Global under- and overprescribing of drugs-a scoping review

Inappropriate prescribing of drugs is a persistent issue with serious consequences for both patients and healthcare systems. This scoping review summarizes and assesses literature about over- and underprescribing of prescription drugs across various conditions. It outlines different levels of prescribing and associated factors, presenting a model to distinguish influencing factors across healthcare systems. Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline, a PubMed and EMBASE search was conducted using the terms "overuse AND underuse AND (drug OR medication)". In cardiovascular treatment, a mixed situation is observed, with underprescription in high-risk patients and overprescription in low-risk groups. In pulmonary diseases such as asthma and chronic obstructive pulmonary disease, short-acting β₂-agonists are overprescribed, while long-acting muscarinic antagonists are underprescribed. In infectious diseases, antibacterial drugs are overprescribed, whereas vaccines, antivirals, antituberculosis and antiparasitic drugs are underprescribed. Analgesic drugs in migraine prophylaxis and µ-opioid receptor agonists (so-called "opioids") in chronic pain are underprescribed. Over- and underprescribing of drugs is common and influenced by individual and systemic factors. Distinguishing between these levels is important, as patterns of over- and undertreatment vary by condition and patient group. Structural factors are particularly relevant, as the healthcare system provides the framework for individualized and condition-specific treatment.