title: Monitoring Polypharmacy in Healthcare Systems Through a Multi-Setting Survey: Should We Put More Attention on Long Term Care Facilities?
abstract: BACKGROUND
  Polypharmacy is a main issue of patient safety in all healthcare settings (i.e. increase adverse drug reactions and incidence of drug-drug interactions, etc.). The main object of the study was to evaluate the prevalence of polypharmacy and the appropriateness of drugs prescriptions in the regional health system (RHS) of Friuli Venezia-Giulia Region, Italy.
  
  
  METHODS
  We carried out a point prevalence study in May 2014; 1582 patients ≥65 years were included from: 14 acute hospitals, 46 Long Term Care Facilities (LTCFs) and 42 general practitioners' (GPs) clinics. Data analysis included the evaluation ofpotentially inappropriate prescriptions(PIPs) taking Beers criteria as a reference.
  
  
  RESULTS
  Patients in therapy with 10 drugs or more were 13.5%: 15.2% in hospitals, 9.7% in GPs' clinics and 15.6% in LTCFs. According to Beers criteria we identified 1152 PIPs that involved globally almost half of patients (46.0%): 41.9% in hospitals, 59.6% in LTCFs and 37.0% in GP's clinics. The 53.9% of patients received at least one mainly kidney excreted drug; for these patients the evaluation of serum creatinine was overall present in the 87.7% (747/852): 96.4% in hospital ones, 87.5% in GPs' clinics and 77.8% in LTCFs. LTCFs residents were significantly (P<0.05) more exposed to PIPs and less monitored for the renal function.
  
  
  CONCLUSIONS
  A reliable estimation of the phenomenon in all the main healthcare settings is a necessary prerequisite to set tailored policies for facing polypharmacy within a RHS; the results showed the necessity to put a special attention on LTCFs.
authors.affiliation: Department of Medical and Biological Sciences, University of Udine.
authors.forename: Luca
authors.initials: L
authors.lastname: Arnoldo
authors.affiliation: Department of Medical and Biological Sciences, University of Udine.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cattani
authors.affiliation: Institute of Clinical Pharmacology , Complex Local Health Unit, Udine, Italy.
authors.forename: Piergiorgio
authors.initials: P
authors.lastname: Cojutti
authors.affiliation: Institute of Clinical Pharmacology , Complex Local Health Unit, Udine, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Pea
authors.affiliation: Department of Medical and Biological Sciences, University of Udine.
authors.forename: Silvio
authors.initials: S
authors.lastname: Brusaferro
keywords: Drugs; Elderly; Health policy; LCTFs; Polypharmacy