Healthcare fragmentation, multimorbidity, and polypharmacy: a vicious circle of interdisciplinary risks

作者：Yu. V. Lukina, V. V. Tsaregorodtseva, Н. П. Кутишенко, A. S. Eliseykina, S. Yu. Martsevich, Oksana M. Drapkina · 发表于：CARDIOVASCULAR THERAPY AND PREVENTION · 年份：2026 · DOI：10.15829/1728-8800-2026-4935 · 研究领域：Chronic Disease Management Strategies、Pharmaceutical Practices and Patient Outcomes、Healthcare Systems and Public Health

Aim . To evaluate the prevalence of potential drug-drug interactions (pDDIs) in patients with cardiovascular diseases and non-cardiac comorbidities, and to determine the role of multimorbidity and healthcare fragmentation in the occurrence of these interactions. Material and methods . Based on the Chuvashia Inappropriate Prescribing Study (CHIP) outpatient registry, an in-depth analysis of pharmacotherapy was conducted in 300 multimorbid cardiac patients aged over 50 years, each having at least one non-communicable non-cardiac disease requiring medication. The median drug burden was >9 drugs per patient. Patients were treated by physicians of 23 specialties. Therapy for a single patient could be prescribed by 1 to 5 specialists simultaneously (147 patients were managed by one physician, 98 by a tandem of two, 39 by three, while significant fragmentation involving 4 and 5 specialists was observed in 12 and 4 patients, respectively). The independent contribution of the number of diseases and attending physicians to the accumulation of medication errors was assessed using multivariate statistical modeling. Results . It was established that a monodisciplinary approach (patient management by a single physician) has the highest safety as follows: 32,0% of patients are completely protected from drug interactions. As the fragmentation of healthcare increases, there are following exponential increase in the number of errors: the involvement of 2 specialists reduces the proportion of s...