title: [Drug prescription profile in patients with advanced chronic diseases].
abstract: OBJECTIVE
  To analyze the prescription profile and the factors associated with multiple medications (polypharmacy) and non-adherence in patients with advanced chronic diseases.
  
  
  METHODS
  Longitudinal cross-sectional study including 41 Spanish hospitals (PALIAR project). Polypharmacy was defined as a prescribed treatment with five or more drugs, and excessive polypharmacy when the number was ten or more. The adherence was evaluated using a questionnaire completed by the patients or their caregivers. Description of drug prescription profile and analysis was performed on the risk factors associated with multiple medications and non-adherence.
  
  
  RESULTS
  The study included 1847 patients, and 1778 (96.2%) completed the questionnaire. Mean age was 78.74±10 years. Antihypertensives (82.6%), gastroprotectives (73.8%), anti-platelets/anticoagulants (70.3%), and psychotropic drugs (51.8%) were the most frequently prescribed drugs. Prevalence of polypharmacy/excessive polypharmacy was 86.2%/31.3%, with a mean of 8±3.5 drugs per patient. Errors in treatment compliance were detected in 48.2% of patients, but 38.5% and 9.6% referred to an occasional or almost daily failure, respectively. Factors associated with non-adherence were: to be a patient with multiple diseases, cognitive impairment, three or more 3 hospital admissions in the last three months, and having polypharmacy. Factors associated with polypharmacy were: to be a patient with multiple diseases, an ECOG score <3, age <85 years, and 3 or more hospital admissions. Factors associated with excessive polypharmacy were: to be a patient with multiple diseases and previous frequent hospital admissions.
  
  
  CONCLUSIONS
  The prevalence of polypharmacy in patients with advanced chronic diseases is high, and mistakes in treatment compliance are frequent. Further studies with better defined objectives and more specific therapeutic limits are needed.
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España. Electronic address: nievesramirezduque@yahoo.es.
authors.forename: Nieves
authors.initials: N
authors.lastname: Ramírez-Duque
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: Carlota
authors.initials: C
authors.lastname: Rivas-Cobas
authors.affiliation: Servicio de Medicina Interna, Hospital Universitario Virgen del Rocío, Sevilla, España.
authors.forename: Máximo
authors.initials: M
authors.lastname: Bernabeu-Wittel
authors.affiliation: Servicio de Medicina Interna, Hospital de la Serranía, Ronda, Málaga, España.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ruiz-Cantero
authors.affiliation: Servicio de Medicina Interna, Hospital de la Vega Baja, Orihuela, Alicante, España.
authors.forename: José
authors.initials: J
authors.lastname: Murcia-Zaragoza
authors.affiliation: Servicio de Medicina Interna, Hospital de Sanlúcar de Barrameda, Sanlúcar de Barrameda, Cádiz, España.
authors.forename: Miguel
authors.initials: M
authors.lastname: Oliver
authors.affiliation: Servicio de Medicina Interna, Hospital Royo Vilanova, Zaragoza, España.
authors.forename: Jesús
authors.initials: J
authors.lastname: Díez-Manglano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019338:Polypharmacy; D016903:Drug Monitoring
keywords: Adherencia; Advanced chronic diseases; Enfermedades crónicas avanzadas; Polimedicación; Polypharmacy; Treatment adherence