Interrelationship of polypharmacy, drug utilisation and medication adherence in chronic liver disease: Evidence from a tertiary care hospital
Abstract
Background/Aim: Management of chronic liver disease (CLD) often involves multiple medications, increasing the risk of polypharmacy, drug-drug interactions (DDIs) and food-drug interactions (FDIs), which may influence medication adherence. This study aimed to evaluate medication use patterns and adherence among patients with CLD at a tertiary care hospital and to examine associations between polypharmacy, DDIs, FDIs and medication adherence.Methods: A prospective observational study was conducted over six months at a tertiary care hospital in Haryana, India. Data were collected from 200 patients with CLD through medical record reviews and patient interviews. Prescriptions were analysed according to the Ministry of Health Prescription Audit Guidelines. Medication adherence was assessed using the Medication Adherence Rating Scale (MARS). Polypharmacy, DDIs and FDIs were identified and their associations with adherence were statistically analysed.Results: The majority of patients were male (79 %) and 52.5 % were aged 41-60 years. Polypharmacy was present in 92 % of patients. DDIs were identified in 84.5 % of prescriptions, predominantly of moderate severity, while FDIs were observed in 43.5 % of cases. Medication adherence was classified as poor in 10 %, moderate in 48 % and strong in 42 % of patients. A statistically significant association was observed between polypharmacy and DDIs (p < 0.001). Medication adherence showed a significant negative association with FDIs (p = 0.002). No significant association was found between medication adherence and either polypharmacy or DDIs.Conclusion: Polypharmacy and DDIs were highly prevalent among patients with CLD; however, they were not significantly associated with medication adherence. FDIs were the only interaction type significantly associated with reduced adherence, highlighting the importance of dietary counselling and patient education in this population.