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Multiple Medication Adherence and Related Outcomes in Community-Dwelling Older People on Chronic Polypharmacy: A Retrospective Cohort Study on Administrative Claims Data

Author

Listed:
  • Carlotta Franchi

    (Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy)

  • Monica Ludergnani

    (Direzione Sanitaria—Centro Cardiologico Monzino (I.R.C.C.S.), 20138 Milan, Italy)

  • Luca Merlino

    (Direzione Sanitaria—Centro Cardiologico Monzino (I.R.C.C.S.), 20138 Milan, Italy)

  • Alessandro Nobili

    (Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy)

  • Ida Fortino

    (Directorate General for Health, Lombardy Region, 20124 Milan, Italy)

  • Olivia Leoni

    (Directorate General for Health, Lombardy Region, 20124 Milan, Italy)

  • Ilaria Ardoino

    (Laboratory of Pharmacoepidemiology and Human Nutrition, Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, 20156 Milan, Italy)

Abstract

Poor medication adherence compromises treatment efficacy and adversely affects patients’ clinical outcomes. This study aims to assess (1) multiple medication adherence to the most common drug classes chronically prescribed to older people, (2) the factors associated, and (3) the clinical outcomes. This retrospective cohort study included 122,655 community-dwelling patients aged 65–94 years old, newly exposed to chronic polypharmacy, and recorded in the Lombardy Region (northern Italy) administrative database from 2016 to 2018. Multiple medication adherence was assessed for drugs for diabetes, antithrombotics, antihypertensives, statins, and bisphosphonates, by calculating the daily polypharmacy possession ratio (DPPR). One-year mortality, nursing home, emergency department (ED), and hospital admission rates were calculated for 2019. The most prescribed drugs were antihypertensives (89.0%). The mean (std.dev) DPPR was 82.9% (15.6). Being female (OR = 0.85, 95%CI: 0.84–0.86), age ≥85 years (OR = 0.77, 95%CI: 0.76–0.79), and multimorbidity (≥4 diseases, OR = 0.88, 95%CI: 0.86–0.90) were associated with lower medication adherence. A higher DPPR was associated with clinical outcomes—in particular, improved survival (HR = 0.93 for 10/100-point increase, 95%CI: 0.92–0.94) and lower incidence in nursing home admissions (SDHR = 0.95, 95%CI: 0.93–0.97). Adherence to the most common chronic drugs co-prescribed to the older population was high. Better multiple medication adherence was associated with better clinical outcomes.

Suggested Citation

  • Carlotta Franchi & Monica Ludergnani & Luca Merlino & Alessandro Nobili & Ida Fortino & Olivia Leoni & Ilaria Ardoino, 2022. "Multiple Medication Adherence and Related Outcomes in Community-Dwelling Older People on Chronic Polypharmacy: A Retrospective Cohort Study on Administrative Claims Data," IJERPH, MDPI, vol. 19(9), pages 1-12, May.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:9:p:5692-:d:810379
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    References listed on IDEAS

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    1. Ospina, Raydonal & Ferrari, Silvia L.P., 2012. "A general class of zero-or-one inflated beta regression models," Computational Statistics & Data Analysis, Elsevier, vol. 56(6), pages 1609-1623.
    2. Daniel Gomes & Ana Isabel Placido & Rita Mó & João Lindo Simões & Odete Amaral & Isabel Fernandes & Fátima Lima & Manuel Morgado & Adolfo Figueiras & Maria Teresa Herdeiro & Fátima Roque, 2019. "Daily Medication Management and Adherence in the Polymedicated Elderly: A Cross-Sectional Study in Portugal," IJERPH, MDPI, vol. 17(1), pages 1-13, December.
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    1. Manuela Casula & Ilaria Ardoino & Carlotta Franchi, 2023. "Appropriateness of the Prescription and Use of Medicines: An Old Concept but More Relevant than Ever," IJERPH, MDPI, vol. 20(3), pages 1-5, February.

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