INTRODUCTION: As the population ages, patient complexity is increasing, intensifying the demand for well-resourced, coordinated care. A deeper understanding of the factors contributing to this complexity is essential for optimising resource allocation. This study evaluates the prevalence of complex care needs in Singapore's primary care settings and identifies the factors associated with these needs. METHOD: Using a qualitative study design, we developed a patient complexity questionnaire to assess how Singapore family physicians recognise patient complexity. Sixty-nine experienced primary care physicians applied this tool to assess patient encounters, categorising each as "routine care" (RC), "medically challenging" (MC), or "complex care" (CC). We compared the care needs across these categories and used mixed-effects multinomial logistic regression to determine the independent predictors of complexity. RESULTS: Of the 4327 encounters evaluated, 15.0% were classified as CC, 18.5% as MC, and 66.4% as RC. In both CC and MC encounters, the most common medical challenges were polypharmacy (66.2% in CC, 44.9% in MC); poorly controlled chronic conditions (41.3% in CC, 24.5% in MC); and treatment interactions (34.4% in CC, 26.0% in MC). Non-medical issues frequently identified included low health literacy (32.6% in CC, 20.8% in MC); limited motivation for healthy lifestyle behaviours (27.2% in CC, 16.6% in MC); and the need for coordinated care with hospital specialists (24.7% in CC, 17.1% in MC). The top 3 independent predictors of complexity included mobility limitations requiring assistance (odds ratio [OR] for requiring wheelchair/trolley: 7.14 for CC vs RC, 95% confidence interval [CI] 4.74-10.74); longer consultation times with physicians (OR for taking >20 minutes for doctor's consultation: 3.96 for CC vs RC, 95% CI 2.86-5.48); and low socioeconomic status (OR for living in 1- or 2-room HDB flats: 2.98 for CC vs RC, 95% CI 1.74-5.13). CONCLUSION High care needs, encompassing both CC and MC encounters, were prevalent in primary care interactions. These findings highlight that relying solely on chronic disease count is insufficient to capture the full spectrum of patient complexity.
Singapore/epidemiology* ; Humans ; Primary Health Care/statistics & numerical data* ; Male ; Female ; Middle Aged ; Aged ; Adult ; Surveys and Questionnaires ; Prevalence ; Polypharmacy ; Qualitative Research ; Chronic Disease/therapy* ; Logistic Models

BACKGROUND

Polypharmacy in patients with chronic disease such as Migraine Headache poses potential harm in patients such that psychological distress may come in. In relation to psychological distress, Migraine Headache patients with multiple drug use are at increased risk of anxiety and depression.

The main objective of the study is to determine the association between anxiety and depression to polypharmacy in migraine headache patients by using the data in the PNA One Headache Database.

We utilized the data obtained from the Philippine Neurological Association One (PNA-1) Headache Database from 2021 to 2024 and determine the association between Anxiety and Depression to Polypharmacy in patients with Migraine.

The number of medications taken by patients does not significantly differ across depression and anxiety levels, indicating that polypharmacy has no impact on patient’s depression and anxiety. However, the study found that patients with anxiety have more tendency to report more severe headache.

The study highlights that participants, primarily middle-aged women, experience chronic headaches with high pain severity, often lasting for hours. Educational attainment may influence headache management compliance with a large proportion having only elementary education. Headache onset typically begins in early adulthood, and medication effectiveness often diminishes over time suggesting potential tolerance issues. Anxiety is associated with reporting of increased headache severity while depression does not significantly impact headache characteristics or polypharmacy. The findings emphasize the need for targeted interventions and revised treatment strategies to improve headache management outcomes.

