Polypharmacy among adults receiving outpatient care at Kitgum General Hospital, Northern Uganda

Abstract

Abstract
Background: Polypharmacy is a major safety concern, associated with adverse outcomes, higher health services utilization, and healthcare costs. However, there is limited data on polypharmacy in the outpatient settings in semi-urban primary care settings. We assessed the prevalence and factors associated with polypharmacy among adults receiving outpatient care at Kitgum General Hospital, Uganda.

Methods: We conducted a facility-based, cross-sectional study among adults receiving outpatient care at Kitgum General Hospital between October and December 2023. Polypharmacy was defined as the concurrent use of five or more medicines. Data was collected using a structured tool. A multivariable logistic regression analysis was performed to assess the factors associated with polypharmacy.

Results: A total of 422 participants, with a mean age of 43.0 ± 18.3 years were enrolled. More than a third of the participants (35.3%, n = 149) had chronic medical conditions. Overall, 43.4% (n = 183) (95% CI: 38.7-48.2) of the participants had polypharmacy. The majority were on antibiotics (91.8%, n = 168) and analgesics (77.6%, n = 142). In total, 145 (34.4%) reported use of over-the-counter drugs and 60 (14.2) used herbal medicines. Having a chronic illness (Adjusted Odds Ratio (aOR): 5.93, 95% CI: 3.10-11.34, p < 0.001), and use of over-the-counter drugs (aOR: 16.7; 95% CI: 8.87-31.42, p = 0.009) were associated with higher odds of polypharmacy. Herbal medicine use was associated with 64% lower odds of polypharmacy (aOR: 0.36; 95% CI: 0.17-0.77, p < 0.001).

Conclusion: Polypharmacy was observed in almost 2 in every 5 adults receiving outpatient care in Kitgum General Hospital. Chronic illness and use of over the counter medicines increased the odds of polypharmacy among adult outpatients. Priority should be put in place to mitigate polypharmacy among outpatients in Northern Uganda and similar low resource settings.