Abstract
Study design
Retrospective cohort study.
Objectives
To examine the prevalence of polypharmacy for individuals with nontraumatic spinal cord dysfunction (NTSCD) following inpatient rehabilitation and to determine associated risk factors.
Setting
Ontario, Canada.
Methods
Administrative data housed at ICES, Toronto, Ontario were used. Between 2004 and 2015, we investigated prescription medications dispensed over a 1-year period for persons following an NTSCD-related inpatient rehabilitation admission. Descriptive and analytical statistics were conducted. Using a robust Poisson multivariable regression model, relative risks related to polypharmacy (ten or more drug classes) were calculated. Main independent variables were sex, age, income quintile, and continuity of care with outpatient physician visits.
Results
We identified 3468 persons with NTSCD during the observation window. The mean number of drug classes taken post-inpatient rehabilitation was 11.7 (SD = 6.0), with 4.0 different prescribers (SD = 2.5) and 1.8 unique pharmacies (SD = 1.0). Significant predictors for post-discharge polypharmacy were: being female, lower income, higher comorbidities prior to admission, lower Functional Independence Measure at discharge, previous number of medication classes dispensed in year prior to admission, and lower continuity of care with outpatient physician visits. The most common drugs dispensed post-inpatient rehabilitation were antihypertensives (70.0%), laxatives (61.6%), opioids (59.5%), and antibiotics (57.8%).
Conclusion
Similar to previous research with traumatic spinal cord injury, our results indicate that polypharmacy is prevalent among persons with NTSCD. Additional research examining medication therapy management for NTSCD is suggested.
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Data availability
The dataset from this study is held securely in coded form at ICES. While data sharing agreements prohibit ICES from making the dataset publicly available, access may be granted to those who meet prespecified criteria for confidential access, available at www.ices.on.ca/DAS.
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Acknowledgements
This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and information compiled and provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions, and statements expressed herein are those of the author, and not necessarily those of the Canadian Institute for Health Information. The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources; no endorsement is intended or should be inferred.
Funding
This project was funded by a Connaught New Investigator Award (University of Toronto), and the Craig H. Neilsen Psychosocial Research Pilot grant (PSR2-17, grant #441259). SJTG is supported by a Canadian Institutes of Health Research Embedded Clinician Scientist Salary Award on Transitions in Care working with Ontario Health (Quality; formerly Health Quality Ontario). AKL is supported by a Canadian Institutes of Health Research New Investigator Award, as a Clinician Scientist at the University of Toronto Department of Family and Community Medicine, and as the Chair in Implementation Science at the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital in partnership with the Canadian Cancer Society.
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Contributions
SJTG conceptualized the study. SJTG, SLH, TP, TaP, and AKL obtained acquisition of study funding and designing the study. SJTG, M-EH, DMC, and AJC, prepared, coordinated, and guided the data analyses and interpretations. DMC and AJC analyzed the data. All authors assisted with overall interpretation and contextualization. SJTG, M-EH and QG assisted with the first draft of the manuscript. All authors critically reviewed and approved manuscript.
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The authors declare that they have no conflict of interest.
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The use of data in this project was authorized under section 45 of Ontario’s Personal Health Information Protection Act, which does not require review by a Research Ethics Board. However, we received Research Ethics Board approval from the University of Toronto (#34063).
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Guilcher, S.J.T., Hogan, ME., McCormack, D. et al. Prescription medications dispensed following a nontraumatic spinal cord dysfunction: a retrospective population-based study in Ontario, Canada. Spinal Cord 59, 132–140 (2021). https://doi.org/10.1038/s41393-020-0511-x
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DOI: https://doi.org/10.1038/s41393-020-0511-x
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