Drug Prescription in Older Swiss Men and Women Followed in Family Medicine

Abstract

Background We sought to estimate the prevalence of polypharmacy, the most prevalent drug classes involved, and the prevalence and type of potentially inappropriate prescribing among older male and female patients in family medicine. Methods We conducted a secondary analysis of baseline data from a pragmatic cluster-randomised trial on the efficacy of a screening and management tool for geriatric syndromes among older community-dwelling patients (aged ≥ 75 years) included by 42 family physicians. Information on drug prescription and clinical diagnoses (International Classification of Primary Care-2nd Edition [ICPC-2] coded) were extracted manually from medical records. The prevalence of polypharmacy, defined as the use of at least five permanent oral or parenteral drugs, and of potentially inappropriate medications (PIMs), identified according to 2015 updated Beers criteria, were compared between men and women. Results We included 429 patients (269 women and 160 men; mean age 82.9 and 81.8 years, respectively). Polypharmacy was found in 59.9% of them. Analgesics, antithrombotic agents and agents acting on the renin-angiotensin system were the most frequently prescribed drug categories. Three-quarters of patients (76.7%) were prescribed at least one PIM according to Beers criteria, without difference by sex/gender (p = 0.760). The most frequent PIMs were proton-pump inhibitors used for > 8 weeks, diuretics, benzodiazepines, aspirin for primary prevention, and chronic use of non-steroidal anti-inflammatory drugs. Prescription patterns markedly differed by sex/gender, but the number and patterns of inappropriate prescriptions were comparable overall. Interpretation Both polypharmacy and PIMs were very common in older patients followed regularly in family medicine in Switzerland. Interestingly, most PIMs involved only a limited number of medication classes. Trial registration Clinicaltrials.gov NCT 02618291.

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

“…Regarding sex differences, we found a higher rate of polypharmacy in women, consistent with the literature ( Guthrie et al, 2015a ; Schnegg et al, 2020 ). The difference was more pronounced at younger ages, and interestingly, hormonal contraceptives did not relevantly contribute to the difference.…”

“…In this context, our polypharmacy prevalence of 20% in patients aged 41-64 years, consistent with findings from Scotland (Guthrie et al, 2015a), raises concerns that polypharmacy may be an important but underappreciated issue in this age group. For older patients, our findings are in line with those of two recent Swiss studies conducted in similar settings but with fewer GPs and patients (polypharmacy prevalence of 37% in a sample aged 75-80 years and of 60% in a sample aged over 75 years, respectively) (Aubert et al, 2016;Schnegg et al, 2020), as well as with general practice prescribing data from Scotland (Guthrie et al, 2015a). Moreover, two Swiss studies with a population-based sampling strategy and presumably less morbid patients than in our general practice-based study found lower polypharmacy rates compared to our results, as would be expected (Castioni et al, 2017;Schneider et al, 2019).…”

“…With regard to prescription rates of specific medication classes, we found highest rates for pain and inflammation medication, medication for cardiovascular risk management, and medications to regulate gastric acidity. These prescription rates are highly concordant with those found in similar national ( Schnegg et al, 2020 ; Muheim et al, 2021 ) and international ( Guthrie et al, 2015a ) studies.…”

“…Large primary care databases have been used before for measuring prescription rates and general practitioner (GP) variability in prescribing, but analyses have generally been limited to specific medication classes (e.g., antibiotics or opioids) ( Guthrie et al, 2015b ; Haastrup et al, 2016 ; Coyle et al, 2019 ) or populations (e.g., older patients) ( Aubert et al, 2016 ; Schnegg et al, 2020 ). Comprehensive assessments across all medication classes and patient demographics are needed to identify the specific medication classes contributing to polypharmacy and to develop targeted initiatives to improve prescribing practices.…”

Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens

“…The Beers criteria have been used by investigators from many countries, including Canada, 71 Jordan, 40 Sweden, 41 Switzerland, 72 Brazil, 39 and the USA, 73 to explore how sex and gender might influence inappropriate prescribing. Most of these studies have reported that women are more likely than men to be prescribed medications that are potentially inappropriate.…”