Determinants of medicine use in a Swedish primary health care practice population

[Satisfaction with the organization of care among elderly users of the services assessed by the PMAQ]

The scope of this study was to identify the levels of satisfaction of the elderly regarding the organization of services in primary health care services. It involved a cross-sectional survey of 18,671 users of the Unified Health System. Information on satisfaction with care was collected, categorized as satisfied (very good, good and average perception) and dissatisfied (poor and very poor). The aspects researched included: characteristics of the organization of care and the secondary data from the 1st cycle of the Brazilian Program for Improving Access and Quality in Primary Health Care (PMAQ-AB). Logistic regression was used to obtain the odds ratio (OR) and confidence interval (CI95%), adjusted for sociodemographic factors. The prevalence of satisfaction was 87%. The aspects associated with satisfaction (p<0.05), after analysis of factors that could distort the results, were access to the health unit, home visit and availability of medication - related to the organization of services; and, performing an active search, solving the problem in the unit, as well as the physical examination and consultation time - related to the organization of care. The analyses describe multiple aspects of the organization of care and services associated with the satisfaction of the elderly with basic health care services.

Socio-economic and behavioral determinants of prescription and non-prescription medicine use: the case of Turkey

BACKGROUND

Demographic and socio-economic factors determine pharmaceutical health care utilization for individuals. Prescription and non-prescription medicine use are expected to have different determinants. Even though prescription and non-prescription medicine use is being well researched for developed countries, there are only a few studies for developing countries.

OBJECTIVES

This paper aims to analyze the socio-economic and individual characteristics that determine the use of prescription and non-prescription medicine. We examine the issue for the specific case of Turkey since Turkey's health system has undertaken significant changes in the last two decades and especially after 2003 with the "Health Transformation Programme".

METHODS

Data from the nationally representative "Health Survey" are used in the analysis. The data set covers the 2008-2016 period with two-year intervals. Pooled multivariate logistic regression is employed to identify the underlying determinants of prescription and non-prescription medicine use.

RESULTS

When compared to 2008, non-prescription medicine use decreases until 2012, however, an increasing trend appears after 2012. For prescription medicine use, a decreasing trend emerges after 2012. Findings from the marginal effects indicate that for non-prescription medicine use, the highest effect stems from the health status. For prescription medicine use, the highest marginal effects arise from age, health and employment status indicating the importance of the need and predisposing factors.

CONCLUSION

Decreasing non-prescription medicine use largely depends on easier access to health care service utilization. Although having a health insurance has a positive relationship with prescription medicine use, there is still a problem for individuals living a rural area and heaving a lower income level since they are more likely to use non-prescription medicine.

Using electronic medical record data to characterize the level of medication use by age-groups in a network of primary care clinics

PURPOSE

Our primary aim was to characterize the level of medication use across age-groups by examining electronic medical record data for a large number of patients receiving care in primary care clinics. A secondary aim was to identify factors associated with higher levels of medication use or polypharmacy.

METHODS

We conducted a retrospective query of electronic medical record data from a clinical data warehouse, evaluating 114 012 patients seen in primary care clinics at least once in the previous 6 months. Medication use was evaluated in 3 different categories: level 1 (0-4 medications), level 2 (5-9 medications), and level 3 (≥ 10 medications). Multivariate analysis was used to analyze different patient demographics and comorbidities for association with level of medication use.

RESULTS

At ages 18 to 24 years, 15% (male) to 23% (female) of patients were taking greater than 5 medications, a trend that continued to increase with older cohorts. Female patients were more likely to have level 2 (odds ratio [OR] = 1.76) and level 3 (OR = 2.73) use compared with men. Level 2 and level 3 use was associated with other patient characteristics, including number of patient encounters (level 2 OR = 2.99; level 3 OR = 8.08 for >7 encounters) and common chronic conditions such as chronic pain (level 2 OR = 2.56; level 3 OR = 6.40), diabetes (level 2 OR = 2.4; level 3 OR = 4.61), heart disease (level 2 OR = 1.99; level 3 OR = 3.65), hypertension (level 2 OR = 2.27; level 3 OR = 2.87), and dyslipidemia (level 2 OR = 1.82; level 3 OR = 2.12).

