http://orcid.org/0000-0001-6132-3223
Peer Review History
| Original SubmissionAugust 7, 2019 |
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PONE-D-19-22287 Prevalence of polypharmacy and its associated factors among Qatari elderly patients attending primary healthcare centers, 2017 PLOS ONE Dear Dr. Al Dahshan, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we have decided that your manuscript does not meet our criteria for publication and must therefore be rejected. Specifically: The paper does not add any value to the existing literature on polypharmacy. The authors should examine other important social and/or health-system-level factors that contribute to polypharmacy. Polypharmacy is not well defined in the paper. Additionally, the paper has a lot of grammatical errors and is not clear to read. ============================== ACADEMIC EDITOR: Here are some specific comments: 1. In the introduction section, the authors talk about physician-related factors that may contribute to polypharmacy, however, such factors are not included in the study. 2. How do you define simultaneous use of five or more medications per person? 3. The authors should also look at polypharmacy as a continuous measure. 4. Data analysis and results sections are not properly written and are not organized well. There are many grammatical mistakes. Discussion: “A possible explanation for the high prevalence of polypharmacy found in our study is the fact that elderly patients are being seen and treated by different health care professionals, which might result in adding new prescription, at different occasions.” If the authors think that continuity of care is an important factor associated with polypharmacy then why was it not included. ============================== I am sorry that we cannot be more positive on this occasion, but hope that you appreciate the reasons for this decision. Yours sincerely, Satya Surbhi, PhD Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly ********** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes ********** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ********** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ********** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear Authors, Thank you for give me the opportunity to review this manuscript. It treats an interesting matter for health care workers. I hope my comments will be useful to do that. The manuscript entitled “Prevalence of polypharmacy and its associated factors among Qatari elderly patients attending primary healthcare centers, 2017” is based on a study that was carried out with the purpose to investigate the prevalence and the associated factors of polypharmacy among the elderly (≥65 years) nationals in this population. Given increased survival for older individuals, including those with multiple chronic conditions and polypharmacy, the topic has high significance and potential impact. Overall, the manuscript contributes to a better understanding of this issue. You have performed an interesting work, where the study problem, as well as the different concepts, are clearly described. The backgrounds are exposed and the need to carry out the study is justified. However, some concerns should be addressed. Please see the following questions: Abstract P.2 line 33, please, provide a definition of the abbreviation BMI. Introduction section P.5 line 97 Main objective There is an inconsistency between the definition that the main objective is made in this section with the one made in the abstract. Given the small number of variables that are taken into account and described in the results, the title of the study can be misleading since the results focus primarily on the relationship between polypharmacy and the main comorbidities observed in the population of study. Therefore, it would be more appropriate for both the title and the objective of the study to refer to the relationship between polypharmacy and such comorbidities. Methods section P.6 line 116 Study population. Reading this section I have raised many doubts. First, it is observed that the study / sample population is made up of the elderly patients (> 65 years old) registered in the Electronic Medical Record (EMR) and who had at least one visit to any primary care center during the study period . This can be a selection bias since the patients who go to the health centers may be the ones with the most pathologies and therefore the most polymedicated. In this case, the results could not be extrapolated to the general Qatari population over 65 years old. What happens to patients not registered in the EMR or who did not go to any health center during the study period? Are they different from those studied? On the other hand, you talk about medication reconciliation but it is not explained what this procedure consists of as well as the functions of the different members of the multidisciplinary team that participated in it. P6 line 122. Definition and Measures. Polypharmacy is defined as the simultaneous use of 5 or more medications per patient. While this definition of polypharmacy is the most frequently described in the literature, as you explain in the introduction, however, this is a poor and very variable definition that would explain the high prevalence of polymedication that you have found in your research. If we want to take into account the possible negative effects that polymedication can have on the health of patients, a definition of polymedication that takes into account the time variable should be used. Furthermore, if one of the objectives of the study is to investigate the associated factors of polypharmacy, it would be advisable to include more variables than those studied such as educational level, socio-economic level, marital status, place of residence, number of prescribers, number of visits to health services, etc. In addition, the section on material and methods should include a section where these variables are described and categorized, both dependent and independent variables. Otherwise both the objective and the title of the study should be changed. P.7 line 149. Ethical considerations There is no mention that the consent of patients has been obtained to be included in the study by signing an informed consent. Results section Table 1. Please provide a definition of the different categories of the Body Mass Index variable. Study strengths and limitations section The fact that the way in which the sample of the study has been selected may imply a selection bias should be included in this section, as well as the lack of convenience of generalizing the results obtained to the general Qatari population older than 65 years. Conclusions section The conclusions should be more concrete, referring exclusively to the proposed objectives and be supported by the results obtained. Recommendations and personal reflections that are not supported by concrete results should be included in another section of the manuscript such as discussion, prospective or recommendations. ********** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] - - - - - For journal use only: PONEDEC3 |
