Abstract
BackgroundThe developed world is undergoing a demographic transition with greater numbers of older adults and higher rates of chronic disease. Most elder care is now provided by primary care physicians, who prescribe the majority of medications taken by these patients. Despite these significant trends, little is known about population-level prescribing patterns to primary care patients aged 65+.MethodsWe conducted a population-based retrospective cohort study to examine 10-year prescribing trends among family physicians providing care to patients aged 65+ in Ontario, Canada.ResultsBoth crude number of prescription claims and prescription rates (i.e., claims per person) increased dramatically over the 10-year study period. The greatest change was in prescribing patterns for females aged 85+. Dramatic increases were observed in the prescribing of preventive medications, such as those to prevent osteoporosis (+2,347%) and lipid-lowering agents (+697%). And lastly, the number of unique classes of medications prescribed to older persons has increased, with the proportion of older patients prescribed more than 10 classes of medications almost tripling during the study period.ConclusionsPrescribing to older adults by family physicians increased substantially during the study period. This raises important concerns regarding quality of care, patient safety, and cost sustainability. It is evident that further research is urgently needed on the health outcomes (both beneficial and harmful) associated with these dramatic increases in prescribing rates.
Highlights
The developed world is undergoing a demographic transition with greater numbers of older adults and higher rates of chronic disease
Most chronic disease management and medication prescription occurs in primary care by family physicians
All Ontario residents aged 65+ who were eligible for universal public health insurance and who made at least one Ontario Drug Benefit (ODB) claim during the study period were included in the analysis
Summary
The developed world is undergoing a demographic transition with greater numbers of older adults and higher rates of chronic disease. Individuals are living longer and accumulating a greater burden of chronic diseases and, as a consequence, are utilizing healthcare services at greater rates [1,2]. These trends are expected to increase further as the “baby-boom” generation advances toward later life. Most chronic disease management and medication prescription occurs in primary care by family physicians. Data are available for overall medication use for all age groups [3] and for specific medical conditions, [4,5,6] little is known about population-level prescribing patterns for family physicians providing care to older adults. Do prescription claims per person vary by patient age and sex?
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