Abstract
Objectives: Target populations with persistent polypharmacy should be identified prior to implementing strategies against inappropriate medication use, yet limited information regarding such populations is available. The main objectives were to explore the trends of excessive polypharmacy, whether transient or persistent, at the individual level. The secondary objectives were to identify the factors associated with persistently excessive polypharmacy and to estimate the probabilities for repeatedly excessive polypharmacy.Methods: Retrospective cohort analyses of excessive polypharmacy, defined as prescription of ≥ 10 medicines at an ambulatory visit, from 2001 to 2013 were conducted using a nationally representative claims database in Taiwan. Survival analyses with log-rank test of adult patients with first-time excessive polypharmacy were conducted to predict the probabilities, stratified by age and sex, of having repeatedly excessive polypharmacy.Results: During the study period, excessive polypharmacy occurred in 5.4% of patients for the first time. Among them, 63.9% had repeatedly excessive polypharmacy and the probabilities were higher in men and old people. Men versus women, and old versus middle-aged and young people had shorter median excessive polypharmacy-free times (9.4 vs. 5.5 months, 5.3 vs. 10.1 and 35.0 months, both p < 0.001). Overall, the probabilities of having no repeatedly excessive polypharmacy within 3 months, 6 months, and 1 year were 59.9, 53.6, and 48.1%, respectively.Conclusion: Although male and old patients were more likely to have persistently excessive polypharmacy, most cases of excessive polypharmacy were transient or did not re-appear in the short run. Systemic deprescribing measures should be tailored to at-risk groups.
Highlights
Polypharmacy, usually conceptualized as concurrent use of multiple medications, has raised concerns in recent decades
In the 1,000,000-person cohort dataset covering the period from 1996 to 2013, only 928,535 people had ambulatory visits after 2000. This group consisted of 225,278 children, 355,330 young people, 263,529 middle-aged people, and 84,398 old people, and their average age at the beginning of 2001 was 33.9 ± 20.2 years old
The first prescriptions of excessive polypharmacy were distributed in each year, and the average age at the first prescription of excessive polypharmacy was 64.2 ± 14.7 years old, with those receiving a first prescription of excessive polypharmacy consisting of 2,222 young people (0.6%), 15,507 middle-aged people (5.9%), and 19,974 old people (23.7%) (χ2 = 7200, p < 0.001) (Table 1)
Summary
Polypharmacy, usually conceptualized as concurrent use of multiple medications, has raised concerns in recent decades. Evidence has supported the association of polypharmacy with various adverse outcomes, including increased risks of inappropriate prescribing (Fialova and Onder, 2009), drugdrug interactions (Delafuente, 2003), adverse drug reactions, non-adherence, falls, functional decline, hospitalization, and mortality among patients, especially the elderly (Maher et al, 2014). The number of concurrent medications taken per person most commonly used to define polypharmacy is five, while the cutoff value ranges from two to eleven (Masnoon et al, 2017). Concomitant use of ten medications or more has been defined as “hyperpolypharmacy,” “excessive polypharmacy,” or “severe polypharmacy” (Masnoon et al, 2017).
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