Profile, cost and pattern of prescriptions for polymedicated patients in Catalonia, Spain

Abstract

ObjectivesPolypharmacy is one of the main management issues in public health policies because of its financial impact and the increasing number of people involved. The polymedicated population according to their demographic and therapeutic profile and the cost for the public healthcare system were characterised.DesignCross-sectional study.SettingPrimary healthcare in Barcelona Health Region, Catalonia, Spain (5 105 551 inhabitants registered).ParticipantsAll insured polymedicated patients. Polymedicated patients were those with a consumption of ≥16 drugs/month.Main outcomes measuresThe study variables were related to age, gender and medication intake obtained from the 2008 census and records of prescriptions dispensed in pharmacies and charged to the public health system.ResultsThere were 36 880 polymedicated patients (women: 64.2%; average age: 74.5±10.9 years). The total number of prescriptions billed in 2008 was 2 266 830 (2 272 920 total package units). The most polymedicated group (up to 40% of the total prescriptions) was patients between 75 and 84 years old. The average number of prescriptions billed monthly per patient was 32±2, with an average cost of €452.7±27.5. The total cost of those prescriptions corresponded to 2% of the drug expenditure in Catalonia. The groups N, C, A, R and M represented 71.4% of the total number of drug package units dispensed to polymedicated patients. Great variability was found between the medication profiles of men and women, and between age groups; greater discrepancies were found in paediatric patients (5–14 years) and the elderly (≥65 years).ConclusionsThis study provides essential information to take steps towards rational drug use and a structured approach in the polymedicated population in primary healthcare.

A cross-sectional evaluation of the prevalence and detection of predictors of polypharmacy amongst adult in Spain

“…In our study, participants treated with antidepressant medication were at greater risk for polypharmacy (OR 9.07; 95% CI 8.94 to 11.02); similar conclusions have also been found by other studies . It would appear that particularly in women, antidepressants, hypnotics, sedatives and anxiolytics may be typical indicators for polypharmacy .…”

“…Several studies have shown that an increase in age correlates positively with the total number of medicines being taken, hence the occurrence of polypharmacy. Evidence showing that women of advanced age tend to be on a polypharmacy regime is solid . Conversely, few studies have reported a correlation between polypharmacy and being male .…”

“…It has been estimated that between 4 and 34% of individuals aged 65 years or more are on polypharmacy regimes . Polypharmacy has been associated with sociodemographic factors (age, gender, education, employment and socio‐economic status), influence of disease (multimorbidity, poor self‐reported health status and chronic illness) and health system factors (number of prescribers, perceived patient pressure or publically funded health care) . Several strategies promoted by community pharmacists have shown a reduction in the level of non‐adherence in patients on a polypharmacy regime and have been able to identify several drug‐related problems in older patients on a polypharmacy regime …”

“…[4] Polypharmacy has been associated with sociodemographic factors (age, gender, education, employment and socio-economic status), [2,[9][10][11] influence of disease (multimorbidity, poor self-reported health status and chronic illness) and health system factors (number of prescribers, perceived patient pressure or publically funded health care). [4,7,[11][12][13] Several strategies promoted by community pharmacists have shown a reduction in the level of non-adherence in patients on a polypharmacy regime [14] and have been able to identify several drug-related problems in older patients on a polypharmacy regime. [15] Although polypharmacy has been studied especially in older people as ageing implies greater morbidity, often resulting in the use of many different medicines, there are few studies in other age groups.…”

Evaluation of electronic prescription implementation in polymedicated users of Catalonia, Spain: a population-based longitudinal study

“…1 17 A polymedicated user in the present study was defined as someone receiving 16 or more drugs in a month, according to the Efficiency Indicators in Primary Care, which are periodically evaluated by an internal Management Committee in the Catalan Health Service (macromanagement level). 18 …”