Abstract
Purpose: The frequency of medication prescribing and polypharmacy has increased in recent years in different settings, including Swiss general practice. We aimed to describe patient age- and sex-specific rates of polypharmacy and of prescriptions of the most frequent medication classes, and to explore practitioner variability in prescribing. Methods: Retrospective cross-sectional study based on anonymized electronic medical records data of 111 811 adult patients presenting to 116 Swiss general practitioners in 2019. We used mixed-effects regression analyses to assess the association of patient age and sex with polypharmacy (≥5 medications) and with the prescription of specific medication classes (second level of the Anatomical Therapeutic Chemical Classification System). Practitioner variability was quantified in terms of the random effects distributions. Results: The prevalence of polypharmacy increased with age from 6.4% among patients aged 18–40 years to 19.7% (41–64 years), 45.3% (65–80 years), and 64.6% (81–92 years), and was higher in women than in men, particularly at younger ages. The most frequently prescribed medication classes were antiinflammatory and antirheumatic products (21.6% of patients), agents acting on the renin-angiotensin system (19.9%), analgesics (18.7%), and drugs for acid related disorders (18.3%). Men were more often prescribed agents targeting the cardiovascular system, whereas most other medications were more often prescribed to women. The highest practitioner variabilities were observed for vitamins, for antiinflammatory and antirheumatic products, and for mineral supplements. Conclusion: Based on practitioner variability, prevalence, and risk potential, antiinflammatory drugs and polypharmacy in older patients appear to be the most pressing issues in current drug prescribing routines.
Highlights
A global increase in life expectancy has been observed in recent decades (GBD 2017 Mortality Collaborators, 2018), resulting in an older and more chronically ill population (Barnett et al, 2012; Cao et al, 2020)
We performed a retrospective cross-sectional study based on data from the large Swiss primary care database FIRE (FIRE is an acronym for Family Medicine ICPC Research using Electronic Medical Records) (Chmiel et al, 2011)
To explore practitioner variability in prescribing, we reported crude distributions of general practitioner (GP)-specific prescription rates
Summary
A global increase in life expectancy has been observed in recent decades (GBD 2017 Mortality Collaborators, 2018), resulting in an older and more chronically ill population (Barnett et al, 2012; Cao et al, 2020) This demographic change is inevitably accompanied by an increasing need for medical interventions such as medication prescribing. The prevalence of polypharmacy (i.e., concurrent prescription of five or more medications) has climbed to over 25% among the older population in many healthcare systems (Guthrie et al, 2015a; Midão et al, 2018; Khezrian et al, 2020) This phenomenon is concerning because incremental health benefits tend to decrease with each additional medication, while the risk of adverse effects increases and may even outweigh the expected benefits (Kongkaew et al, 2013; Donaldson et al, 2017; Insani et al, 2021). Practitioner variability can serve as an indicator of issues with indication quality and potential healthcare inequity, which are problematic in publicly funded healthcare systems like the Swiss
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