Canadian Seniors: Polypharmacy and Management in Primary Health Care Settings

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1 Canadian Seniors: Polypharmacy and Management in Primary Health Care Settings Ali Moses McKeag Project Lead Primary Health Care Information CAHSPR Date Wednesday May 11, 2011 Time 2:30 3:45 pm Stream F 1

2 No conflict of interest to disclose. 2

3 Outline 1. About CIHI 2. CIHI s PHC Information Program 3. Study Methods 4. Results 5. Conclusion 3

4 About CIHI CIHI works to improve the health of Canadians and the health care system by providing quality health information > A national, independent, non-profit agency > Mandate: National coordination mechanism for health information in Canada Provide accurate and timely information for: Sound health policy Effective management of the health system Public awareness of health determinants 4

CIHI s PHC Information Program Input from major CIHI stakeholders confirmed a high priority need for more and better PHC information to help jurisdictions

5 CIHI s PHC Information Program Input from major CIHI stakeholders confirmed a high priority need for more and better PHC information to help jurisdictions establish effective policies and programs by monitoring and understanding primary health care in Canada. Improved PHC Policies and Programs Measurement Understanding 5

Vision, Mission & Strategic Goals 2011-2014 VISION MISSION Healthier populations and sustainable health care

health care data and information across Canada STRATEGIC GOALS 1. Data and Information Standards 2.

6 Vision, Mission & Strategic Goals VISION MISSION Healthier populations and sustainable health care through better primary health care information Increase the availability and effective use of relevant primary health care data and information across Canada STRATEGIC GOALS 1. Data and Information Standards 2. Data Source Development 3. Information for Measurement, Understanding and Use Driven by and Responding to Stakeholders Needs 6

7 Study Methods & Results 8

8 Experiences with Primary Health Care Across Canada > CIHI and the Health Quality Council co-funded the 2008 Canadian Survey of Experiences With Primary Health Care (CSE- PHC), which was conducted by Statistics Canada > Responses were weighted to ensure that age and sex were representative of the population > This analysis focused primarily on seniors (age 65+) with one or more of 11 select chronic conditions arthritis, asthma, chronic pain, emphysema or chronic obstructive pulmonary disease (COPD), cancer, depression, a mood disorder other than depression, diabetes, heart disease, stroke, and high blood pressure > Sample size: 11,582 respondents, including 3,132 seniors. > Sample excluded those Canadians living on a reserve or in an institution (i.e. Long Term Care facility) 9

Background: Medication Management for Seniors > As adults age, morbidities and prescription medication use rises > More medication increase risk of ADRs (adverse drug reactions) > More ADRs increase

9 Background: Medication Management for Seniors > As adults age, morbidities and prescription medication use rises > More medication increase risk of ADRs (adverse drug reactions) > More ADRs increase likelihood of hospitalization > Patient safety issue > Seniors high risk of ADRs Altered pharmacokinetics Reduced functionality of liver and kidneys > Polypharmacy (5+ medications) can lead to: Reduced compliance with medication regimens Drug drug interactions ADRs 10

10 Percentage of Seniors Results: Seniors Who Reported At Least One Chronic Condition Overall, 74% of seniors (65+) reported at least one chronic condition and 24% reported at least three. 71% 20% 1+ CCs 3+ CCs 80% 80% 30% 36% The likelihood of having at least one chronic condition increases from (71%) to years (80%), but does not increase any further among seniors 85+ (80%). Older seniors (85+) are more likely than younger seniors (65-74) to report having at least three chronic conditions. 65 to to Age Group (years) Source: Canadian Survey of Experiences With Primary Health Care, Notes: CC=chronic conditions. 11

11 Average Number of Prescription Medications Results: Prescription Medications Taken Regularly Average Number of Prescription Medications Seniors Reported Taking Regularly The number of prescription medications was more strongly associated with the number of chronic conditions compared to age Number of Chronic Conditions Age Group (years) Source: Canadian Survey of Experiences With Primary Health Care,

