Comorbidity and polypharmacy in the practice of a general practitioner


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Abstract

The high prevalence of cardiovascular diseases and their pathophysiological association with various comorbid conditions contributes to the progressive increase in the number of patients with a concurrence of several diseases. Combined pathology creates a new clinical situation that requires the consideration of its features when choosing therapeutic, diagnostic, and preventive strategies. A comorbid patient is a serious problem for any clinician, since in this case it is necessary to take into account several components of therapy, which makes it difficult to control treatment efficiency, contributes to an increase in polypharmacy, the risk of local and systemic side effects of drugs, and reduces adherence to therapy. Treatment for comorbid disorders requires careful compliance with the requirements of rational pharmacotherapy, high clinical professionalism, and a wide range of knowledge of related specialties. The paper describes and discusses the clinical case of a comorbid patient in the practice of a general practitioner. It gives the steps in the performed diagnostic search, by verifying the clinical diagnosis and prescribed pharmacotherapy strategies. The presented data show that it is difficult for a physician to avoid polypharmacy in case of comorbidities. Such difficulties are daily encountered by any clinician regardless of his/her clinical experience and awareness of medical science.

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About the authors

E. I Polozova

N.P. Ogarev Mordovia State University

Professor

V. V Skvortsov

Volgograd State Medical University, Ministry of Health of Russia

Email: vskvortsov1@ya.ru

S. V Aksenova

N.P. Ogarev Mordovia State University

Professor

D. A Zinyakov

N.P. Ogarev Mordovia State University

T. M Levina

N.P. Ogarev Mordovia State University

Candidate of Medical Sciences

N. S Nefedov

N.P. Ogarev Mordovia State University

M. A Narvatkina

N.P. Ogarev Mordovia State University

References

  1. Оганов Р.Г., Денисов И.Н., Симаненков В.И. и др. Коморбидная патология в клинической практике. Клинические рекомендации. Кардиоваскулярная терапия и профилактика. 2017; 16 (6): 5-56 [Oganov R.G., Denisov I.N., Simanenkov V.I. et al. Comorbidities in practice. Clinical guidelines. Cardiovascular Therapy and Prevention. 2017; 16 (6): 5-56 (in Russ.)]. https://doi. org/10.15829/1728-8800-2017-6-5-56
  2. Арьева Г.Т., Советкина Н.В., Овсянникова Н.А. и др. Коморбидные и мультиморбидные состояния в гериатрии (обзор). Успехи геронтологии. 2011; 4: 612-9 [Arieva G.T., Sovetkina N.V., Ovsiannikova N.A. et al. Comorbid and multimorbid conditions in geriatrics (review). Uspekhigerontologii. 2011; 4: 612-9 (in Russ.)].
  3. Ширинский В.С., Ширинский И.В. Коморбидные заболевания - актуальная проблема. Сибирский журнал клинической и экспериментальной медицины. 2014; 29 (1): 7-12 [Shirinsky V.S., Shirinsky I.V. Comorbid diseases as an important problem of clinical medicine. The Siberian Journal of Clinical and Experimental Medicine. 2014; 29 (1): 7-12 (in Russ.)]. https://doi. org/10.29001/2073-8552-2014-29-1-7-12
  4. Прощаев К.И., Рапопорт С.И., Жернакова Н.И. и др. Полиморбидность и старение. Клиническая нейро-иммуноэндокринология полиморбидных состояний у пациентов пожилого возраста. Владикавказ мед-биол вестн. 2010; 11 (18): 95-9 [Prashchayeu K.I., Rapoport S.I., Zhernakova N.I. et al. Polymorbidity and ageing. The clinical neuroimmunoendocrinology of polymorbidity in seniors. Vladikavkaz med-biol vestn. 2010; 11 (18): 95-9 (in Russ.)].
