Abstract

Objective

Polypharmacy, or use of multiple medications, is associated with patient factors. Less is known regarding variation in polypharmacy by individual physicians. The objective of this study was to assess patient and physician factors associated with polypharmacy among older patients.

Methods

This is a cross-sectional study of patients aged ≥65 years with a primary care visit at Cleveland Clinic Health System in 2015 and their physicians. We collected patient demographics, comorbidities and current medications from the electronic health record, including potentially inappropriate medications (PIMs). We used mixed effects linear regression to estimate adjusted differences in the number of medications by patient factors. We generated adjusted prescribing rates for individual physicians and assessed differences in physician performance on quality measures by their prescribing rate.

Results

Our study included 44,570 patients who were prescribed an average of 6.8 medications (standard deviation: 4.0) by 701 physicians. Female sex, higher BMI, having Medicaid insurance, current or former smoking status, comorbidities and seeing a specialist were associated with number of medications. Age was not. Among 267 physicians who saw ≥20 study-eligible patients, the adjusted mean number of medications per patient ranged from 5.2 to 9.6. Compared to physicians who prescribed above the mean, lower prescribing physicians performed significantly better on medication reconciliation (p = .007) and hypertension control (p < .001) and prescribed fewer PIMs (p < .001).

Conclusions

Individual physicians varied in their prescribing practices, even after adjusting for patient demographic and clinical characteristics. Interventions to reduce polypharmacy in older adults should target high prescribing physicians, as physician behavior is more actionable than patient factors.

中文翻译：

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导致老年患者服用多种药物的患者和医生因素

摘要

客观的

多种药物或多种药物的使用与患者因素有关。关于个别医生的多药治疗变化知之甚少。本研究的目的是评估老年患者中与多重用药相关的患者和医生因素。

方法

这是一项针对 2015 年在克利夫兰诊所卫生系统接受初级保健就诊的 65 岁以上患者及其医生的横断面研究。我们从电子健康记录中收集了患者的人口统计数据、合并症和当前药物，包括可能不适当的药物 (PIM)。我们使用混合效应线性回归来估计患者因素对药物数量的调整差异。我们为个别医生生成了调整后的处方率，并通过他们的处方率评估了医生在质量指标上的表现差异。

结果

我们的研究包括 44,570 名患者，他们平均由 701 名医生开具 6.8 种药物（标准差：4.0）。女性、较高的 BMI、有医疗补助保险、当前或以前的吸烟状况、合并症和看专科医生与药物数量有关。年龄不是。在 267 名医生中，他们看到了 ≥20 名符合研究条件的患者，每名患者的调整后平均药物数量在 5.2 到 9.6 之间。与处方高于平均水平的医生相比，处方量较低的医生在药物调整 ( p  = .007) 和高血压控制 ( p  < .001) 方面的表现明显更好，并且开出的 PIM 更少 ( p  < .001)。

结论

即使在调整了患者的人口统计学和临床​​特征之后，个别医生的处方实践也各不相同。减少老年人多药用药的干预措施应针对高处方医师，因为医师行为比患者因素更具可操作性。