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Original research
Medication adherence in community-dwelling older people exposed to chronic polypharmacy
  1. Carlotta Franchi1,
  2. Ilaria Ardoino1,
  3. Monica Ludergnani2,
  4. Gjiliola Cukay2,
  5. Luca Merlino3,
  6. Alessandro Nobili1
  1. 1 Department of Neuroscience, Unit of Pharmacoepidemiological Research in Older People, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
  2. 2 ARIA S.p.A. Azienda Regionale per l'Innovazione e gli Acquisti, Milan, Italy
  3. 3 Lombardy Regional Health Welfare General Management, Milano, Lombardia, Italy
  1. Correspondence to Dr Carlotta Franchi, Department of Neuroscience, Unit of Pharmacoepidemiological Reseach in Older People, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy; carlotta.franchi{at}marionegri.it

Abstract

Background To evaluate medication adherence and associated factors of seven of the most common drug classes prescribed to community-dwelling older people.

Methods This is a retrospective cohort study on medication adherence in community-dwelling older people (65–94 years old) on chronic polypharmacy and recorded from 2013 to 2015 in the administrative database of the Lombardy region (Northern Italy). Adherence was assessed for diabetic drugs, antithrombotic agents, drugs acting on the renin–angiotensin system, statins, bisphosphonates, antidepressants and drugs for obstructive airway diseases by calculating the medication possession ratio (MPR). Patients were then divided in fully (MPR ≥80%), partially (40%≤MPR<80%) and poorly adherent (10%<MPR<40%).

Results Among 140 537 patients included in the study, only 19.3% was fully adherent to all the therapies considered. Almost 40% of them were poorly adherent to at least one drug class, becoming 50% when patients exposed to four or more drug classes were considered. In adjusted regression model, being women (OR=1.14, 95% CI 1.13 to 1.16) and aged ≥80 years old (OR=1.22, 95% CI 1.20 to 1.24) were associated with an overall lower adherence. Instead, the participation to an experimental healthcare programme was associated with higher adherence (OR=0.92, 95% CI 0.87 to 0.96). Furthermore, being coprescribed with ≥10 drugs was associated with lower adherence to all the drug classes, with different effects (ORs from 0.42 to 0.73).

Conclusion This study overall shows a low medication adherence in community-dwelling older people on chronic polypharmacy, especially in women and oldest old. The implementation and promotion of healthcare programmes for these patients could help improve overall adherence to chronic drug therapies.

  • elderly
  • pharmacoepidemiology
  • primary health care

Data availability statement

No data are publicly available. The data used in this study are property of Lombardy Region and stored by Lombardia Informatica S.p.A (Healthcare utilisation databases) and My search (GP data). It is only possible to have access to the data but they cannot be shared. The data access procedure implies the submission of a study protocol to the data owner and the protocol evaluation from a qualified committee. If the research question is of interest for the data owner and the study is well designed, the permission for data access is provided.

https://doi.org/10.1136/jech-2020-214238

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    Data availability statement

    No data are publicly available. The data used in this study are property of Lombardy Region and stored by Lombardia Informatica S.p.A (Healthcare utilisation databases) and My search (GP data). It is only possible to have access to the data but they cannot be shared. The data access procedure implies the submission of a study protocol to the data owner and the protocol evaluation from a qualified committee. If the research question is of interest for the data owner and the study is well designed, the permission for data access is provided.

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    Footnotes

    • Contributors Study concept and design: CF, IA. Acquisition of data: ML, GC. Analysis and interpretation of data: CF, IA, ML, LM. Drafting of the manuscript: CF. Critical revision of the manuscript for important intellectual content: CF, IA, ML, LM, AN.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer In Italy, studies using retrospective aggregated-anonymous data from administrative databases do not require Ethics Committee/IRB approval.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.