Humans ; Proton Pump Inhibitors/therapeutic use* ; Deprescriptions

INTRODUCTION: Proton pump inhibitors (PPIs) are effective treatments for upper gastrointestinal pathologies and short-term courses are well-tolerated. However, indiscriminate use of PPIs is undesirable due to its potential harms. We implemented a series of deprescribing interventions between 2016 and 2017 to curb PPI overutilisation in our institution. The aim of this study was to evaluate the effectiveness and safety of these interventions. METHODS: An institutional PPI deprescribing guide was disseminated by email and educational roadshows were conducted to prescribers. Interrupted time series analysis was used to evaluate the effectiveness of the deprescribing interventions over a 7-year period from 2013 to 2019. To ascertain the safety of PPI deprescribing, we analysed the peptic ulcer disease incidence from 2015 to 2018 and conducted a retrospective chart review of 262 inpatients who were deprescribed PPIs. RESULTS: Following the first intervention, there was a significant decrease in mean oral PPI utilisation by 2,324.46 defined daily doses (DDD) per 1,000 prescriptions (95% confidence interval [CI] -3,542.66, -1,106.26) per month, followed by a month-to-month decrease of 302.61 DDD per 1,000 prescriptions per month thereafter (95% CI -473.95, -131.27). A second targeted educational intervention was only effective in sustaining the decline in the outpatient, but not in the inpatient setting. There were no significant changes in incidence of peptic ulcer disease. In the retrospective chart review, a majority (62.6%) of patients remained deprescribed at 6 months. CONCLUSION We observed a sustained decrease in PPI utilisation in our institution for more than 12 months following our educational interventions. Cautious deprescribing of PPIs in eligible candidates was found to be safe with low recurrence rates of upper gastrointestinal events.
Deprescriptions ; Humans ; Proton Pump Inhibitors ; Quality Improvement ; Retrospective Studies ; Singapore/epidemiology* ; Tertiary Care Centers

Background: Quality of Life (QoL) is an indicator of an elderly patient’s health status in achieving optimum care. However, no available local studies focused on QoL in elderly patients with polypharmacy. Better knowledge on this may help healthcare practitioners design and modify interventions that will suit elderly patients’ needs to improve both care and well-being. This study examined the QoL of elderly patients with polypharmacy and evaluated its relationship with demographic and clinical profile. Methods: A descriptive cross-sectional study was done among 333 elderly patients with polypharmacy seen at Region 1 Medical Center-Family and Community Medicine Out-Patient Department (R1MC-FCM OPD) from January to June 2019 using a self-administered EuroQoL-5 Dimension 5-Level (EQ-5D-5L) questionnaire to elicit the domains of QoL. The following statistical tests were utilized: Frequency count and percentage for analyzing gathered data; Spearman’s rank correlation for determining correlation between ordinal and continuous variables; and Mann-Whitney U and Kruskal-Wallis H tests for comparison of mean ranks. All analyses were performed using SPSS version 25. Results: Majority of the respondents were 60-69 years old (59.5%), female (55.3%), married (65.5%), attained at least elementary level education (38%), diagnosed with two illnesses (53%), taking four medications (65.5%) with an average monthly income below Php 10,000.00 (82.6%). Most of the respondents reported “no problems” in all five dimensions of EQ-5D-5L; however, decrease in usual activities (49.8%), pain (49.5%), and mobility (39%) were noted to be the common problems. Lower EQ-5D index and EQ-Visual Analogue Scale (EQ-VAS) scores were observed among respondents aged 80-90 years old, attained at least elementary level education, with three diagnosed illnesses, taking more than four medications, suffering mild cognitive impairment, partially dependent on activities in daily living, and mildly depressed (p <0.05). Conclusion The quality of life was reduced in the ageing population with low educational attainment, polypharmacy, multimorbidity, functional incapacity, cognitive impairment, and emotional problem.
Quality of Life ; Polypharmacy ; Outpatients ; Tertiary Care Centers

