Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study

Abstract

ObjectivesTo examine: (1) changes in polypharmacy in 1997, 2002, 2007 and 2012 and; (2) changes in potentially inappropriate prescribing (PIP) prevalence and the relationship between PIP and polypharmacy in individuals aged ≥65 years over this period in Ireland.MethodsThis repeated cross-sectional study using pharmacy claims data included all individuals eligible for the General Medical Services scheme in the former Eastern Health Board region of Ireland in 1997, 2002, 2007 and 2012 (range 338 025–539 752 individuals). Outcomes evaluated were prevalence of polypharmacy (being prescribed ≥5 regular medicines) and excessive polypharmacy (≥10 regular medicines) in all individuals and PIP prevalence in those aged ≥65 years determined by 30 criteria from the Screening Tool for Older Persons’ Prescriptions.ResultsThe prevalence of polypharmacy increased from 1997 to 2012, particularly among older individuals (from 17.8% to 60.4% in those aged ≥65 years). The adjusted incident rate ratio for polypharmacy in 2012 compared to 1997 was 4.16 (95% CI 3.23 to 5.36), and for excessive polypharmacy it was 10.53 (8.58 to 12.91). Prevalence of PIP rose from 32.6% in 1997 to 37.3% in 2012. High-dose aspirin and digoxin prescribing decreased over time, but long-term proton pump inhibitors at maximal dose increased substantially (from 0.8% to 23.8%). The odds of having any PIP in 2012 were lower compared to 1997 after controlling for gender and level of polypharmacy, OR 0.39 (95% CI 0.39 to 0.4).ConclusionsAccounting for the marked increase in polypharmacy, prescribing quality appears to have improved with a reduction in the odds of having PIP from 1997 to 2012. With growing numbers of people taking multiple regular medicines, strategies to address the related challenges of polypharmacy and PIP are needed.

Assessing Potentially Inappropriate Prescribing in Community-Dwelling Older Patients Using the Updated Version of STOPP-START Criteria: A Comparison of Profiles and Prevalences with Respect to the Original Version

“…The decrease in the prevalence of long-term use of NSAIDs may be due to recent notices published on its cardiovascular safety. This fact also evidences that the pattern of PIMs evolves over time, as shown in studies on trends in prescribing habits [22]. …”

Determinants of change in polypharmacy status in Switzerland: the population-based CoLaus study

“…Importantly, this increase in hypolipidemic drugs is lower than the increase in dyslipidaemia prevalence. [15] Nevertheless, this doubling of hypolipidemic drugs between baseline and follow-up, with one-fifth of participants taking them, is in line with a study conducted in Ireland [1] and also with a wider acceptance of preventive medication for the general population. [16] Contrary to United States, there is no consensus regarding guidelines for cardiovascular prevention In Switzerland.…”

“…[1] Subsequently, prevalence of polypharmacy, referred as the simultaneous intake of five or more medications, has been increasing [2] not only among the elderly but also in other ages. [3] Polypharmacy is driven by the increase in age and multimorbidity.…”

Deprescribing: a primary care perspective

“…People in the care home setting are also likely to be at a point where deprescribing is indicated. Nevertheless, deprescribing is relevant in other clinical situations as well, particularly given that over a third of older general practice patients experience inappropriate prescribing 34. Objective measures of inappropriate prescribing (eg, Beers' criteria35 and the STOPP/START criteria36) are a key primary care patient safety tool,37 and thus an important potential means of identifying individuals in whom deprescribing may be of value.…”