Nationwide Long-Term Evaluation of Polypharmacy Reduction Policies Focusing on Older Adults in Japan

Abstract

Polypharmacy is a serious health issue for older adults worldwide, including in Japan, which has a rapidly aging society. The “Proper Medication Guideline for Older Adults” was published for healthcare providers in May 2018, and polypharmacy reduction incentives were initiated for medical facilities in April 2016 and April 2018. This study identified the long-term reduction in polypharmacy prescriptions focusing on older adults aged 75 years and above from April 2015 to March 2019. The national health insurance claims database, which covers most reimbursement claims in Japan, was selected as the primary data source. In this study, polypharmacy was defined as the simultaneous prescription of seven or more medications or multi-psychotropic medications. The primary outcome was the polypharmacy reduction ratio, which indicates the decrease in polypharmacy proportion based on the number of medications on an outpatient prescription. A total polypharmacy reduction of 19.3% for the “75–89 years” subgroup and 16.5% for the “90 years and above” subgroup was observed over four years. Based on prefecture analysis, the mean values of polypharmacy proportion showed a statistically significant reduction over four years. This study showed a successful nationwide reduction in polypharmacy prescriptions after implementing the polypharmacy management guidelines for older adults and incentive-based policies.

Prevalence of urgent hospitalizations caused by adverse drug reactions: a cross-sectional study

“…In Japan, the “Proper Medication Guideline for Older Adults” was published for healthcare providers in May 2018 20 , and polypharmacy reduction incentives were initiated in 2016 21 and 2018 22 . A recent study reported that the prevalence of polypharmacy among elderly individuals subsequently decreased in Japan 23 . Therefore, it is possible that the national strategy for polypharmacy among elderly patients in Japan might have reduced hospital admissions due to ADRs.…”