Geographical Variation in Medication Prescriptions: A Multiregional Drug-Utilization Study

Veronica Russo; Valentina Orlando; Valeria Marina Monetti; Federica Galimberti; Manuela Casula; Elena Olmastroni; Elena Tragni; Enrica Menditto; EDU.RE.DRUG Group

doi:10.3389/fphar.2020.00418

Geographical Variation in Medication Prescriptions: A Multiregional Drug-Utilization Study

Front Pharmacol. 2020 May 5:11:418. doi: 10.3389/fphar.2020.00418. eCollection 2020.

Authors

Veronica Russo^{1

2}, Valentina Orlando^{1

2}, Valeria Marina Monetti^{1

2}, Federica Galimberti³, Manuela Casula^{3

4}, Elena Olmastroni³, Elena Tragni³, Enrica Menditto^{1

2}; EDU.RE.DRUG Group

Affiliations

¹ Department of Pharmacy, University of Naples Federico II, Naples, Italy.
² CIRFF-Center of Pharmacoeconomics and Drug Utilization Research, University of Naples Federico II, Naples, Italy.
³ Centro Interuniversitario di Epidemiologia e Farmacologia Preventiva, Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Milan, Italy.
⁴ MultiMedica (IRCCS), Milan, Italy.

Abstract

Background: Studies have emphasized the importance of geographical factors and general practitioner (GP) characteristics in influencing drug prescriptions.

Objectives: To: (i) ascertain the prevalence rate (PR) of use of drugs in six therapeutic categories used for chronic conditions; (ii) assess how geographical characteristics and GP characteristics may influence drug prescribing.

Methods: This study is part of the EDU.RE.DRUG Project, a national collaborative project founded by Italian Medicine Agency (AIFA). Cross-sectional analyses were undertaken employing the pharmacy-claim databases of four local health units (LHUs) located in two Italian regions: Lombardy and Campania. Six drug categories were evaluated: proton-pump inhibitors; antibiotics; respiratory-system drugs; statins; agents acting on the renin-angiotensin system; psychoanaleptic drugs. The PR was estimated according to drug categories at the LHU level. A linear multivariate regression analysis was undertaken to evaluate the association between the PR and geographical area, age and sex of GPs, number of patients, and percentage of patients aged >65 per GP.

Results: LHUs in Campania showed a PR that was significantly higher than that in Lombardy. Antibiotics showed the highest PR in all the LHUs assessed, ranging from 32.5% in Lecco (Lombardy) to 59.7% in Naples-2 (Campania). Multivariate linear regression analysis confirmed the association of the PR with geographical area for all drug categories. Being located in Campania increased the possibility of receiving a drug prescription from the categories considered, with estimates more marked for antibiotics, proton-pump-inhibitors, and respiratory-system drugs.

Conclusions: This study provides information about the PR of medications used for treating common and costly conditions in Italy and highlighted a significant geographical variation. These insights could help to develop area-specific strategies to optimize prescribing behavior.

Keywords: drug use; drug-utilization; general practitioner; geographical difference; pharmacy claims; prevalence.