12 Percentage of Seniors Results: Regular Prescription Medication Use by Number of Chronic Conditions Seniors Who Reported Taking Prescription Medications Regularly 0 prescriptions 1 to 4 prescriptions 5+ prescriptions Almost 2 in 3 seniors who reported three or more chronic 6% 13% conditions were taking at least five 33% prescription medications on a 50% 62% regular basis. 74% 44% 13% 64% 4% E 36% Number of chronic conditions Sources: Canadian Survey of Experiences With Primary Health Care, E=Coefficient of variation is between 16.6% and 33.3%; Interpret with caution because of high variability. F= Coefficient of variation is in excess of 33.3%; estimate suppressed because of high sampling variability. F 13

13 Percentage of Seniors Results: Side Effects from Prescription Medication Seniors With Chronic Conditions Who Take Regular Prescription Medication and Reported a Side Effect from a Prescription that Required Medical Attention Overall, 9% (~258,000) of seniors with chronic conditions taking regular prescription medication reported a side effect requiring medical attention. 6% 7% E ~139,000 seniors 13% E 13% of seniors with chronic conditions taking 5+ prescription medications reported a side effect requiring medical attention, more than twice the level of seniors taking 1 or 2 prescription medications. 1 or 2 3 or 4 5+ Number of Prescription Medications Taken Regularly Sources: Canadian Survey of Experiences With Primary Health Care, Notes: E=Coefficient of variation is between 16.6% and 33.3%; Interpret with caution because of high variability. 14

of which 41% reported that the error caused a serious health problem.

14 Results: Medication Errors 4% E of seniors (~106,000) with chronic conditions who take regular prescription medications have been given the wrong medication or wrong dose in the past year. of which 41% reported that the error caused a serious health problem. 22% E reported that their doctor told them an error had been made. Sources: Canadian Survey of Experiences With Primary Health Care, Notes: E=Coefficient of variation is between 16.6% and 33.3%; Interpret with caution because of high variability. 15

15 Percentage of Seniors Results: Medication Reviews Seniors With Chronic Conditions Taking Regular Prescription Medications and Reported Having Their Medications Reviewed by Their Doctor Overall, 48% of seniors with chronic conditions reporting having their medication reviewed. 38% 49% 56% Less than half of seniors with chronic conditions had their medications reviewed. Likelihood of medication review increased with the number of prescription medications taken. 1 or 2 3 or 4 5+ Number of Prescription Medications Taken Regularly Source: Canadian Survey of Experiences With Primary Health Care, Notes: Responses include Always, Often or Sometimes. 16

16 Percentage of Seniors Results: Side Effect Reviews Seniors With Chronic Conditions Taking Regular Prescription Medications and Reported That Their Health Care Provider Explained the Side Effects of Prescribed Medications 46% 50% 48% Similar to medication reviews, less than half of seniors with chronic conditions (47%) reported having the side effects of prescribed medication explained. 1 or 2 3 or 4 5+ Number of Prescription Medications Taken Regularly Source: Canadian Survey of Experiences With Primary Health Care, Notes: Responses include Always, Often or Sometimes. 17

17 Conclusions 18

Conclusions & Moving Forward > A greater proportion of seniors taking at least five prescription medications experienced side effects that required medical attention than seniors taking fewer

18 Conclusions & Moving Forward > A greater proportion of seniors taking at least five prescription medications experienced side effects that required medical attention than seniors taking fewer prescription medications. > The results from the survey indicate that there is room for improvement to effectively manage polypharmacy in seniors. > Providers should ensure medications are appropriate and that seniors understand effects. 19

19 Need More Information on Seniors? > Antipsychotic Use in Seniors: An Analysis Focusing on Drug Claims, 2001 to 2007 (2009) > Bisphosphonates in Osteoporosis: An Analysis Focusing on Drug Claims by Seniors, 2001 to 2007 (2009) > Drug Claims by Seniors: An Analysis Focusing on Potentially Inappropriate Medication Use, 2000 to 2006 (2007) > Drug Use Among Seniors on Public Drug Programs in Canada, 2002 to 2008 (2010) > Hormone Replacement Therapy: An Analysis Focusing on Drug Claims by Female Seniors, 2000 to 2007 (2008) 20

20 Acknowledgements Andi Camden Li Dong Ali Moses McKeag Ben Reason Patricia Sullivan-Taylor Michael Terner Brenda Tipper Greg Webster 21

21 Canadian Seniors Polypharmacy and Management in Primary Health Care Settings For more information, please see full report: Seniors and the Health Care System: What is the Impact of Multiple Chronic Conditions? 22

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