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Prevalence of polypharmacy in a Scottish primary care population

  • Pharmacoepidemiology and Prescription
  • Published:
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Abstract

Purpose

Polypharmacy—the use of multiple medications by a single patient—is an important issue associated with various adverse clinical outcomes and rising costs. It is also a topic rarely addressed by clinical guidelines. We used routine Scottish health records to address the lack of data on the prevalence of polypharmacy in the broader, adult primary care population, particularly in relation to long-term conditions.

Methods

We conducted a cross-sectional analysis of adult electronic primary healthcare records and used linear regression models to examine the association between the number of medicines prescribed regularly and both multimorbidity and specific clinical conditions, adjusting for age, gender and socioeconomic deprivation.

Results

Overall, 16.9 % of the adults assessed were receiving four to nine medications, and 4.6 % were receiving ten or more medications, increasing with age (28.6 and 7.4 %, respectively, in those aged 60–69 years; 51.8 and 18.6 %, respectively, in those aged ≥80 years), but relatively unaffected by gender or deprivation. Of those patients with two clinical conditions, 20.8 % were receiving four to nine medications, and 1.1 % were receiving ten or more medications; in those patients with six or more comorbidities, these values were 47.7 and 41.7 %, respectively. The number of medications varied considerably between clinical conditions, with cardiovascular conditions associated with the greatest number of additional medications. The accumulation of additional medicines was less with concordant conditions.

Conclusions

Polypharmacy is common in UK primary care. The main factor associated with this is multimorbidity, although considerable variation exists between different conditions. The impact of clinical conditions on the number of medicines is generally less in the presence of co-existing concordant conditions.

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References

  1. Hovstadius B, Hovstadius K, Astrand B et al (2010) Increasing polypharmacy—an individual-based study of the Swedish population 2005-2008. BMC Clin Pharmacol 10:16. doi:10.1186/1472-6904-10-16

    Article  PubMed Central  PubMed  Google Scholar 

  2. Barnett K, Mercer SW, Norbury M et al (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380(9836):37–43. doi:10.1016/S0140-6736(12)60240-2

    Article  PubMed  Google Scholar 

  3. Boyd CM, Darer J, Boult C et al (2005) Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 294(6):716–724

    Article  CAS  PubMed  Google Scholar 

  4. Avery AJ, Barber N, Ghaleb M et al (2012) Investigating the prevalence and causes of prescribing errors in general practice: The PRACtICe Study. GMC Publication 1-5-2012. General Medical Council, London

  5. Dequito AB, Mol PG, van Doormaal JE et al (2011) Preventable and non-preventable adverse drug events in hospitalized patients: a prospective chart review in the Netherlands. Drug Saf 34(11):1089–1100. doi:10.2165/11592030-000000000-00000

    Article  PubMed  Google Scholar 

  6. Vik SA, Maxwell CJ, Hogan DB (2004) Measurement, correlates, and health outcomes of medication adherence among seniors. Ann Pharmacother 38(2):303–312

    Article  PubMed  Google Scholar 

  7. Tsai KT, Chen JH, Wen CJ et al (2012) Medication adherence among geriatric outpatients prescribed multiple medications. Am J Geriatr Pharmacother 10(1):61–68. doi:10.1016/j.amjopharm.2011.11.005

    Article  PubMed  Google Scholar 

  8. Fincke BG, Miller DR, Spiro A III (1998) The interaction of patient perception of overmedication with drug compliance and side effects. J Gen Intern Med 13(3):182–185

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  9. Bradley MC, Fahey T, Cahir C et al (2012) Potentially inappropriate prescribing and cost outcomes for older people: a cross-sectional study using the Northern Ireland Enhanced Prescribing Database. Eur J Clin Pharmacol 68(10):1425–1433. doi:10.1007/s00228-012-1249-y

    Article  PubMed  Google Scholar 

  10. Model of Care Polypharmacy Working Group (2012) Polypharmacy guidance. Scottish Government, Edinburgh

  11. Guthrie B, Payne K, Alderson P et al (2012) Adapting clinical guidelines to take account of multimorbidity. BMJ 345:e6341. doi:10.1136/bmj.e6341

    Article  PubMed  Google Scholar 

  12. Qato DM, Alexander GC, Conti RM et al (2008) Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA 300(24):2867–2878. doi:10.1001/jama.2008.892

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Gallagher P, Lang PO, Cherubini A et al (2011) Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol 67(11):1175–1188. doi:10.1007/s00228-011-1061-0

    Article  PubMed  Google Scholar 

  14. Nobili A, Licata G, Salerno F et al (2011) Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wards. The REPOSI study. Eur J Clin Pharmacol 67(5):507–519. doi:10.1007/s00228-010-0977-0

    Article  PubMed  Google Scholar 

  15. Fattinger K, Roos M, Vergeres P et al (2000) Epidemiology of drug exposure and adverse drug reactions in two swiss departments of internal medicine. Br J Clin Pharmacol 49(2):158–167

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Information Services Division Scotland. Practice Team Information (PTI) statistics. Available at:http://www.isdscotland.org/Health-Topics/General-Practice/GP-Consultations/. Accessed 31 July 2013

  17. Office of the Chief Statistician (OCS) (2010) Scottish Index of Multiple Deprivation 2009 technical report. Scottish Government, Edinburgh

  18. National Records of Scotland (2011) Mid-2010 Population estimates Scotland: Population estimates by sex, age and administrative area. Office for National Statistics, Edinburgh

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Correspondence to R. A. Payne.

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Payne, R.A., Avery, A.J., Duerden, M. et al. Prevalence of polypharmacy in a Scottish primary care population. Eur J Clin Pharmacol 70, 575–581 (2014). https://doi.org/10.1007/s00228-013-1639-9

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  • DOI: https://doi.org/10.1007/s00228-013-1639-9

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