Association of inappropriate polypharmacy with emergency department visits in older patients receiving anti-neoplastic t
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ORIGINAL ARTICLE
Association of inappropriate polypharmacy with emergency department visits in older patients receiving anti-neoplastic therapy: a population-based study Yewon Suh 1,2 & Young-Mi Ah 3 & Eunsook Lee 2 & Ju-Yeun Lee 1 Received: 7 June 2020 / Accepted: 8 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose We aimed to investigate the prevalence and predicting factors of inappropriate polypharmacy including potentially inappropriate medications (PIMs) and drug-drug interactions (DDIs) and their associations with emergency department (ED) visits in older Korean patients receiving anti-neoplastic therapy. Methods We identified older patients receiving anti-neoplastic therapy in 2016 from the National Health Claims database. We investigated the prevalence of inappropriate polypharmacy comprising PIMs and DDIs in geriatric patients according to the 2019 American Geriatrics Society Beers Criteria® and chemotherapeutic DDIs using Lexicomp OnlineTM and Micromedex®. A nested case-control study was conducted to evaluate the associations between inappropriate polypharmacy and ED visits during antineoplastic therapy. Multivariate logistic regressions were performed after adjusting for age, sex, cancer diagnosis, prior ED visits, Charlson Comorbidity Index, and type of anti-neoplastic therapy. Results Inappropriate polypharmacy, its subtype PIMs, geriatric, and chemotherapeutic DDIs were observed in 85.4%, 80.4%, 17.3%, and 37.9% of the 21,956 patients receiving anti-neoplastic therapy, respectively. After adjusting for confounding factors, the presence of inappropriate polypharmacy (adjusted odds ratio (aOR) 2.15, 95% confidence interval (CI) 1.97–2.35), 2 or more PIMs (aOR 1.85, 95% CI 1.68–2.02), 2 or more chemotherapeutic DDIs (aOR 2.88, 95% CI 2.54–3.28), and geriatric DDIs (aOR 1.61, 95% CI 1.43–1.80) increased the likelihood of ED visits during anti-neoplastic therapy. Conclusion This nationwide study showed that inappropriate polypharmacy was prevalent and increased the risk of ED visits in older patients receiving anti-neoplastic therapy. Study findings suggested a need to implement deprescribing strategies in this population. Keywords Anti-neoplastic agents . Geriatrics . Inappropriate polypharmacy . Potentially inappropriate medication . Drug interaction . Emergency department
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05759-5) contains supplementary material, which is available to authorized users. * Ju-Yeun Lee [email protected] 1
College of Pharmacy and Research Institute of Pharmaceutical Sciences, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul 08826, Republic of Korea
2
Department of Pharmacy, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea
3
College of Pharmacy, Yeungnam University, 280 Daehak-ro, Gyeongsan-si, Gyeongsangbuk-do 38541, Republic of Korea
Introduction Cancer burden among older adults
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