Effectiveness of polypharmacy reduction policy in Japan: nationwide retrospective observational study

Ishida, Toshihisa; Yamaoka, Kazue; Suzuki, Asuka; Nakata, Yoshinori

doi:10.1007/s11096-021-01347-7

Cited by 4 publications

(8 citation statements)

References 29 publications

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“…This study reveals more frequent polypharmacy in the “75 years and above” population in Japan, which is consistent with a previous report [ 2 ]. PRR3 shows a favorable reduction ratio of polypharmacy among all subgroups, and this is consistent with that observed in PRR1, as we previously reported [ 17 ]. This implies the effectiveness of incentives for pharmacies that were introduced in the medical fee amendment of 2018.…”

Section: Discussionsupporting

confidence: 91%

“…Table 4 shows the results of the multiple linear regression analyses conducted to identify the factors associated with the effectiveness of the polypharmacy reduction policy. Long-term PRR was set as an outcome variable using the same independent variables as our previous study [ 17 ]. No factor showed a statistically significant association with long-term PRR.…”

Section: Resultsmentioning

confidence: 99%

“…Following the outcome measures used in our previous study [ 17 ], we calculated the polypharmacy proportion (PP) using Equation (1). Furthermore, we set the polypharmacy reduction ratio (PRR), calculated using Equation (2), as the outcome variable for this study (see below).…”

Section: Methodsmentioning

confidence: 99%

“…A multiple linear regression analysis considering each prefecture as an individual unit ( n = 47) was conducted according to the analysis method used in our previous study [ 17 ]. The authors obtained the human variables of the population data and healthcare resource data for each prefecture disclosed in e-Stat, sponsored by the Ministry of Internal Affairs and Communications (MIC), and the number of medical facilities for each prefecture disclosed by the MHLW and MIC [ 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

“…We have previously reported on the effectiveness of the April 2016 medication point amendment, which led to a 7.3% reduction in polypharmacy nationwide [ 17 ]. A study indicated that the polypharmacy trend among older adults in Japan declined from 2013 to 2016, following an increasing trend from 2010 to 2013 [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Nationwide Long-Term Evaluation of Polypharmacy Reduction Policies Focusing on Older Adults in Japan

Ishida

Suzuki

Nakata

2022

IJERPH

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Polypharmacy is a serious health issue for older adults worldwide, including in Japan, which has a rapidly aging society. The “Proper Medication Guideline for Older Adults” was published for healthcare providers in May 2018, and polypharmacy reduction incentives were initiated for medical facilities in April 2016 and April 2018. This study identified the long-term reduction in polypharmacy prescriptions focusing on older adults aged 75 years and above from April 2015 to March 2019. The national health insurance claims database, which covers most reimbursement claims in Japan, was selected as the primary data source. In this study, polypharmacy was defined as the simultaneous prescription of seven or more medications or multi-psychotropic medications. The primary outcome was the polypharmacy reduction ratio, which indicates the decrease in polypharmacy proportion based on the number of medications on an outpatient prescription. A total polypharmacy reduction of 19.3% for the “75–89 years” subgroup and 16.5% for the “90 years and above” subgroup was observed over four years. Based on prefecture analysis, the mean values of polypharmacy proportion showed a statistically significant reduction over four years. This study showed a successful nationwide reduction in polypharmacy prescriptions after implementing the polypharmacy management guidelines for older adults and incentive-based policies.

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Section: Discussionsupporting

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Nationwide Long-Term Evaluation of Polypharmacy Reduction Policies Focusing on Older Adults in Japan

Ishida

Suzuki

Nakata

2022

IJERPH

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Comparing prevalence and types of potentially inappropriate medications among patient groups in a post-acute and secondary care hospital

Nakashima,

Ando,

Umegaki

2023

Sci Rep

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Reducing potentially inappropriate medications (PIMs) is a challenge in post-acute care hospitals. Some PIMs may be associated with patient characteristics and it may be useful to focus on frequent PIMs. This study aimed to identify characteristic features of PIMs by grouping patients as in everyday clinical practice. A retrospective review of medical records was conducted for 541 patients aged 75 years or older in a Japanese post-acute and secondary care hospital. PIMs on admission were identified using the Screening Tool for Older Person’s Appropriate Prescriptions for Japanese. The patients were divided into four groups based on their primary disease and reason for hospitalization: post-acute orthopedics, post-acute neurological disorders, post-acute others, and subacute. Approximately 60.8% of the patients were taking PIMs, with no significant difference among the four patient groups in terms of prevalence of PIMs (p = 0.08). However, characteristic features of PIM types were observed in each patient group. Hypnotics and nonsteroidal anti-inflammatory drugs were common in the post-acute orthopedics group, multiple antithrombotic agents in the post-acute neurological disorders group, diuretics in the post-acute others group, and hypnotics and diuretics in the subacute group. Grouping patients in clinical practice revealed characteristic features of PIM types in each group.

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Effect of a Financial Incentive Scheme for Medication Review on Polypharmacy in Elderly Inpatients With Dementia: A Retrospective Before-and-After Study

Morita,

Sasabuchi,

Yamana

et al. 2024

J Patient Saf

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Objectives Polypharmacy is an important healthcare issue, especially in elderly patients with dementia. As an incentive to reduce polypharmacy, a health insurance reimbursement scheme was introduced in 2016 for medication review and the reduction of medications for inpatients in Japan. However, the effects of these incentive schemes were not evaluated. Methods We identified 1,465,881 inpatients aged ≥65 years with dementia. An interrupted time-series analysis was conducted by fitting a Prais-Winsten linear regression model. The outcome measure was the number of classes of medications prescribed during discharge. Results No significant changes were observed in the average number of medication classes at discharge immediately after the introduction of the scheme (coefficient: −0.022, 95% confidence interval [CI]: −0.17 to 0.13). The slope change, representing the effect of the intervention over time, was also not significant (coefficient: −0.00053, 95% confidence interval: −0.0012 to 0.00018). Conclusions The incentive scheme was not associated with a reduction in the number of medication classes at discharge among older inpatients with dementia.

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Effectiveness of polypharmacy reduction policy in Japan: nationwide retrospective observational study

Cited by 4 publications

References 29 publications

Nationwide Long-Term Evaluation of Polypharmacy Reduction Policies Focusing on Older Adults in Japan

Nationwide Long-Term Evaluation of Polypharmacy Reduction Policies Focusing on Older Adults in Japan

Comparing prevalence and types of potentially inappropriate medications among patient groups in a post-acute and secondary care hospital

Effect of a Financial Incentive Scheme for Medication Review on Polypharmacy in Elderly Inpatients With Dementia: A Retrospective Before-and-After Study

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