CONCLUSION

Electronic medical record data may be an important tool for providing more comprehensive information regarding medication usage. Medication usage assessed by electronic medical records, even among the youngest cohort, appears to be greater than other sources of medication usage indicate. Higher levels of medication use were associated with a number of factors, including gender, body mass index, number of patient encounters, and comorbid conditions.

Interference of NSAIDs with the thrombocyte inhibitory effect of aspirin: a placebo-controlled, ex vivo, serial placebo-controlled serial crossover study

PURPOSE

Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetylsalicylic acid (ASA) are often prescribed concurrently in patients with nociceptive pain and cardiovascular comorbidity. NSAIDs and ASA inhibit the same COX-enzymes, and thus may interact. ASA's cardioprotective antiplatelet effect is entirely COX-1 dependent. NSAIDs can be either non-COX-1 and COX-2 selective or COX-2 selective. The aim of this study was to examine the interaction between ASA and different selective and nonselective NSAIDs on thrombocyte function.

METHODS

Single-blind, prospective, placebo-controlled, ex vivo, serial crossover trial of 3-day cycles separated by washout periods of at least 12 days in 30 healthy volunteers, evaluating interaction on ASA's antithrombocyte effect by naproxen, ibuprofen, meloxicam, or etoricoxib taken 2 h before ASA. Ex vivo thrombocyte function, closure time (CT) in seconds, was measured using the Platelet Function Analyzer 100 (PFA-100). CT prolongation during a cycle reflects thrombocyte inhibitory effect. ASA nonresponse was defined as CT prolongation <40 % in the placebo cycle. ASA nonresponders were excluded. Wilcoxon signed-rank was used to evaluate NSAID effect on ASA-induced CT prolongation.

RESULTS

Ibuprofen and naproxen inhibit ASA's antithrombocyte effect below the nonresponse threshold. Etoricoxib and meloxicam do not cause relevant change in ASA thrombocyte inhibition. Naproxen has an inherent weak thrombocyte inhibitory action below the ASA response threshold.

CONCLUSIONS

COX-1 affinity determines the interaction between NSAIDs and ASA on thrombocyte adhesion and aggregation. Ibuprofen and naproxen, but not etoricoxib or meloxicam, taken 2 h before ASA, significantly inhibit ASA's antithrombocyte effect.

Prescribing patterns and predictors of high-level polypharmacy in the elderly population: A prospective surveillance study from two teaching hospitals in India

BACKGROUND

Polypharmacy has been reported to increase the risks for inappropriate prescribing, adverse drug reactions, geriatric syndromes, and morbidity and mortality in elderly populations in the United States and Europe. Data on prescribing patterns and polypharmacy in the elderly population in India are limited.

OBJECTIVES

The aims of this study were to assess prescribing patterns and to determine the predictors of high-level polypharmacy in the elderly population in 2 tertiary care hospitals in India.

METHODS

This prospective surveillance study used medical records from patients aged 60 to 95 years admitted to the medicine wards of the 2 tertiary care hospitals between January 2008 and June 2009. Data on medication prescribing from admission through discharge were reviewed. Diseases were coded using the World Health Organization (WHO) International Classification of Diseases, 10th Revision, and medications were coded using the WHO Anatomical, Therapeutic, and Chemical classification. Concordance of prescribing with the indications in the product labeling as listed in the American Hospital Formulary Services Drug Information 2007 was determined. The prevalences of polypharmacy (5-9 medications) and high-level polypharmacy (>or=10 medications) were determined. Bivariate analysis and multivariate logistic regression analysis were used to determine the influential predictors of high-level polypharmacy during hospital stays.

