Drug Treatment in Older People before and after the Transition to a Multi-Dose Drug Dispensing System–A Longitudinal Analysis

Abstract

BackgroundAn association has been found between multi-dose drug dispensing (MDD) and use of many drugs. The aim of this study was to investigate the nature of this association, by performing a longitudinal analysis of the drug treatment before and after the transition to MDD.MethodsInclusion critera in this register-based study were inhabitants in Region Västra Götaland, Sweden, who, at ≥65 years of age and between 1st July 2006 and 30th June 2010, filled their first MDD prescription. For each individual, prescribed drugs were estimated at three month intervals before and after (maximum 3 years, respectively) the first date of filling an MDD prescription (index date).ResultsA total of 30,922 individuals matched the inclusion criteria (mean age: 83.2 years; 59.9% female). There was a temporal association between the transition to MDD and an increased number of drugs: 5.4±3.9 and 7.5±3.8 unique drugs three months before and after the index date, respectively, as well as worse outcomes on several indicators of prescribing quality. When either data before or after the index date were used, a multi-level regression analysis predicted the number of drugs at the index date at 5.76 (95% confidence limits: 5.71; 5.80) and 7.15 (7.10; 7.19), respectively, for an average female individual (83.2 years, 10.8 unique diagnoses, 2.4 healthcare contacts/three months). The predicted change in the number of drugs, from three months before the index date to the index date, was greater when data before this date was used as compared with data after this date: 0.12 (0.09; 0.14) versus 0.02 (−0.01; 0.05).ConclusionsAfter the patients entered the MDD system, they had an increased number of drugs, more often potentially harmful drug treatment, and fewer changes in drug treatment. These findings support a causal relationship between such a system and safety concerns as regards prescribing practices.

Long‐term use of proton pump inhibitors and prevalence of disease‐ and drug‐related reasons for gastroprotection—a cross‐sectional population‐based study

“…Logistic regression was performed to obtain odds ratios and 95% confidence intervals (CI) for long‐term use of PPI according to disease‐ and/or drug‐related reasons for gastroprotection. Adjustments were made for age, sex, number of drugs (a proxy for burden of disease), residence (defined as nursing home or not), and multi‐dose drug dispensing (a system which has been associated with an extensive medication list and poor quality of drug treatment) . To identify predictors of long‐term use of PPI in individuals without a reason for treatment, logistic regression with and without adjustments was performed in this subgroup.…”

Potential drug-related problems detected by electronic expert support system: physicians’ views on clinical relevance

“…Multi-dose drug dispensing (MDDD) is a service in which patients receive their medication packed in bags with one unit for each dose occasion [30][31][32][33]. Patients with MDDD are often of high age, have several diseases and many different medications.…”

“…Patients with MDDD are often of high age, have several diseases and many different medications. In this population, there is a high prevalence of potential DRPs [28,31,32]. In Sweden, almost all prescriptions for MDDD patients are sent electronically and are stored in an e-prescription repository.…”

Do multidose compliance aids do more harm than good?

“…3,4 The same researchers reported that MCAs are associated with increased prescribing, more potentially harmful treatment, more suboptimal treatment and fewer treatment changes in both cross-sectional and longitudinal studies. 5,6 The Aberdeen study is, however, the first to describe such a high level of potentially significant drug interactions -something the authors attribute to a greater prevalence of psychotropic drug use. However, they suggest the higher use of psychotropic drugs by under-65s and 65 to 79-year-olds compared with older people may be due to a healthy survivor effect in those over 80 years old.…”