Background: Polypharmacy has been linked to multiple undesirable effects notably medication, non-compliance and adverse drug reactions. Objective: This case-control study aimed to determine the association between polypharmacy and dementia among Filipino elderly patients in a tertiary care hospital in Metro Manila, Philippines. Methods: The average daily use of medications was compared between cases and controls composed of admitted Filipino elderly patients with and without dementia, respectively, while controlling for co-morbidities and sociodemographic factors. Data collection was accomplished by obtaining relevant information from medical records. These underwent descriptive statistical analysis, chi-square test, and logistic regression. The odds ratio between dementia and polypharmacy was ultimately determined, among other variables. Results: The incidence of polypharmacy is 12.6% greater in those with diagnosed dementia vis-à-vis those without. Although multivariate logistic regression analysis showed that the odds ratio of dementia was 1.474 (95% CI 0.834–2.604) for those considered to experience polypharmacy compared to patients using four or less drugs, none of the variables identified, including polypharmacy, have p-values of less than 0.05. Conclusion The risk of developing dementia does not have a statistically significant association with the number of regularly administered medications in the Filipino elderly. Other variables also revealed no significant correlation on both bivariate and multivariate analyses. This may be the first study to report such an absence of association, particularly in the Philippines, and thus calls for further research and investigation on this subject.
Polypharmacy ; Dementia ; Case-Control Studies

BACKGROUND: The 48/6 Model of Care is an integrative care initiative for improving the health outcomes of hospitalized older patients; however, its applicability in community-dwelling older adults as a health screening tool has not been investigated. The present study aimed to examine the applicability of this model, prevalence of dysfunction in 6 care areas, and its relationship with self-reported mobility in community-dwelling older adults.METHODS: This was a cross-sectional survey study of community-dwelling adults aged 65 or older. Participants were screened for problems using 9 items corresponding to the 6 care areas of the 48/6 Model of Care (cognitive functioning, functional mobility, pain management, nutrition and hydration, bladder and bowel management, and medication management). Mobility was assessed via the Life-Space Assessment (LSA). We examined the correlation between each screening item and the LSA.RESULTS: A total of 444 older adults (260 women, 58.6%) participated. The mean number of health problems was 2.3 ± 2.1, with the most common being pain, cognitive impairment, and urinary incontinence. These problems and LSA scores were significantly different by age groups. A multiple regression analysis showed that polypharmacy (β = −10.567, P < 0.001), dysphagia (β = −9.610, P = 0.021), and pain (β = −7.369, P = 0.004) were significantly associated with life-space mobility after controlling for age.CONCLUSION: The 48/6 Model of Care is applicable to community-dwelling older adults, who show high prevalence of dysfunction in the 6 care areas. This study supports the role of the model in screening for the health status of older adults living in the community, and in estimating mobility.
Adult ; Cognition Disorders ; Cross-Sectional Studies ; Deglutition Disorders ; Female ; Humans ; Mass Screening ; Pain Management ; Polypharmacy ; Prevalence ; Urinary Bladder ; Urinary Incontinence

BACKGROUND/AIMS: Polypharmacy is a common clinical problem with chronic diseases that can be associated with adverse patient outcomes. The present study aimed to determine the prevalence and patient-specific characteristics associated with polypharmacy in an ulcerative colitis (UC) population and to assess the impact of polypharmacy on disease outcomes.METHODS: A retrospective chart review of patients with UC who visited a tertiary medical center outpatient clinic between 2006 and 2011 was performed. Polypharmacy was defined as major ( ≥ 5 non-UC medications) or minor (2–4 non-UC medications). UC medications were excluded in the polypharmacy grouping to minimize the confounding between disease severity and polypharmacy. Outcomes of interest include disease flare, therapy escalation, UC-related hospitalization, and surgery within 5 years of the initial visit.RESULTS: A total of 457 patients with UC were eligible for baseline analysis. Major polypharmacy was identified in 29.8% of patients, and minor polypharmacy was identified in 40.9% of the population. Polypharmacy at baseline was associated with advanced age (P< 0.001), female sex (P= 0.019), functional gastrointestinal (GI) disorders (P< 0.001), and psychiatric disease (P< 0.001). Over 5 years of follow-up, 265 patients remained eligible for analysis. After adjusting for age, sex, functional GI disorders, and psychiatric disease, major polypharmacy was found to be significantly associated with an increased risk of disease flare (odds ratio, 4.00; 95% confidence interval, 1.66–9.62). However, major polypharmacy was not associated with the risk of therapy escalation, hospitalization, or surgery.CONCLUSIONS: Polypharmacy from non-inflammatory bowel disease medications was present in a substantial proportion of adult patients with UC and was associated with an increased risk of disease flare.
Adult ; Ambulatory Care Facilities ; Chronic Disease ; Cohort Studies ; Colitis, Ulcerative ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Polypharmacy ; Prevalence ; Retrospective Studies ; Risk Factors ; Ulcer

