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Inter‐practice variation in polypharmacy prevalence amongst older patients in primary care
Author(s) -
Sinnige Judith,
Braspenning Jozé C.,
Schellevis François G.,
Hek Karin,
Stirbu Irina,
Westert Gert P.,
Korevaar Joke C.
Publication year - 2016
Publication title -
pharmacoepidemiology and drug safety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.023
H-Index - 96
eISSN - 1099-1557
pISSN - 1053-8569
DOI - 10.1002/pds.4016
Subject(s) - polypharmacy , medicine , socioeconomic status , logistic regression , medication therapy management , cohort , variation (astronomy) , primary care , family medicine , population , demography , pediatrics , environmental health , intensive care medicine , physics , pharmacist , sociology , astrophysics , pharmacy
Purpose Complex medication management in older people with multiple chronic conditions can introduce practice variation in polypharmacy prevalence. This study aimed to determine the inter‐practice variation in polypharmacy prevalence and examine how this variation was influenced by patient and practice characteristics. Methods This cohort study included 45,731 patients aged 55 years and older with at least one prescribed medication from 126 general practices that participated in NIVEL Primary Care Database in the Netherlands. Medication dispensing data of the year 2012 were used to determine polypharmacy. Polypharmacy was defined as the chronic and simultaneous use of at least five different medications. Multilevel logistic regression models were constructed to quantify the polypharmacy prevalence variation between practices. Patient characteristics (age, gender, socioeconomic status, number, and type of chronic conditions) and practice characteristics (practice location and practice population) were added to the models. Results After accounting for differences in patient and practice characteristics, polypharmacy rates varied with a factor of 2.4 between practices (from 12.4% to 30.1%) and an overall mean of 19.8%. Age and type of conditions were highly positively associated with polypharmacy, and to a lesser extent a lower socioeconomic status. Conclusions Considerable variation in polypharmacy rates existed between general practices, even after accounting for patient and practice characteristics, which suggests that there is not much agreement concerning medication management in this complex patient group. Initiatives that could reduce inappropriate heterogeneity in medication management can add value to the care delivered to these patients. Copyright © 2016 John Wiley & Sons, Ltd.