Prescription Rates, Polypharmacy and Prescriber Variability in Swiss General Practice—A Cross-Sectional Database Study

Rachamin, Yael; Jäger, Levy; Meier, Rahel; Grischott, Thomas; Senn, Oliver; Burgstaller, Jakob M; Markun, Stefan

doi:10.3389/fphar.2022.832994

Cited by 7 publications

(3 citation statements)

References 45 publications

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“…The best-met of all QIs involved withholding NSAIDs to CKD patients and showed an achievement rate over 80%. This proportion aligns with the recently determined yearly prescription rates of NSAIDs in the Swiss general practice population of the same age range [ 42 ]. Whether GPs take presence of CKD into account when prescribing NSAIDs therefore remains undetermined.…”

Section: Discussionsupporting

confidence: 87%

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

et al. 2022

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Background Chronic kidney disease (CKD) is a common condition in general practice. Data about quality and physician-level variation of CKD care provided by general practitioners is scarce. In this study, we evaluated determinants and variation of achievement of 14 quality indicators for CKD care using electronic medical records data from Swiss general practice during 2013–2019. Methods We defined two patient cohorts from 483 general practitioners, one to address renal function assessment in patients with predisposing conditions (n = 47,201, median age 68 years, 48.7% female) and one to address care of patients with laboratory-confirmed CKD (n = 14,654, median age 80 years, 57.5% female). We investigated quality indicator achievement with mixed-effect logistic regression and expressed physician-level variation as intraclass correlation coefficients (ICCs) and range odds ratios (rORs). Results We observed the highest quality indicator achievement rate for withholding non-steroidal anti-inflammatory drug prescription in patients with CKD staged G2–3b within 12 months of follow-up (82.6%), the lowest for albuminuria assessment within 18 months of follow-up (18.1%). Highest physician-level variation was found for renal function assessment during 18 months of follow-up in patients with predisposing conditions (diabetes: ICC 0.31, rOR 26.5; cardiovascular disease: ICC 0.28, rOR 17.4; hypertension: ICC 0.24, rOR 17.2). Conclusion This study suggests potentially unwarranted variation in general practice concerning RF assessment in patients affected by conditions predisposing for CKD. We further identified potential gaps in quality of CKD monitoring as well as lower quality of CKD care for female patients and patients not affected by comorbidities.

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Section: Discussionsupporting

confidence: 87%

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

et al. 2022

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“…In a Scottish study of patients from a general population (older than or equal to 20 years), the prevalence of polypharmacy was 16.3 per cent and that of hyper-polypharmacy was 5.8 per cent 30 . Similarly, a study of general practice patients (older than or equal to 18 years) in Switzerland found that the prevalence of either polypharmacy or hyper-polypharmacy was 24 per cent 28 . Likewise, a Danish study of general practice older adults (older than or equal to 65 years) found the prevalence of polypharmacy and hyper-polypharmacy to be 29.0 and 5 per cent respectively 26 .…”

