The California Workers’ Compensation Institute (CWCI) has released a new study that measures the prevalence of polypharmacy in the California workers’ comp system.
Polypharmacy – the simultaneous use of multiple drugs by an individual patient – can frequently be inappropriate and result in health concerns that delay functional improvement and return to work, in turn increasing claim costs. The insights found in this report can be used to understand where polypharmacy is occurring in claims, giving workers’ comp professionals the knowledge they need to lower the frequency of polypharmacy.
To study the prevalence of polypharmacy in California workers’ comp claims, the CWCI extracted pharmaceutical and claim demographic data from their Industry Research Information System (IRIS) database, sourcing information from nearly 6.1 million claims. CWCI then focused on data from January 1, 2016 through December 31, 2017, and for the purposes of this study, zeroed in on claims with five or more concurrent medications during the study period.
Polypharmacy claims tend to be older, with 21.5% of them being at least 10 years old. Only 6% of non-polypharmacy claims were 10 years old, and when looking at all active polypharmacy claims at the end of 2017, 57.5% of those claims were from 2014 or prior. For non-polypharmacy claims that were still active at the end of 2017, only 21.8% were opened in 2014 and prior.
Furthermore, it was also found that the patients involved in polypharmacy claims tend to be older workers, as 52.3% of polypharmacy claims involved patients aged 50 or older at the time of injury. For non-polypharmacy claims, only 39.3% of claims involved workers of a similar age.
The study also found that 24% of claims with at least one dispensed drug had three or more different prescriptions concurrently dispensed. As for drugs commonly found in polypharmacy claims, opioids and anti-inflammatory analgesics were the top two most common drugs.
In claims with five or more drugs concurrently prescribed, opioids made up 16.7% of drugs, while anti-inflammatory analgesics made up 14.4% of drugs.
Muscle relaxants were also significantly common in polypharmacy claims, making up 9.9% of drugs in claims with five or more concurrent medications, as were gastrointestinal drugs (likely due to opioid side effects such as constipation), which made up 12.3% of drugs under similar parameters.
And when it came to diagnoses tied to polypharmacy, claims involving back conditions without spinal cord involvement made up 21.3% of polypharmacy claims. This was the number one diagnosis tied to polypharmacy, with ruptured tendon, tendonitis, myositis and bursitis making up just 10.2% of polypharmacy claims; the other top diagnoses, such as sprain, heart and circulatory issues, and other musculoskeletal diagnoses, were not far behind percentage-wise.