1 2 3 Multiple drug use in patients with comorbidity and multimorbidity: proposal for standard 4 5 definitions beyond the term polypharmacy 6 7 Kadam UT1,4*, Roberts I2, White S3, Bednall R2, Khunti K4, Nilsson PM5, Lawson CA4 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 *corresponding author 27 28 Umesh T. Kadam 29 30 Professor of Primary Care and Public Health Research 31 32 Diabetes Research Centre, Gwendolen Rd, Leicester, United Kingdom, LE5 4PW 33 34
[email protected] 35 36 37 1. Department of Health Sciences, University of Leicester, UK 38 39 2. University Hospitals of North Staffordshire, Staffordshire, UK 40 41 3. School of Pharmacy, Keele University, UK 42 43 4. Diabetes Research Centre, University of Leicester, UK 44 45 5. Department of Clinical Sciences, Lund University, Sweden 46 47 48 49 Keywords: diabetes; heart failure; breast cancer; polypharmacy; comorbidity; multimorbidity 50 51 52 53 54 55 56 57 58 1 59 60 61 62 Abstract 63 64 With older and ageing populations, patients experience multiple chronic diseases at the 65 66 same time. Individual chronic disease guidelines often recommend pharmacological 67 68 therapies as a key intervention, resulting in patients being prescribed multiple regular 69 70 medications for their different diseases. Whilst the term ‘polypharmacy’ has been applied to 71 72 the use of multiple medications, there is no consistent definition and this term is now being 73 74 used all inclusively. To improve both scientific rigor and optimal patient care, it is crucial that 75 76 a standard terminology is used which reclassifies the term ‘polypharmacy’ into distinct 77 78 phenotypes relating to the index chronic disease, additional conditions to the index 79 80 (‘comorbidity’) or the experience of multiple chronic conditions at the same time 81 82 (multimorbidity).