To determine the association between polypharmacy and adverse drug events (ADEs), medication appropriateness, adherence, and healthcare utilization in children with medical complexity (CMC).
Approach:
Study Design: Retrospective cohort study of 1,486 CMC aged 0–18 years at The People's Hospital of Danyang, with a minimum 12-month follow-up.
Polypharmacy Definition: Defined as concurrent use of 5 or more chronic medications for 90 or more consecutive days, excluding PRN medications.
Outcomes: Primary outcomes included ADEs, potentially inappropriate medication (PIM) use, and medication adherence. Secondary outcomes included healthcare utilization metrics.
Key Findings:
Of 1,486 CMC, 628 (42.3%) had polypharmacy.
Polypharmacy was associated with significantly higher ADE rates (5.5 vs 1.5 per patient-year; adjusted rate ratio 2.70; 95% CI 2.30–3.20).
PIM use was significantly higher in the polypharmacy group (53.8% vs 17.7%).
Increased emergency department visits (5.5 vs 2.3 per year) and unplanned admissions (3.5 vs 1.3 per year) were noted.
ICU admissions were higher in the polypharmacy group (43.3% vs 20.9%).
Lower medication adherence was observed (mean PDC 63.5% vs 80.2%).
A dose-response relationship was evident (P for trend < 0.001).
Interpretation:
Polypharmacy in CMC is strongly associated with increased ADEs, PIM use, reduced adherence, and elevated healthcare utilization.
