Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burdenReport as inadecuate

Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden - Download this document for free, or read online. Document in PDF available to download.

BMC Medicine

, 12:151

First Online: 03 October 2014Received: 24 April 2014Accepted: 12 August 2014DOI: 10.1186-s12916-014-0151-0

Cite this article as: Gallacher, K.I., Batty, G.D., McLean, G. et al. BMC Med 2014 12: 151. doi:10.1186-s12916-014-0151-0


BackgroundThe prevalence of multimorbidity the presence of two or more long-term conditions is rising internationally. Multimorbidity affects patients by increasing their burden of symptoms, but is also likely to increase the self-care demands, or treatment burden, that they experience. Treatment burden refers to the effort expended in operationalising treatments, navigating healthcare systems and managing relations with healthcare providers. This is an important problem for people with chronic illness such as stroke. Polypharmacy is an important marker of both multimorbidity and burden of treatment. In this study, we examined the prevalence of multimorbidity and polypharmacy in a large, nationally representative population of primary care patients with and without stroke, adjusting for age, sex and deprivation.

MethodsA cross-sectional study of 1,424,378 participants aged 18 years and over, from 314 primary care practices in Scotland that were known to be demographically representative of the Scottish adult population. Data included information on the presence of stroke and another 39 long-term conditions, plus prescriptions for regular medications.

ResultsIn total, 35,690 people 2.5% had a diagnosis of stroke. Of the 39 comorbidities examined, 35 were significantly more common in people with stroke. Of the people with a stroke, the proportion that had one or more additional morbidities present 94.2% was almost twice that in the control group 48% odds ratio OR adjusted for age, sex and socioeconomic deprivation 5.18; 95% confidence interval CI 4.95 to 5.43. In the stroke group, 12.6% had a record of 11 or more repeat prescriptions compared with only 1.5% of the control group OR adjusted for age, sex, deprivation and morbidity count 15.84; 95% CI 14.86 to 16.88. Limitations include the use of data collected for clinical rather than research purposes, a lack of consensus in the literature on the definition of certain long-term conditions, and the absence of statistical weighting in the measurement of multimorbidity, although the latter was deemed suitable for descriptive analyses.

ConclusionsMultimorbidity and polypharmacy were strikingly more common in those with a diagnosis of stroke compared with those without. This has important implications for clinical guidelines and the design of health services.

AbbreviationsAFAtrial fibrillation

CHDCoronary heart disease

NHSNational Health Service

PCCIUPrimary Care Clinical Informatics Unit

QOFQuality and Outcomes Framework

Electronic supplementary materialThe online version of this article doi:10.1186-s12916-014-0151-0 contains supplementary material, which is available to authorized users.

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Author: Katie I Gallacher - G David Batty - Gary McLean - Stewart W Mercer - Bruce Guthrie - Carl R May - Peter Langhorne - Fra



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