Data from: Associations between polypharmacy and treatment intensity for hypertension and diabetes: a cross-sectional study of nursing home patients in British Columbia, Canada

Objectives: Describe nursing home polypharmacy prevalence in the context
of prescribing for diabetes and hypertension and determine possible
associations between lower surrogate markers for treated hypertension and
diabetes (over treatment) and polypharmacy. Design: Cross sectional study.
Setting: 6 nursing homes in British Columbia, Canada. Participants: 214
patients, residing in one of selected facilities during data collection
period. Primary and secondary outcome measures: Polypharmacy was defined
as >=9 regular medications. Over treatment of diabetes was defined
as being prescribed at least one hypoglycemic medication and a
glycosylated hemoglobin (A1c) <=7.5%. Over treatment of
hypertension required being prescribed at least one hypertension
medication and having a systolic blood pressure (SBP) <=128 mmHg.
Polypharmacy prescribing, independent of over treatment, was calculated by
subtracting disease specific medications from total medications
prescribed. Results: Data gathering was completed for 214 patients, 104
(48%) of whom were prescribed >=9 medications. All patients were
very frail. Patients with polypharmacy were more likely to have a
diagnosis of hypertension (p=.04) or congestive heart failure (p=.003) and
less likely to have a diagnosis of dementia (p=.03). Patients with over
treated hypertension were more likely to also experience polypharmacy (RR
1.77 (1.07-2.96), p=.027). Patients with over treated diabetes were
prescribed more non-diabetic medications than those with a higher A1c
(11.0 ±3.7 versus 7.2 ±3.1, p=.01). Conclusion: Over treated diabetes and
hypertension may be quite prevalent in nursing home patients and the
presence of polypharmacy is associated with more aggressive disease
treatment. Further study of interventions designed to reduce over
treatment of hypertension and diabetes is needed to fully understand the
potential links between polypharmacy and potential of harms of
disease-specific over treatment.