Differences in healthcare service utilization in patients with polypharmacy according to their risk level by adjusted morbidity groups: a population-based cross-sectional study

Abstract

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.

Keywords:

• Polypharmacy
• Chronic disease
• Primary care
• Hospital care
• Healthcare utilization
• Management
• Morbidity grouper
• Stratification

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00665-7.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s40545-023-00665-7.

Funding

This project received a grant for English editing and publication from the Foundation for Biosanitary Research and Innovation in Primary Care.

Availability of data and materials

The data sets generated and analysed during the study are not publicly available, because they belong to Madrid Health Service, but they are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study received ethical approval from the Hospital Universitario La Princesa Drug Research Ethics Committee and obtained a favourable report from the Local Research Commission of the Primary Care Management of the Community of Madrid. Every method was performed in accordance with relevant guidelines and regulations. The requirement of informed consent from patients was waived, because this study is retrospective and does not contain individual personal information, since the data were obtained from a secondary database with anonymized and dissociated information as stablished by the current legislation at the time of the study.

Consent for publication

Not applicable.

Supplementary Information

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