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

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

doi:10.3389/fphar.2022.832994

Cited by 7 publications

(4 citation statements)

References 45 publications

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“…The best-met of all QIs involved withholding NSAIDs to CKD patients and showed an achievement rate over 80%. This proportion aligns with the recently determined yearly prescription rates of NSAIDs in the Swiss general practice population of the same age range [ 42 ]. Whether GPs take presence of CKD into account when prescribing NSAIDs therefore remains undetermined.…”

Section: Discussionsupporting

confidence: 87%

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

et al. 2022

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Background Chronic kidney disease (CKD) is a common condition in general practice. Data about quality and physician-level variation of CKD care provided by general practitioners is scarce. In this study, we evaluated determinants and variation of achievement of 14 quality indicators for CKD care using electronic medical records data from Swiss general practice during 2013–2019. Methods We defined two patient cohorts from 483 general practitioners, one to address renal function assessment in patients with predisposing conditions (n = 47,201, median age 68 years, 48.7% female) and one to address care of patients with laboratory-confirmed CKD (n = 14,654, median age 80 years, 57.5% female). We investigated quality indicator achievement with mixed-effect logistic regression and expressed physician-level variation as intraclass correlation coefficients (ICCs) and range odds ratios (rORs). Results We observed the highest quality indicator achievement rate for withholding non-steroidal anti-inflammatory drug prescription in patients with CKD staged G2–3b within 12 months of follow-up (82.6%), the lowest for albuminuria assessment within 18 months of follow-up (18.1%). Highest physician-level variation was found for renal function assessment during 18 months of follow-up in patients with predisposing conditions (diabetes: ICC 0.31, rOR 26.5; cardiovascular disease: ICC 0.28, rOR 17.4; hypertension: ICC 0.24, rOR 17.2). Conclusion This study suggests potentially unwarranted variation in general practice concerning RF assessment in patients affected by conditions predisposing for CKD. We further identified potential gaps in quality of CKD monitoring as well as lower quality of CKD care for female patients and patients not affected by comorbidities.

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Section: Discussionsupporting

confidence: 87%

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

et al. 2022

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“…In a Scottish study of patients from a general population (older than or equal to 20 years), the prevalence of polypharmacy was 16.3 per cent and that of hyper-polypharmacy was 5.8 per cent 30 . Similarly, a study of general practice patients (older than or equal to 18 years) in Switzerland found that the prevalence of either polypharmacy or hyper-polypharmacy was 24 per cent 28 . Likewise, a Danish study of general practice older adults (older than or equal to 65 years) found the prevalence of polypharmacy and hyper-polypharmacy to be 29.0 and 5 per cent respectively 26 .…”

Section: Discussionmentioning

confidence: 96%

Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study

et al. 2023

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Background The aim of this study was to determine the prevalence of preoperative polypharmacy and the incidence of postoperative polypharmacy/hyper-polypharmacy in surgical patients and their association with adverse outcomes. Methods This was a retrospective, population-based cohort study among patients older than or equal to 18 years undergoing surgery at a university hospital between 2005 and 2018. Patients were categorized based on the number of medications: non-polypharmacy (fewer than 5); polypharmacy (5–9); and hyper-polypharmacy (greater than or equal to 10). The 30-day mortality, prolonged hospitalization (greater than or equal to 10 days), and incidence of readmission were compared between medication-use categories. Results Among 55 997 patients, the prevalence of preoperative polypharmacy was 32.3 per cent (95 per cent c.i. 33.5 to 34.3) and the prevalence of hyper-polypharmacy was 25.5 per cent (95 per cent c.i. 25.2 to 25.9). Thirty-day mortality was higher for patients exposed to preoperative hyper-polypharmacy (2.3 per cent) and preoperative polypharmacy (0.8 per cent) compared with those exposed to non-polypharmacy (0.6 per cent) (P < 0.001). The hazards ratio (HR) of long-term mortality was higher for patients exposed to hyper-polypharmacy (HR 1.32 (95 per cent c.i. 1.25 to 1.40)) and polypharmacy (HR 1.07 (95 per cent c.i. 1.01 to 1.14)) after adjustment for patient and procedural variables. The incidence of longer hospitalization (greater than or equal to 10 days) was higher for hyper-polypharmacy (11.3 per cent) and polypharmacy (6.3 per cent) compared with non-polypharmacy (4.1 per cent) (P < 0.001). The 30-day incidence of readmission was higher for patients exposed to hyper-polypharmacy (10.2 per cent) compared with polypharmacy (6.1 per cent) and non-polypharmacy (4.8 per cent) (P < 0.001). Among patients not exposed to polypharmacy, the incidence of new postoperative polypharmacy/hyper-polypharmacy was 33.4 per cent (95 per cent c.i. 32.8 to 34.1), and, for patients exposed to preoperative polypharmacy, the incidence of postoperative hyper-polypharmacy was 16.3 per cent (95 per cent c.i. 16.0 to 16.7). Conclusion Preoperative polypharmacy and new postoperative polypharmacy/hyper-polypharmacy are common and associated with adverse outcomes. This highlights the need for increased emphasis on optimizing medication usage throughout the perioperative interval. Registration number NCT04805151 (http://clinicaltrials.gov).

