Prescription Rates, Polypharmacy and Prescriber Variability in Swiss General Practice-A Cross-Sectional Database Study

Yael Rachamin; Levy Jäger; Rahel Meier; Thomas Grischott; Oliver Senn; Jakob M Burgstaller; Stefan Markun

doi:10.3389/fphar.2022.832994

Prescription Rates, Polypharmacy and Prescriber Variability in Swiss General Practice-A Cross-Sectional Database Study

Front Pharmacol. 2022 Feb 14:13:832994. doi: 10.3389/fphar.2022.832994. eCollection 2022.

Authors

Yael Rachamin¹, Levy Jäger¹, Rahel Meier¹, Thomas Grischott¹, Oliver Senn¹, Jakob M Burgstaller¹, Stefan Markun¹

Affiliation

¹ Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland.

Abstract

Purpose: The frequency of medication prescribing and polypharmacy has increased in recent years in different settings, including Swiss general practice. We aimed to describe patient age- and sex-specific rates of polypharmacy and of prescriptions of the most frequent medication classes, and to explore practitioner variability in prescribing. Methods: Retrospective cross-sectional study based on anonymized electronic medical records data of 111 811 adult patients presenting to 116 Swiss general practitioners in 2019. We used mixed-effects regression analyses to assess the association of patient age and sex with polypharmacy (≥5 medications) and with the prescription of specific medication classes (second level of the Anatomical Therapeutic Chemical Classification System). Practitioner variability was quantified in terms of the random effects distributions. Results: The prevalence of polypharmacy increased with age from 6.4% among patients aged 18-40 years to 19.7% (41-64 years), 45.3% (65-80 years), and 64.6% (81-92 years), and was higher in women than in men, particularly at younger ages. The most frequently prescribed medication classes were antiinflammatory and antirheumatic products (21.6% of patients), agents acting on the renin-angiotensin system (19.9%), analgesics (18.7%), and drugs for acid related disorders (18.3%). Men were more often prescribed agents targeting the cardiovascular system, whereas most other medications were more often prescribed to women. The highest practitioner variabilities were observed for vitamins, for antiinflammatory and antirheumatic products, and for mineral supplements. Conclusion: Based on practitioner variability, prevalence, and risk potential, antiinflammatory drugs and polypharmacy in older patients appear to be the most pressing issues in current drug prescribing routines.

Keywords: Switzerland; clinical practice variation; demographic aging; drug prescriptions; polypharmacy; primary care; sex differences.