ArticlePloS one2023
Combinations of medicines in patients with polypharmacy aged 65-100 in primary care: Large variability in risks of adverse drug related and emergency hospital admissions.
Article in PloS one, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it, 20 citations in OpenAlex.
- Association of Drug-Disease Interactions with Mortality or Readmission in Hospitalised Middle-Aged and Older Adults: A Systematic Review and Meta-Analysis.Drugs - real world outcomes · 2024Pooled it
- The Role of Artificial Intelligence in Medication Management for Older Adults: A Systematic Review.Aging medicine (Milton (N.S.W)) · 2026Review
- Developing an AI-Assisted Tool That Identifies Patients With Multimorbidity and Complex Polypharmacy to Improve the Process of Medication Reviews: Qualitative Interview and Focus Group Study.Journal of medical Internet research · 2026Article
- Burden of geriatric and cognitive disorders and the impact of integrated care models on morbidity, functional decline, and health service utilization among older adults.Frontiers in medicine · 2026Article
- Analytical approaches for medication management for patient safety: a scoping review.npj health systems · 2025Article
- Polypill in heart failure: a pathway to simplified treatment and improved adherence and outcomes.Heart failure reviews · 2025Review
- Adverse Drug Reactions and Drug Interactions in Multimorbid Patients: A Review of Current Evidence.Cureus · 2025Review
- Cataloguing and evaluating Irish health data resources for primary care cancer research.BJC reports · 2025Review
- Electronic Health Records: A Gateway to AI-Driven Multimorbidity Solutions-A Comprehensive Systematic Review.Journal of clinical medicine · 2025Review
- Associations of high-risk drug patterns with mortality among community-dwelling older adults: A 23-year prospective cohort study.PloS one · 2025Article
- Article
- Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review.BMJ open · 2024Article
- The association between continuous polypharmacy and hospitalization, emergency department visits, and death in older adults: a nationwide large cohort study.Frontiers in pharmacology · 2024Article
- Clinical evidence of human pathogens implicated in Alzheimer's disease pathology and the therapeutic efficacy of antimicrobials: an overview.Translational neurodegeneration · 2023Review
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundPolypharmacy can be a consequence of overprescribing that is prevalent in older adults with multimorbidity. Polypharmacy can cause adverse reactions and result in hospital admission. This study predicted risks of adverse drug reaction (ADR)-related and emergency hospital admissions by medicine classes.
methodsWe used electronic health record data from general practices of Clinical Practice Research Datalink (CPRD GOLD) and Aurum. Older patients who received at least five medicines were included. Medicines were classified using the British National Formulary sections. Hospital admission cases were propensity-matched to controls by age, sex, and propensity for specific diseases. The matched data were used to develop and validate random forest (RF) models to predict the risk of ADR-related and emergency hospital admissions. Shapley Additive eXplanation (SHAP) values were calculated to explain the predictions.
resultsIn total, 89,235 cases with polypharmacy and hospitalised with an ADR-related admission were matched to 443,497 controls. There were over 112,000 different combinations of the 50 medicine classes most implicated in ADR-related hospital admission in the RF models, with the most important medicine classes being loop diuretics, domperidone and/or metoclopramide, medicines for iron-deficiency anaemias and for hypoplastic/haemolytic/renal anaemias, and sulfonamides and/or trimethoprim. The RF models strongly predicted risks of ADR-related and emergency hospital admission. The observed Odds Ratio in the highest RF decile was 7.16 (95% CI 6.65-7.72) in the validation dataset. The C-statistics for ADR-related hospital admissions were 0.58 for age and sex and 0.66 for RF probabilities.
conclusionsPolypharmacy involves a very large number of different combinations of medicines, with substantial differences in risks of ADR-related and emergency hospital admissions. Although the medicines may not be causally related to increased risks, RF model predictions may be useful in prioritising medication reviews. Simple tools based on few medicine classes may not be effective in identifying high risk patients.
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