the prescribing on multiple medications to one individual. Polypharmacy is often appropriate, such as the routine use of multiple medications in the management of many cardiovascular diseases and related risk factors such as diabetes or hypertension. However, it can also be inappropriate, such as where the intended benefit is not realised, harm outweighs benefit, undesirable prescribing cascades result, or the treatment burden for patients is unacceptable. Measuring and understanding the extent of inappropriate polypharmacy, the factors influencing it, and the adverse consequences, are subject to ongoing study within CCHSR.

Related publications

  • Paddison, CA, Saunders, CL, Abel, GA, Payne, RA, Campbell, JL, Roland, M (2015) Why do patients with multimorbidity in England report worse experiences in primary care? Evidence from the General Practice Patient Survey. BMJ Open 5: e006172 PubMed Full text
  • Mujica-Mota, RE, Roberts, M, Abel, G, Elliott, M, Lyratzopoulos, G, Roland, M, Campbell, J (2015) Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey. Qual Life Res 24: 909-18 PubMed Full text
  • Appleton, SC, Abel, GA, Payne, RA (2014) Cardiovascular polypharmacy is not associated with unplanned hospitalisation: evidence from a retrospective cohort study. BMC Fam Pract 15: 58 PubMed Full text
  • Payne, RA, Avery, AJ, Duerden, M, Saunders, CL, Simpson, CR, Abel, GA (2014) Prevalence of polypharmacy in a Scottish primary care population. Eur. J. Clin. Pharmacol. 70: 575-81 PubMed Full text
  • Payne, RA, Abel, GA, Avery, AJ, Mercer, SW, Roland, MO (2014) Is polypharmacy always hazardous? A retrospective cohort analysis using linked electronic health records from primary and secondary care. Br J Clin Pharmacol 77: 1073-82 PubMed Full text
  • Roland, M, Paddison, C (2013) Better management of patients with multimorbidity. BMJ 346: f2510 PubMed Full text
  • Payne, RA, Abel, GA, Guthrie, B, Mercer, SW (2013) The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study. CMAJ 185: E221-8 PubMed Full text
  • Valderas, JM, Starfield, B, Sibbald, B, Salisbury, C, Roland, M Defining comorbidity: implications for understanding health and health services. Ann Fam Med 7: 357-63 PubMed Full text
  • Higashi, T, Wenger, NS, Adams, JL, Fung, C, Roland, M, McGlynn, EA, Reeves, D, Asch, SM, Kerr, EA, Shekelle, PG (2007) Relationship between number of medical conditions and quality of care. N. Engl. J. Med. 356: 2496-504 PubMed
  • Kirk, SA, Campbell, SM, Kennell-Webb, S, Reeves, D, Roland, MO, Marshall, MN (2003) Assessing the quality of care of multiple conditions in general practice: practical and methodological problems. Qual Saf Health Care 12: 421-7 PubMed
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