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Multimorbidity and Medication Order Patterns in Skilled Nursing Facilities: A Real-World Evidence Study
Ashraf, H.; Tsasis, P.; Mathers, K. E.; DiSanto, L.; Wong, A.; Sharma, D.; Heffernan, J. M.; Wagner et al.. medRxiv (preprint), 2026-09-23
Topic: Risk, prevention and care in population studies
BackgroundMultimorbidity is common among U.S. skilled nursing facilities (SNFs) residents and complicates pharmacologic management, yet real-world evidence on treatment patterns in this population remains limited. This study evaluated medication order rates and identified resident- and facility-level factors among SNF residents with multimorbidity. MethodsRetrospective, observational study using electronic health record (EHR) data from PointClickCares Life Sciences database. Participants were 728,222 residents active in a U.S. SNF on April 30, 2025 with at least one documented diagnosis of hypertension, hyperlipidaemia, type 2 diabetes (T2D), depression, or Alzheimers disease and related dementias (ADRD). The outcome was presence of guideline-recommended medication order for each condition, modelled with modified Poisson regression to estimate adjusted prevalence risk ratios (RRs) and 95% confidence intervals. ResultsMedication order rates were 79% for ADRD, 79.1% for T2D, 87.7% for hypertension, 83.3% for hyperlipidaemia, and 90.8% for depression. Rates varied across comorbidity combinations: ADRD was associated with lower medication order prevalence, while cardiometabolic multimorbidity profiles associated with higher prevalence. Black/African American identity had the lowest likelihoods of a medication order for 3 of 5 conditions (RRs of 0.93 to 0.92), while having hypertension or hyperlipidaemia medication order was associated with higher likelihood of having orders for 3 of remaining 4 conditions (RRs of 1.02 to 1.19). ConclusionsMost SNF residents with multimorbidity had a medication order for common chronic conditions, although important variability and disparities remain. Differences by comorbidity profile and social context underscore the need for targeted strategies supporting equitable, integrated prescribing and person-centred care in SNFs.
Key findings
- Rates varied across comorbidity combinations: ADRD was associated with lower medication order prevalence, while cardiometabolic multimorbidity profiles associated with higher prevalence.
- Black/African American identity had the lowest likelihoods of a medication order for 3 of 5 conditions (RRs of 0.93 to 0.92), while having hypertension or hyperlipidaemia medication order was associated with higher likelihood of having orders for 3 of remaining 4 conditions (RRs of 1.02 to 1.19).
Why it matters
Among nursing home residents with multiple health conditions, those with Alzheimer's disease and related dementias were less likely to have a medication order recorded for their conditions. This points to possible gaps in medication management for people with dementia, but it is about prescribing patterns, not treating or preventing Alzheimer's itself.
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Study details
- Effect size79.1%; 87.7%; 83.3%
- Evidence strengthLow
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 20 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, sample size, studied in people and randomised / blinded because the record does not state it. We have no data on impact for its field and year, so that was left out: it earned 19 of the 94 points we could judge it on, which is 20 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv (preprint)) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 2 / 3 | Effect reported as a number, without an interval or test |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 1 / 4 | Last-listed author Tyler M. Saumur: h-index 6 (OpenAlex, whole career) |
| Institution's track record | 0 / 3 | York University: institution h-index 552 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 19 / 94 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 19 of the 94 points we could judge it on is 20 out of 100. |
| Total | 20 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Ashraf, H., Tsasis, P., Mathers, K. E., DiSanto, L., Wong, A., Sharma, D., et al. (2026). Multimorbidity and Medication Order Patterns in Skilled Nursing Facilities: A Real-World Evidence Study. medRxiv (preprint). https://doi.org/10.64898/2026.09.22.26363593
Vancouver
Ashraf H, Tsasis P, Mathers KE, DiSanto L, Wong A, Sharma D, et al. Multimorbidity and Medication Order Patterns in Skilled Nursing Facilities: A Real-World Evidence Study. medRxiv (preprint). 2026. doi:10.64898/2026.09.22.26363593.
BibTeX
@article{ashraf2026-de9f14da,
author = {Ashraf, H. and Tsasis, P. and Mathers, K. E. and DiSanto, L. and Wong, A. and Sharma, D. and Heffernan, J. M. and Wagner and others},
title = {{Multimorbidity and Medication Order Patterns in Skilled Nursing Facilities: A Real-World Evidence Study}},
journal = {medRxiv (preprint)},
year = {2026},
doi = {10.64898/2026.09.22.26363593},
url = {https://doi.org/10.64898/2026.09.22.26363593}
}