Section: Discussionmentioning

confidence: 96%

Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study

et al. 2023

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Background The aim of this study was to determine the prevalence of preoperative polypharmacy and the incidence of postoperative polypharmacy/hyper-polypharmacy in surgical patients and their association with adverse outcomes. Methods This was a retrospective, population-based cohort study among patients older than or equal to 18 years undergoing surgery at a university hospital between 2005 and 2018. Patients were categorized based on the number of medications: non-polypharmacy (fewer than 5); polypharmacy (5–9); and hyper-polypharmacy (greater than or equal to 10). The 30-day mortality, prolonged hospitalization (greater than or equal to 10 days), and incidence of readmission were compared between medication-use categories. Results Among 55 997 patients, the prevalence of preoperative polypharmacy was 32.3 per cent (95 per cent c.i. 33.5 to 34.3) and the prevalence of hyper-polypharmacy was 25.5 per cent (95 per cent c.i. 25.2 to 25.9). Thirty-day mortality was higher for patients exposed to preoperative hyper-polypharmacy (2.3 per cent) and preoperative polypharmacy (0.8 per cent) compared with those exposed to non-polypharmacy (0.6 per cent) (P < 0.001). The hazards ratio (HR) of long-term mortality was higher for patients exposed to hyper-polypharmacy (HR 1.32 (95 per cent c.i. 1.25 to 1.40)) and polypharmacy (HR 1.07 (95 per cent c.i. 1.01 to 1.14)) after adjustment for patient and procedural variables. The incidence of longer hospitalization (greater than or equal to 10 days) was higher for hyper-polypharmacy (11.3 per cent) and polypharmacy (6.3 per cent) compared with non-polypharmacy (4.1 per cent) (P < 0.001). The 30-day incidence of readmission was higher for patients exposed to hyper-polypharmacy (10.2 per cent) compared with polypharmacy (6.1 per cent) and non-polypharmacy (4.8 per cent) (P < 0.001). Among patients not exposed to polypharmacy, the incidence of new postoperative polypharmacy/hyper-polypharmacy was 33.4 per cent (95 per cent c.i. 32.8 to 34.1), and, for patients exposed to preoperative polypharmacy, the incidence of postoperative hyper-polypharmacy was 16.3 per cent (95 per cent c.i. 16.0 to 16.7). Conclusion Preoperative polypharmacy and new postoperative polypharmacy/hyper-polypharmacy are common and associated with adverse outcomes. This highlights the need for increased emphasis on optimizing medication usage throughout the perioperative interval. Registration number NCT04805151 (http://clinicaltrials.gov).

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“…The prescription rate was defined, based on [ 32 ], as the proportion of insurees who had at least one prescription dispensed in a given quarter within a specific ATC group per 1000 insurees in the same age and sex group (therefore representing an age- and sex-adjusted rate). An insuree receiving the respective medication is counted distinctly per quarter, meaning he or she is only counted once per quarter even if the prescribed medication is received several times.…”

Section: Methodsmentioning

confidence: 99%

The impact of the COVID-19 pandemic on rates of adolescents receiving psychopharmacological medication in Austria

Otter,

Kothgassner,

Lepuschütz

et al. 2024

Child Adolesc Psychiatry Ment Health

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Background The COVID-19 pandemic has impacted many aspects of everyday life, including the (mental) healthcare system. An increase in depression and anxiety symptoms has been reported worldwide, and is particularly pronounced in females and young people. We aimed to evaluate changes in prescription rates for psychopharmacological medication, which is often used to treat depression and anxiety. Method Based on data from the Austrian public health insurance institutions, we conducted an interrupted time series analysis of antidepressants and antipsychotics, comparing prescription rate developments before and throughout the COVID-19 pandemic (2013 to 2021), with a special focus on adolescents (10–19 years) in comparison to the general population. Data were based on all public prescriptions in the outpatient sector nationwide. Age- and sex-stratified time-series models were fitted to the pre-COVID period (first quarter (Q1) of 2013 to second quarter (Q2) of 2020). These were used to generate forecasts for the period from the third quarter (Q3) of 2020 to the fourth quarter (Q4) of 2021, which were subsequently compared to observed developments in order to assess significant deviations from the forecasted development paths. Results For the majority of the evaluated period, we found a significant excess of antidepressant prescriptions among both male and female adolescents (10–14 and 15–19 years) compared to the forecasted development path, while the general population was mostly within 97.5% confidence intervals of the forecasts. Regarding antipsychotics, the interrupted time series analysis revealed a significant excess in the group of female adolescents in almost all quarters, which was especially pronounced in the 15–19 age group. Prescription rates of antipsychotics in the general population only showed a significant excess in two quarters. Conclusion Increased rates of adolescents receiving psychopharmacological treatment echo the epidemiological trends of an increase in depression and anxiety symptoms reported in the literature. This increase is especially pronounced in female adolescents.

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Prescription Rates, Polypharmacy and Prescriber Variability in Swiss General Practice—A Cross-Sectional Database Study

Cited by 7 publications

References 45 publications

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study

The impact of the COVID-19 pandemic on rates of adolescents receiving psychopharmacological medication in Austria

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