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Polypharmacy in primary care practices: an analysis using a large health insurance database
Thomas Grimmsmann1, Wolfgang Himmel
1Medical Review Board of the Statutory Health Insurance Funds Mecklenburg-Vorpommern, Schwerin, Germany.
Pharmacoepidemiology and Drug Safety
|October 2, 2009
Summary
Approximately 10% of patients on continuous medication in German general practices experience polypharmacy. Differences in patient demographics and prescribing habits do not fully explain variations in polypharmacy rates between practices.
Area of Science:
- Geriatric Medicine
- General Practice
- Health Services Research
Background:
- Polypharmacy, defined as the continuous prescription of five or more drugs, is a growing concern in primary care.
- Understanding the prevalence and practice-level variations of polypharmacy is crucial for optimizing patient care.
Purpose of the Study:
- To determine the rate and range of continuous polypharmacy in German general practices.
- To compare practice characteristics and prescribing profiles between practices with high (HPP) and low (LPP) rates of polypharmacy patients.
Main Methods:
- An observational study utilizing prescription data from a large German statutory health insurance database.
- Polypharmacy patients were identified as those continuously receiving five or more different drugs.
- Practices were categorized as HPP or LPP based on the percentage of polypharmacy patients.
Main Results:
- Out of 136,521 patients on continuous medication, 10% (14,293) had polypharmacy.
- HPP had 15.1% polypharmacy patients compared to 4.2% in LPP.
- While patient numbers were similar, HPP had a higher proportion of patients with prescriptions (76.9% vs. 70.8%). Doctors in HPP more frequently prescribed proton pump inhibitors and NSAIDs.
Conclusions:
- Modest differences in age and gender distribution were observed between HPP and LPP.
- Prescribing quality, indicated by me-too drug rates, was similar across practices.
- Factors beyond patient demographics and prescribing habits likely explain variations in polypharmacy rates.
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