| Revision 1 |
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PONE-D-19-22287R1 Prevalence of polypharmacy and the association with non-communicable diseases in Qatari elderly patients attending primary healthcare centers: A cross-sectional study PLOS ONE Dear Dr. Al-Dahshan, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITORS: We have concluded that a major revision should be performed for the paper to be published according to Plos One criteria. Moreover a bit more speculation might be useful to suggest strategies for clinical improvement or further investigations. The main point is represented by external validity. It seems clear that the data are not representative of general elderly population in Qatar: prevalence of obesity >50%, diabetes almost 80%, asthma 20% are largely greater than population estimates around the world, and may clearly explain the high prevalence of polypharmacy – almost double in comparison with international estimates (to be cited): 39% in US according to ref 18, 44% in Sweden according to Morin L et al., Clin Epidemiol, 2018). In fact Authors state: "The study population included all Qatari elderly patients (≥65 years) who attended PHC centers during a period of six months from April 1 to September 30, 2017, AND WHO HAD MEDICATION RECONCILIATION DONE". What proportion of older Qataris attend PHC? And, most important, which percentage of older patients who attended the PHC underwent a medication reconciliation? Is the sample at least representative of older subjects who attend a Primary Health Center? If this is the case, conclusions should be moderated, stating that the prevalence of polypharmacy of older subjects ATTENDING A PHC in Qatar is very high, and discussion may be enriched adding information and perspectives on PHCs. Specific aspects to be covered include: - Was there any evaluation of adherence? - Was there potential to examine potential drug – drug interactions, ADR or inappropriate use? - Could the difference of polypharmacy between the sexes be explained by differential attendance at PHC? Or to different socio-economic condition? Have you got information regarding frequency of attendance to PHC as a possible marker of poorer control of comorbid conditions/greater polypharmacy? - Is there an urban rural discrepancy? - Is any information available regarding geriatric syndromes (malnutrition, impaired mobility, falls), nursing home placement, and hospitalizations? It would be of interest to assess the association with polypharmacy, controlled for comorbid conditions - Please add a brief description of PHC: are patients attached to an individual physician or is this a “drop in” type system with multiple prescribers? Is the PHC on an electronic medical record viewable by all and are there prescribing reminders according to condition? The authors might usefully refer to Hughes et al., Age Aging, 2013 which examines the potential for polypharmacy in the presence of more than one chronic condition when physicians are adhering to prescribing guidelines ============================== We would appreciate receiving your revised manuscript by 16-JUN-2020. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols Please include the following items when submitting your revised manuscript:
Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out. We look forward to receiving your revised manuscript. Kind regards, Enrico Mossello and Adrian Stuart Wagg Academic Editors PLOS ONE Journal Requirements: 1.) When submitting your revision, we need you to address these additional requirements: Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at http://www.plosone.org/attachments/PLOSOne_formatting_sample_main_body.pdf and http://www.plosone.org/attachments/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2.) We note that you have included the phrase “data not shown” in your manuscript. Unfortunately, this does not meet our data sharing requirements. PLOS does not permit references to inaccessible data. We require that authors provide all relevant data within the paper, Supporting Information files, or in an acceptable, public repository. Please add a citation to support this phrase or upload the data that corresponds with these findings to a stable repository (such as Figshare or Dryad) and provide and URLs, DOIs, or accession numbers that may be used to access these data. Or, if the data are not a core part of the research being presented in your study, we ask that you remove the phrase that refers to these data. 3.) In the ethics statement in the manuscript and in the online submission form, please provide additional information about the patient records used in your retrospective study. Specifically, please ensure that you have discussed whether all data were fully anonymized before you accessed them and/or whether the IRB or ethics committee waived the requirement for informed consent. If patients provided informed written consent to have data from their medical records used in research, please include this information. Additional Editor Comments (if provided): [Note: HTML markup is below. Please do not edit.] [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. |
| Revision 2 |
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Prevalence of polypharmacy and the association with non-communicable diseases in Qatari elderly patients attending primary healthcare centers: A cross-sectional study PONE-D-19-22287R2 Dear Dr. Ayman Al Dahshan, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Enrico Mossello Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: |
| Formally Accepted |
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PONE-D-19-22287R2 Prevalence of polypharmacy and the association with non-communicable diseases in Qatari elderly patients attending primary healthcare centers: A cross-sectional study Dear Dr. Al Dahshan: I am pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. For any other questions or concerns, please email plosone@plos.org. Thank you for submitting your work to PLOS ONE. With kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Satya Surbhi Academic Editor PLOS ONE |
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