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Prescriptions Rise With Age in Ontario HIV+, But Drug-Related Problems Don't
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4th International Workshop on HIV and Aging, October 30-31, 2013, Baltimore
Mark Mascolini
Prevalence of comorbidities and prescribed medications rose steadily with age in HIV-positive people in Ontario, Canada [1]. But rates of drug-related problems identified by HIV pharmacists remained stable across the four age groups analyzed.
Pharmacists routinely perform medication reconciliation to identify drug-related problems. Such reconciliations are critical in an aging HIV-positive population taking a growing number of HIV and non-HIV drugs. The Canadian HIV/AIDS Pharmacists (CHAPS, http://hivclinic.ca/chap/) developed the Medsrec Tool to collect demographic and disease-related data specific to the HIV population, and the tool is available online in English and French [2]. Medsrec aims to identify potential drug-drug or drug-food interactions, adverse drug reactions, incorrect dosing, poor adherence, and other problems.
Using Medsrec data, researchers conducted this study to identify relationships between four age strata and number and types of (1) comorbidities, (2) prescription drugs, and (3) drug-related problems among HIV-positive people in Ontario. The investigators predicted that disease and drug burden would rise with age and cause more drug-related problems.
For 2 months 8 pharmacists from three Ontario regions used Medsrec to perform medication reconciliation on randomly selected HIV-positive people. They divided 161 study participants into 35 people (21.7%) younger than 40, 63 (39.1%) from 40 to 49, 46 (28.6%) from 50 to 59, and 17 (10.6%) 60 or older. The researchers counted number and types of comorbidities, number of medications, and number and types of drug-related problems.
Most study participants (80%) were men, and 79% were older than 40. Study participants took an average 7 medications (range 1 to 19); 78% were prescription drugs and 22% were over-the-counter. Participants averaged 3 comorbidities, with cardiovascular, mental health, and neuromuscular conditions predominating. The pharmacists identified 226 drug-related problems, ranging from 0 to 4 per person. The most common problems involved adherence, adverse drug reactions, identification of conditions that required medication, and subtherapeutic responses.
Median number of comorbidities rose with age from 1 in people under 40, to 2 in people 40 to 49, 2 in people 50 to 59, and 3 in people 60 or older. Median numbers of prescription medications in those four groups were 5, 5, 8, and 10. But, contrary to expectation, median number of drug-related problems did not rise with age: 1 in people under 40, 1 in people 40 to 49, 1.5 in people 50 to 59, and 1 in people 60 or older.
Proportions of people with adverse drug reactions and adherence problems were similar in patients under 50 (64.7%) and those 50 or older (65%). A higher proportion of people 50 or older than younger had drug interactions (12.7% versus 8.2%), and a higher proportion of the 50-and-older group had conditions requiring therapy and subtherapeutic responses (68.3% versus 49%).
The Ontario team concluded that medication reconciliation for people with HIV can identify a substantial number of drug-related problems. They proposed that their findings "demonstrate the increased need for greater pharmacovigilance as the HIV population ages and the number of comorbidities and prescriptions drugs increases." The researchers believe their results also underline the need for trained HIV pharmacists on HIV care teams.
References
1. Robinson L, Tolmie B, Lui D, et al. Age, co-morbidities, prescriptions, and drug related problems: Analysis of a multi-centre, pharmacist-directed medication reconciliation in Ontario. 4th International Workshop on HIV and Aging, October 30-31, 2013, Baltimore. Abstract 3.
2. Canadian HIV/AIDS Pharmacists Network. Medsrec.
http://hivclinic.ca/chap/downloads/MedsRec-Form-English-Sept12.pdf and http://hivclinic.ca/chap/downloads/MedsRec-Form-French-Nov12.pdf
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