OBJECTIVES: Clozapine is the drug of choice in treatment-resistant schizophrenia. However, its use is often delayed and a significant proportion of clozapine treated patients fails to respond and experience potentially dangerous side-effects. The aim of this retrospective study was to describe the clinical characteristics of patients started on clozapine and the rate and reason of discontinuation of clozapine. METHODS: Medical records of 83 patients started on clozapine during the period of 2012–2016 were reviewed. RESULTS: Clozapine started on patients in chronic phase; the mean age of start was 38.1 years old and the mean number of psychiatric admission was 6.5. A majority (80.7%) of the patients had been subjected to antipsychotic polypharmacy prior to clozapine and most (61.5%) of them were being treated with polypharmacy including clozapine. Overall, 39 (47.0%) subjects had continued clozapine whereas 15 (18.1%) discontinued it; 29 (34.9%) were lost to follow-up. The most common reason for discontinuation was side-effects (n=13) including six life-threatening cases, most of which occurred within 6 months of its start. CONCLUSION: This study demonstrated that there is some evidence of delays to clozapine use, high rates of polypharmacy and significant rate of discontinuation during the early phase of clozapine treatment.
Antipsychotic Agents ; Clozapine ; Humans ; Lost to Follow-Up ; Medical Records ; Polypharmacy ; Retrospective Studies ; Schizophrenia

BACKGROUND: Geriatric syndromes are associated with morbidity and poor quality of life (QOL). Urinary incontinence (UI) is one of the most prevalent geriatric syndromes. However, there is little research on the association of UI and UI-related QOL with other geriatric syndromes. We investigated the relationship between geriatric syndromes and UI according to gender and UI-related QOL among older inpatients. METHODS: This study was conducted among 444 older inpatients (aged 65 years and older) between October 2016 and July 2017. We examined geriatric syndromes and related factors involving cognitive impairment, delirium, depression, mobility decline, polypharmacy, undernutrition, pain, and fecal incontinence. UI-related QOL was assessed using the International Consultation on Incontinence Questionnaire-Short Form. Multiple logistic regression analysis was used to evaluate these associations. RESULTS: Geriatric syndromes and related factors were associated with UI. Mobility decline (odds ratio [OR], 4.16; 95% confidence interval [CI], 2.29–7.56), polypharmacy (OR, 3.35; 95% CI, 1.89–5.92), and pain (OR, 6.80; 95% CI, 3.53–13.09) were related to UI in both genders. Especially, delirium (OR, 7.55; 95% CI, 1.61–35.44) and fecal incontinence (OR, 10.15; 95% CI, 2.50–41.17) were associated with UI in men, while cognitive impairment (OR, 4.19; 95% CI, 1.14–15.44) was significantly associated with UI in women. Patients with depression were more likely to have poor UI-related QOL (OR, 8.54; 95% CI, 1.43–51.15). CONCLUSION: UI was associated with different geriatric syndromes and related factors according to gender. Care for patients with depression, related to poor UI-related QOL, should be considered in primary care to improve the UIrelated QOL of these individuals.
Cognition Disorders ; Cross-Sectional Studies ; Delirium ; Depression ; Fecal Incontinence ; Female ; Humans ; Inpatients ; Logistic Models ; Male ; Malnutrition ; Polypharmacy ; Primary Health Care ; Quality of Life ; Urinary Incontinence