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Adjudication committee
- First opponent: Professor Hege Salvesen Blix, Norwegian Institute of Public Health
- Second opponent: Senior Clinical Pharmacist Ulrika Gillespie, Uppsala University hospital, Sweden
- Third member and chair of the evaluation committee: Professor Torgeir Bruun Wyller, University of Oslo
Chair of the Defence
Associate Professor Ingrid Nermoen, University of Oslo
Principal Supervisor
Professor II Knut Stavem, University of Oslo
Summary
Chronic kidney disease (CKD) is common in older adults, as is polypharmacy. Polypharmacy increases the risk of medication inappropriateness, complex medication regimen and reduced medication adherence.
In this thesis, we describe medication use, medication adherence and medication complexity in an older haemodialysis cohort and in a cohort of older patients with advanced CKD.
We found (1) a high prevalence of potentially inappropriate medications (PIMs) by using the STOPP criteria and Beers criteria. (2) The medication regimen is very complex in all patients with an overall score of 22.8±7.7. Female sex, Charlson Comorbidity index 4 or 5 and the use of phosphate binders were associated with a higher complexity score. (3) Moderate or high adherence were found in 83% of the patients. There was no association between adherence and medication complexity, age or other selected variables. (4) Finally, we conducted a randomized clinical trial to assess the effect of medication reviews with the intention of reducing PIMs, improving health-related quality of life and medication adherence. We reported a reduction in numbers of underprescribed medicines in the intervention group, but no reduction of overprescribed inappropriate medicines, neither in improved adherence or health-related quality of life.
Overall, the results contribute to increase awareness of inappropriateness in medication regimen and that high complexity of a medication regimen does not affect medication adherence.
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