By Amaia Calderón and Alexandra Prados-Torres
A paper entitled “Multimorbidity, polypharmacy, referrals, and adverse drug events: are we doing things well?” was recently published in the British Journal of General Practice. The work was carried out by members of the EpiChron Research Group on Chronic Diseases of the Aragon Health Sciences Institute in Spain, and its objective was to shed light on the interrelations between multimorbidity, polypharmacy, multiple referrals to specialised care, and the occurrence of adverse drug events (ADEs), in the context of a national healthcare system.
Results of this observational study demonstrate that multimorbidity, polypharmacy and multiple referrals are strongly and independently associated to occurrence of ADEs, even after adjusting for potential confounders. As the clinical situation of the patient becomes more complex and requires the intervention of different specialists, the likelihood of a lack of coordination among professionals and potential interactions among prescribed medications could favour the occurrence of undesirable effects, such as ADEs.
As indicated by Starfield et al[1] a decade ago, it is necessary, now more than ever, to design strategies that focus on individual’s health problems in their totality, rather than examining each of the patient’s illnesses individually. This approach is important given the high frequency of multimorbidity in all stages of life, the proved risk of interactions between illnesses and medications or among medications, and the acknowledged impact of not doing so both for the healthcare system and the health of the patient.
This research, financed by the Spanish Institute of Health Carlos III, is framed within a wider project focused on the epidemiology of multimorbidity, utilization patterns and the response of healthcare systems to populations suffering from it.
[1] Starfield B, Lemke KW, Bernhardt T, et al. Comorbidity: implications for the importance of primary care in ‘case’ management. Ann Fam Med 2003; 1(1): 8–14.