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Legacy Drug-Prescribing Patterns in Primary Care.

Dee Mangin1,2, Jennifer Lawson3, Jessica Cuppage4

  • 1Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada mangind@mcmaster.ca.

Annals of Family Medicine
|November 14, 2018
PubMed
Summary

Legacy prescribing, the continuation of intermediate-term medications, is common in primary care. This practice, particularly with antidepressants and proton pump inhibitors (PPIs), contributes to unnecessary polypharmacy and warrants intervention.

Keywords:
antidepressive agentsbisphosphonateselectronic health recordsfamily practicehealth services researchinappropriate prescribingpolypharmacypotentially inappropriate medication listpractice-based researchprimary health careproton pump inhibitors

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Area of Science:

  • Primary Care Medicine
  • Clinical Pharmacology
  • Health Services Research

Background:

  • Polypharmacy presents a significant challenge in primary care settings.
  • Intermediate-term medications, if not discontinued appropriately, can lead to prolonged use and contribute to polypharmacy.
  • This phenomenon of continued intermediate-term prescribing has been termed 'legacy prescribing'.

Purpose of the Study:

  • To evaluate the prevalence of legacy prescribing for commonly prescribed medications.
  • To identify the proportion of legacy prescribing within specific drug classes: antidepressants, bisphosphonates, and proton pump inhibitors (PPIs).

Main Methods:

  • A population-based retrospective cohort study was conducted using prospectively collected data.
  • Data from the McMaster University Sentinel and Information Collaboration (MUSIC) Primary Care Practice Based Research Network (2010-2016) were analyzed.
  • Legacy prescribing rates were calculated for antidepressants (>15 months), bisphosphonates (>5.5 years), and PPIs (>15 months) in adult patients (N=50,813).

Main Results:

  • Legacy prescribing was observed in a substantial proportion of patients: 46% for antidepressants, 14% for bisphosphonates, and 45% for PPIs.
  • Many patients maintained current legacy prescriptions, with significantly longer mean prescription durations compared to non-legacy prescriptions (P <.001).
  • Concurrent legacy prescriptions for antidepressants and PPIs were common, suggesting potential prescribing cascades.

Conclusions:

  • Legacy prescribing is a prevalent issue in primary care.
  • This practice significantly contributes to unnecessary polypharmacy.
  • System-level interventions in primary care are needed to address legacy prescribing and improve patient outcomes.