The prevalence of polypharmacy in older Europeans: a multi-national database study of general practitioner prescribing

Marion Bennie, Yared Santa-Ana-Tellez, Githa Fungie Galistiani, Julien Trehony, Johanna Despres, Laurence Sophie Jouaville, Elisabetta Poluzzi, Lucas Morin, Ingrid Schubert, Seán MacBride-Stewart, Monique Elseviers, Paola Nasuti, Katja Taxis

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Abstract

Aims: The aims of this study were to measure the prevalence of polypharmacy and describe the prescribing of selected medications known for overuse in older people with polypharmacy in primary care. Methods: This was a multinational retrospective cohort study across six countries: Belgium, France, Germany, Italy, Spain and the UK. We used anonymized longitudinal patient‐level information from general practice databases hosted by IQVIA. Patients ≥65 years were included. Polypharmacy was defined as having 5–9 and ≥10 distinct drug classes (ATC Level 3) prescribed during a 6‐month period. Selected medications were: opioids, antipsychotics, proton pump inhibitors (PPI), benzodiazepines (ATC Level 5). We included country experts on the healthcare context to interpret findings. Results: Age and gender distribution was similar across the six countries (mean age 75–76 years; 54–56% female). The prevalence of polypharmacy of 5–9 drugs was 22.8% (UK) to 58.3% (Germany); ≥10 drugs from 11.3% (UK) to 28.5% (Germany). In the polypharmacy population prescribed ≥5 drugs, opioid prescribing ranged from 11.5% (France) to 27.5% (Spain). Prescribing of PPI was highest with almost half of patients receiving a PPI, 42.3% (Germany) to 65.5% (Spain). Benzodiazepine prescribing showed a marked variation between countries, 2.7% (UK) to 34.9% (Spain). The healthcare context information explained possible underreporting for selected medications. Conclusions: We have found a high prevalence of polypharmacy with more than half of the older population being prescribed ≥5 drugs in four of the six countries. Whilst polypharmacy may be appropriate in many patients, worryingly high usage of PPIs and benzodiazepines supports current efforts to improve polypharmacy management across Europe.
Original languageEnglish
Pages (from-to)2124-2136
Number of pages13
JournalBritish Journal of Clinical Pharmacology
Volume90
Issue number9
Early online date29 May 2024
DOIs
Publication statusPublished - 1 Sept 2024

Keywords

  • polypharmacy
  • potentially inappropriate medication
  • cross national comparison
  • elderly
  • primary

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