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. 2022 Feb 14:13:832994.
doi: 10.3389/fphar.2022.832994. eCollection 2022.

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

Yael Rachamin  1 , Levy Jäger  1 , Rahel Meier  1 , Thomas Grischott  1 , Oliver Senn  1 , Jakob M Burgstaller  1 , Stefan Markun  1
Affiliations

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

Yael Rachamin et al. Front Pharmacol. .

Abstract

Purpose: The frequency of medication prescribing and polypharmacy has increased in recent years in different settings, including Swiss general practice. We aimed to describe patient age- and sex-specific rates of polypharmacy and of prescriptions of the most frequent medication classes, and to explore practitioner variability in prescribing. Methods: Retrospective cross-sectional study based on anonymized electronic medical records data of 111 811 adult patients presenting to 116 Swiss general practitioners in 2019. We used mixed-effects regression analyses to assess the association of patient age and sex with polypharmacy (≥5 medications) and with the prescription of specific medication classes (second level of the Anatomical Therapeutic Chemical Classification System). Practitioner variability was quantified in terms of the random effects distributions. Results: The prevalence of polypharmacy increased with age from 6.4% among patients aged 18-40 years to 19.7% (41-64 years), 45.3% (65-80 years), and 64.6% (81-92 years), and was higher in women than in men, particularly at younger ages. The most frequently prescribed medication classes were antiinflammatory and antirheumatic products (21.6% of patients), agents acting on the renin-angiotensin system (19.9%), analgesics (18.7%), and drugs for acid related disorders (18.3%). Men were more often prescribed agents targeting the cardiovascular system, whereas most other medications were more often prescribed to women. The highest practitioner variabilities were observed for vitamins, for antiinflammatory and antirheumatic products, and for mineral supplements. Conclusion: Based on practitioner variability, prevalence, and risk potential, antiinflammatory drugs and polypharmacy in older patients appear to be the most pressing issues in current drug prescribing routines.

Keywords: Switzerland; clinical practice variation; demographic aging; drug prescriptions; polypharmacy; primary care; sex differences.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Proportion of patients with the specified number of medications, depending on age. Each shaded region represents the overall percentage of patients with the respective number of medications.
FIGURE 2
FIGURE 2
Age-dependent polypharmacy rates, by sex. The dotted line represents the proportion of female patients with polypharmacy if hormonal contraceptives for systemic use are excluded.
FIGURE 3
FIGURE 3
Age-dependent prescription rates of different medication classes, by sex. The 20 most common medication classes (second level of the anatomical therapeutic chemical classification system) are displayed, ordered by decreasing overall prescription rate.
FIGURE 4
FIGURE 4
Practitioner variability in medication class prescribing (GPs: n = 100). Boxplots of the crude among-GP distributions of prescription rates, and the unexplained variability in terms of ORlib/cons, for the 20 most common medication classes (second level of the anatomical therapeutic chemical classification system) ordered by overall prescription rate. Prescription rates were calculated for each GP as the percentage of their patients who had a prescription within the respective medication class; ORlib/cons represents the OR between a liberal prescriber (95th percentile of the random effects distribution) and a conservative prescriber (5th percentile). Abbreviations: GP, general practitioner; OR, odds ratio.
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