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Starting Two or More Drugs Concurrently in Primary Care: How Often Is It Done, How Often Is It Needed?
Tewodros Eguale1,2, Maria Mirica2, Alejandra Salazar2
1Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA.
Journal of General Internal Medicine
|March 28, 2025
Summary
Primary care physicians often start multiple new medications simultaneously, frequently without strong evidence. This practice varies significantly among doctors and healthcare sites, indicating potential safety improvement opportunities.
Area of Science:
- Pharmacology and Therapeutics
- Primary Care Medicine
- Health Services Research
Background:
- Growing emphasis on conservative prescribing principles.
- Limited understanding of concurrent new medication initiation by primary care physicians (PCPs).
- Need to identify when starting multiple medications concurrently is necessary.
Purpose of the Study:
- Quantify the frequency of PCPs initiating multiple new prescriptions concurrently.
- Assess the evidence supporting the necessity of concurrent multi-drug initiation.
- Describe variability in concurrent prescribing practices among PCPs and clinical sites.
Main Methods:
- Retrospective cohort study design.
- Analysis of prescriptions written by PCPs across four clinical sites.
- Data collected from January 2017 to December 2018.
Main Results:
- Nearly half a million prescriptions analyzed, with significant variation in concurrent new drug starts across sites (14.0% to 27.2%).
- Wide inter-physician variability in prescribing multiple new medications within each site.
- Minimal concurrent prescribing (0.6%) supported by strong evidence; most lacked simultaneous initiation evidence or posed potential risks.
Conclusions:
- PCPs frequently initiate multiple new medications concurrently, often without robust evidence.
- Significant variations in prescribing practices exist across individual physicians and institutions.
- Findings suggest opportunities to enhance prescribing safety by addressing concurrent medication initiation patterns.
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