Abstract and Introduction
Introduction: To date, no study has investigated the impact of polypharmacy (use of ≥5 medications concurrently) on health-related quality of life (HRQOL) and psychological distress in a combined sample of chronic disease patients and patients with multimorbidity, using diverse HRQOL measures. This study aimed to explore the association between polypharmacy and HRQOL/psychological distress by using data from a cross-sectional study in Flanders (Belgium).
Methods: We analyzed cross-sectional survey data on 544 chronically ill patients recruited from June 2019 through June 2021. HRQOL was measured with the EuroQol-5 Dimension-5 Level questionnaire (EQ-5D-5L) and the 12-Item Short Form Health Survey (SF-12); psychological distress was measured with the Hospital Anxiety and Depression Scale (HADS). Multiple linear regression models were built to assess the association between polypharmacy and HRQOL/psychological distress.
Results: Overall, compared with patients without polypharmacy, patients with polypharmacy reported worse EQ-5D-5L index values, EuroQol visual analogue scale (EQ-VAS) scores, SF-12 physical component scores (PCS), SF-12 mental component scores (MCS), and HADS anxiety and depression subscales. In the final regression model adjusting for age, sex, educational attainment, and multimorbidity, polypharmacy remained significantly associated with lower HRQOL in terms of the EQ-5D-5L index (β = −0.12; P = .008), EQ-VAS (β = −0.11; P = .01), and SF-12 PCS (β = −0.15; P = .002) but not with psychological distress (HADS) and SF-12 MCS.
Conclusion: This study found that polypharmacy was negatively associated with the physical domain of HRQOL, but not with the mental domain, among patients with chronic diseases. These results may be especially important for patients with multimorbidity, given their greater risk of polypharmacy.
During the past few decades, chronic diseases have predominated over infectious diseases, and their prevalence is still rising. In addition, people with chronic conditions often have multimorbidity — multiple chronic conditions at the same time. Having 1 or more chronic conditions has negative effects on a person's well-being and health-related quality of life (HRQOL).[3–5] In addition to optimal longevity, an ultimate goal of modern health care is to achieve the best possible life for patients in terms of an optimal HRQOL, especially since the shift from problem-oriented care to goal-oriented care. HRQOL has become an important outcome because it captures a person's self-perceived physical, mental, and social functioning.[6,7]
Because chronically ill patients tend to have a higher risk of multimorbidity, multiple drug use is common.[8,9] The resulting polypharmacy, defined as the use of 5 or more medications,[10,11] however, increases the risk of adverse drug–drug or drug–disease interactions and the risk of a "prescription cascade" (ie, the process whereby side effects of drugs are misdiagnosed as symptoms of another medical event and lead to an additional prescription), which may negatively affect a patient's HRQOL.[13,14] The association between polypharmacy and low HRQOL has been documented for single health conditions such as end-stage kidney disease, arthritis, and cardiometabolic risk factors. However, to date, no study has investigated the impact of polypharmacy on HRQOL in a combined sample of chronic disease patients and patients with multimorbidity by using diverse HRQOL measures. Hence, this study aimed to explore the association between polypharmacy and HRQOL among people with chronic conditions and multimorbidity by using data from a cross-sectional study in Flanders (Belgium).
Prev Chronic Dis. 2022;19(8):e50 © 2022 Centers for Disease Control and Prevention (CDC)