Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan

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.

Long‐term trajectories of medicine use among older adults experiencing polypharmacy in Australia

“…The majority of people in our study experienced sustained exposure to a large number of medicines over time. While few studies have explored temporal changes in polypharmacy, our findings are consistent with population‐based studies of older adults in Sweden and Taiwan that found the majority (74%) of older adults exposed to 5 or more medicines sustained this exposure over the subsequent year, 15 and 2/3 (67%) of people with exposure to 10+ medicines had repeat period of exposure to 10+ medicines within a year 17 …”

“…Most of the extant research quantifying polypharmacy report cross‐sectional or annual trends in estimates of prevalence 9–13 . The few studies that have explored polypharmacy longitudinally have examined duration of exposure to polypharmacy, or time to repeat polypharmacy episodes 15,17 . Little is known about how the number of medicines and the nature of medicine use change for patients over time—which is needed to understand the types of common patient journeys (e.g.…”

How Chronic Is Polypharmacy in Old Age? A Longitudinal Nationwide Cohort Study

“…These two dimensions, the intensity and the composition of polypharmacy, are important. However, only few studies have made a distinction between chronic and transient polypharmacy . Our study shows that exposure to polypharmacy is not always stable over time and that transient polypharmacy episodes are not uncommon.…”

Potentially inappropriate medications for the elderly: Incidence and impact on mortality in a cohort ten-year follow-up

“…Hospitalization in the previous year was identified through the question: “Did you stay in the hospital last year?” Polypharmacy was defined as taking five or more medications [ 10 , 39 ].…”