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“…In this context, the EMR-C MED may act as a moderator, provided that there is less dispersion among general practitioners in drug prescribing than in other activities reflected in EMR-Cs. This might not be the case for the prescription of pain medication or proton pump inhibitors, which are themselves subject to significant between-general practitioner variation in Switzerland [71][72]. Therefore, prevalence estimates of chronic pain and acidity-related stomach problems as measured in our study may have suffered from this source of bias.…”

Section: Original Articlementioning

confidence: 81%

Importance of different electronic medical record components for chronic disease identification in a Swiss primary care database: a cross-sectional study

Meier,

Grischott,

Rachamin

et al. 2023

Swiss Med Wkly

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BACKGROUND: Primary care databases collect electronic medical records with routine data from primary care patients. The identification of chronic diseases in primary care databases often integrates information from various electronic medical record components (EMR-Cs) used by primary care providers. This study aimed to estimate the prevalence of selected chronic conditions using a large Swiss primary care database and to examine the importance of different EMR-Cs for case identification. METHODS: Cross-sectional study with 120,608 patients of 128 general practitioners in the Swiss FIRE (“Family Medicine Research using Electronic Medical Records”) primary care database in 2019. Sufficient criteria on three individual EMR-Cs, namely medication, clinical or laboratory parameters and reasons for encounters, were combined by logical disjunction into definitions of 49 chronic conditions; then prevalence estimates and measures of importance of the individual EMR-Cs for case identification were calculated. RESULTS: A total of 185,535 cases (i.e. patients with a specific chronic condition) were identified. Prevalence estimates were 27.5% (95% CI: 27.3–27.8%) for hypertension, 13.5% (13.3–13.7%) for dyslipidaemia and 6.6% (6.4–6.7%) for diabetes mellitus. Of all cases, 87.1% (87.0–87.3%) were identified via medication, 22.1% (21.9–22.3%) via clinical or laboratory parameters and 19.3% (19.1–19.5%) via reasons for encounters. The majority (65.4%) of cases were identifiable solely through medication. Of the two other EMR-Cs, clinical or laboratory parameters was most important for identifying cases of chronic kidney disease, anorexia/bulimia nervosa and obesity whereas reasons for encounters was crucial for identifying many low-prevalence diseases as well as cancer, heart disease and osteoarthritis. CONCLUSIONS: The EMR-C medication was most important for chronic disease identification overall, but identification varied strongly by disease. The analysis of the importance of different EMR-Cs for estimating prevalence revealed strengths and weaknesses of the disease definitions used within the FIRE primary care database. Although prioritising specificity over sensitivity in the EMR-C criteria may have led to underestimation of most prevalences, their sex- and age-specific patterns were consistent with published figures for Swiss general practice.

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

Cited by 7 publications

References 45 publications

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

Quality and variation of care for chronic kidney disease in Swiss general practice: A retrospective database study

Epidemiology and association with outcomes of polypharmacy in patients undergoing surgery: retrospective, population-based cohort study

Importance of different electronic medical record components for chronic disease identification in a Swiss primary care database: a cross-sectional study

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