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The Prevalence of Polypharmacy In Older Europeans: A Multi-country Database Study of General Practitioner Prescribing
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  • Marion Bennie,
  • Yared Santa-Ana-Tellez,
  • Githa Fungie Galistiani,
  • Julien Trehony,
  • Johanna Despres,
  • Sophie Jouaville,
  • Elisabetta Poluzzi,
  • Lucas Morin,
  • Ingrid Schubert,
  • Sean MacBride-Stewart,
  • Monique Elseviers,
  • Paola Nasuti,
  • Katja Taxis
Marion Bennie
Strathclyde Institute of Pharmacy and Biomedical Sciences

Corresponding Author:marion.bennie@strath.ac.uk

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Yared Santa-Ana-Tellez
Utrecht University
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Githa Fungie Galistiani
Universitas Muhammadiyah Purwokerto
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Julien Trehony
IQVIA Ltd
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Johanna Despres
IQVIA Ltd
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Sophie Jouaville
IQVIA Ltd
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Elisabetta Poluzzi
University of Bologna
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Lucas Morin
Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP
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Ingrid Schubert
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Sean MacBride-Stewart
NHS Greater Glasgow and Clyde
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Monique Elseviers
UGent
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Paola Nasuti
IQVIA Ltd
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Katja Taxis
University of Groningen, PharmacoTherapy, Epidemiology and Economics
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Abstract

Aim: To measure the prevalence of polypharmacy and describe the prescribing of potentially inappropriate medication (PIM) in older people with polypharmacy in primary care. Methods: A multi-country retrospective cohort study across six countries: Belgium, France, Germany, Italy, Spain, UK. We used anonymized longitudinal patient level information from general practice databases hosted by IQVIA. Patients ≥65 years were included. Polypharmacy was defined as having 5-9, and ≥10 distinct drug classes (ATC Level 3) prescribed during a 6-month period. PIM defined: opioids, antipsychotics, proton pump inhibitors (PPI), benzodiazepines (ATC Level 5). We included country experts on the health care context to interpret findings. Results: Age and gender distribution was similar across the six countries (mean age 75-76 years; 54-56% female). The prevalence of polypharmacy of 5-9 drugs was 22.8% (UK) to 58.3% (Germany); ≥10 drugs from 11.3% (UK) to 28.5% (Germany). In the polypharmacy population prescribed ≥5 drugs, opioid prescribing ranged from 11.5% (France) to 27.5% (Spain). Prescribing of PPI was highest with almost half of patients receiving a PPI, 42.3% (Germany) to 65.5% (Spain). Benzodiazepine prescribing showed a marked variation between countries, 2.7% (UK) to 34.9% (Spain). The health care context information explained possible underreporting for PIM. Conclusion: We have found a high prevalence of polypharmacy with more than half of the older population being prescribed ≥5 drugs in four of the six countries. Whilst polypharmacy may be appropriate in many patients, worrying high usage of PIM (PPIs and benzodiazepines) supports current efforts to improve polypharmacy management across Europe.
16 Oct 2023Submitted to British Journal of Clinical Pharmacology
17 Oct 2023Submission Checks Completed
17 Oct 2023Assigned to Editor
17 Oct 2023Review(s) Completed, Editorial Evaluation Pending
30 Oct 2023Reviewer(s) Assigned
08 Mar 20241st Revision Received
11 Mar 2024Submission Checks Completed
11 Mar 2024Assigned to Editor
09 May 2024Editorial Decision: Accept