  5. Nobrega T.C., Jaluul O., Machado A.N. et al. Quality of life and multimorbidity of elderly outpatients. Clinics (Sao Paulo). 2009; 64 (1): 45-50. DOI: 10.1590/ s1807-59322009000100009
  6. Органов Р.Г., Драпкина О.М. Полиморбидность: закономерности формирования и принципы сочетания нескольких заболеваний у одного пациента. Кардиоваскулярная терапия и профилактика. 2016; 15 (4): 4-9 [Oganov R.G., Drapkina O.M. Polymorbidity: specifics of co-development and concomitance of several diseases in one patient. Cardiovascular Therapy and Prevention. 2016; 15 (4): 4-9 (in Russ.)]. https://doi.org/10.15829/1728-8800-2016-4-4-9
  7. Верткин А.Л., Скотников А.С., Румянцев М.А. и др. Коморбидность: от истоков развития до современного понятия. Как оценить и прогнозировать. Врач скорой помощи. 2011; 4: 15-22 [Vyortkin A.L., Rumyantsev M.A., Skotnikov A.S. et al. Comorbidity: from the start of development up to modern conception. How to estimate and prognosticate? Vrach skoroipomoshchi. 2011; 4: 15-22 (in Russ.)].
  8. Fabbri E., Zoli M., Gonzalez-Freire M. et al. Aging and Multimorbidity: New Tasks, Priorities, and Frontiers for Integrated Gerontological and Clinical Research. J Am Med Dir Assoc. 2015; 16 (8): 640-7. doi: 10.1016/j.jamda.2015.03.013
  9. Агафонова О.В., Булгакова С.В., Богданова Ю.В. и др. Поликлиническая терапия. Учебник. 2-е изд., перераб. и доп. М., 2020 [Agafonova O.V., Bulgakova S.V., Bogdanova Yu.V. et al. Poliklinicheskaya terapiya. Uchebnik. 2-e izd, pererab. i dop. M., 2020 (in Russ.)]. doi: 10.33029/9704-5545-6-PLT-2020-1-840
  10. Беляева Ю.Н., Карпов Ю.В. Подходы к тактике ведения пациентов с коморбидными состояниями. Бюллетень медицинских интернет-конференций. 2016; 6: 1295-300 [Belyaeva Yu.N., Karpov Yu.V. Podkhody k taktike vedeniya patsientov s komorbidnymi sostoyaniyami. Bulletin of Medical Internet Conferences. 2016; 6: 1295-300 (in Russ.)].
  11. Fitzgerald S.P., Bean N.G. An Analysis of the Interactions Between Individual Comorbidities and Their Treatments - Implications for Guidelines and Polypharmacy. J Am Med Dir Assoc. 2010; 11 (7): 475-84. DOI: 10.1016/j. jamda.2010.05.008
  12. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-Centered Care for Older Adults with ultiple Chronic Conditions: A Stepwise Approach from the American Geriatrics Society. J Am Geriatr Soc. 2012; 60 (10): 1957-68. doi: 10.1111/j.1532-5415.2012.04187.x
  13. Губанова Г.В., Беляева Ю.Н., Шеметова Г.Н. Коморбидный пациент: этапы формирования, факторы риска и тактика ведения. Современные проблемы науки и образования. 2015; 6: 18-23 [Gubanova G.V., Belyaeva Yu.N., Shemetova G.N. Multimorbidity patient: stages of formation, risk factors and management tactics. Modern problems of science and education. 2015; 6: 18-23 (in Russ.)].
  14. Чесникова А.И., Батюшин М.М., Терентьев В.П. Артериальная гипертензия и коморбидность: современное состояние проблемы. Артериальная гипертензия. 2016; 22 (5): 432-40 [Chesnikova A.I., Batyushin M.M., Terentyev V.P. Arterial hypertension and comorbidity: state of the art. Arterial Hypertension. 2016; 22 (5): 432-40 (in Russ.)]. doi: 10.18705/1607-419X-2016-22-5-432-440
  15. Booth H.P., Prevost A.T., Gulliford M.C. Impact of body mass index on prevalence of multimorbidity in primary care: cohort study. Family Practice. 2014; 31 (1): 38-43. doi: 10.1093/fampra/cmt061
  16. O’Toole J., Hambly R., Cox A.M. et al. Methadone-maintained patients in primary care have higher rates of chronic disease and multimorbidity, and use health services more intensively than matched controls. Eur J Gen Pract. 2014; 20 (4): 275-80. doi: 10.3109/13814788.2014.905912

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