Patient safety in primary health care and polypharmacy: cross-sectional survey among patients with chronic diseases.
Lorena Ulhôa Araújo, Delba Fonseca Santos, Emerson Cotta Bodevan and 3 others
PMID 31826159WHAT IT FOUND
Among 558 primary care patients with hypertension or diabetes, 210 used four or more medicines; older age, diabetes plus hypertension, hospital admission, and mixed public/private purchase were linked to polypharmacy.
Key findings
01Of 558 patients, 210 (37.6%) used four or more medications.
02After adjustment, polypharmacy was associated with age, economic strata, obtaining medicines through both out-of-pocket payment and SUS, having diabetes and hypertension, stroke, arrhythmia, hypercholesterolemia, coronary artery disease, and hospital admission.
03Among participants aged over 65 years, 114 (41.0%) were treated with a potentially inappropriate medication; 77.2% of those with polypharmacy used one, and taking more than four medications was associated with 4 times greater likelihood of receiving one.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was cross-sectional, so it cannot show that any factor caused polypharmacy or inappropriate medication use. Lifestyle information and medication use were based on self-report during household interviews, so recall and reporting errors are possible. The authors called the study exploratory with limited statistical power, and household interviews may have biased the sample. Pregnant women, people with mental illness, and hospitalized patients were excluded, so results may not apply to those groups. The study was done in one urban area of Brazil, so polypharmacy patterns may differ elsewhere.
Declared interests
The paper states that data collection began after consent and without conflict of interest. It does not report a funding source.
The easy way to misread this
Do not treat every medication in the polypharmacy group as unnecessary or conclude that stopping one drug will improve safety. The study counted prescriptions and flagged Beers criteria use; it did not measure adverse events, deprescribing, or clinical outcomes, and its cross-sectional design cannot show cause.