RESULTS

Data from 814 patients were included (493 [60.6%] men, 321 [39.4%] women; median age, 66 years [range, 60-95 years]). Systemic antibacterials were the most commonly prescribed therapeutic class of medications (574 [70.5%]), and pantoprazole was the most commonly prescribed medication (498 [61.2%]). The majority (7/10 [70.0%]) of the most commonly prescribed medications were prescribed as indicated. Medications prescribed "off-label" included pantoprazole (432/498 [86.7%]), ceftriaxone (212/259 [81.9%]), and atorvastatin (109/237 [46.0%]). Polypharmacy and high-level polypharmacy were prescribed in 366 (45.0%) and 370 (45.5%) patients, respectively. On multivariate logistic regression analysis, multiple (>or=3) diagnoses (odds ratio [OR] = 1.55; 95% CI, 1.16-2.08; P = 0.003), angina pectoris (OR = 2.58; 95% CI, 1.50-4.37; P < 0.001), and a length of stay >or=10 days (10-<15 days, OR = 3.14; 95% CI, 2.09-4.71; P < 0.001; and >or=15 days, OR = 5.74; 95% CI, 2.43-13.51; P < 0.001) were found to be predictors of high-level polypharmacy during hospital stays.

CONCLUSIONS

The campaign for rational drug use in hospitalized elderly patients in India should promote pantoprazole, ceftriaxone, and atorvastatin prescribing in concordance with their indications. Interventions to reduce the high-level polypharmacy in the elderly during their stays in tertiary care hospitals in India should focus on patients with >/=3 diagnoses, angina pectoris, and/or >or=10 days of hospital stay.

Factors Associated with Multiple Medication Use in Different Age Groups

Background:

Multiple medicine use among elderly persons is likely to be the result of treatment regimens developed over a long period of time. By learning more about how multiple medication use develops, the quality of prescribing may be improved across the adult lifespan.

Objective:

To describe patterns of multiple medicine use in the general Swedish population and its association with sociodemographic, lifestyle, and health status factors.

Methods:

Data from a cross-sectional population health survey collected during 2001-2005 from 2816 randomly selected Swedish residents (age 30–75 y; response rate 76%) were analyzed. Multiple medicine use was restricted to prescription drugs and defined as the 75th percentile; that is, the 25% of the study group using the highest number of drugs per individual.

Results:

Seventy-one percent of the respondents used some kind of drug, 51.5% used one or more prescription drug, 38.4% used one or more over-the-counter (OTC) medication, and 8.3% used one or more herbal preparation. The cutoff amounts defining multiple medicine use were: 2 or more medications for 30- to 49-year-olds, 3 or more for 50- to 64-year-olds, and 5 or more for 65- to 75-year-olds. No association between use of multiple medicines and use of OTC drugs or herbal preparations was found. When drugs were classified into therapeutic subgroups, 76.3% of those aged 30–49 years, 97.9% of those aged 50–64 years, and 100% of those aged 65–75 years were taking a unique combination of drugs. Multivariate analyses showed that diabetes and poor self-rated health were associated with multiple medicine use in all age cohorts. Female sex and hypertension were associated with multiple medicine use among those aged 30–49 and 50–64 years, current smoking among those aged 50–64 years, and obesity among those aged 65–75 years.

Conclusions:

Multiple medicine use was associated with morbidity and poor self-rated health across all age groups. The vast majority of users of multiple drugs are taking a unique combination of medications.

Evolution of Medication Use in Jerusalem Elders

BACKGROUND

While overall rates of medication use have been increasing over time, less is known about how medication use changes within individuals as they age.

OBJECTIVE

The aim of this study was to evaluate changes in medication use and predictors of medication accrual among community-dwelling elders followed for a 7-year period, from age 70 +/- 1 years to age 77 +/- 1 years.

METHODS

The study was a community-based, longitudinal, cohort study. The study group consisted of 280 patients from the Jerusalem Longitudinal Study, a population-based sample of Jerusalem residents born in 1920-1 who underwent extensive evaluation in 1990-1 and again in 1997-8. The main outcome measure of the study was the change in the total number of medications taken between baseline and follow-up. Medication use was assessed by home interviews.

RESULTS

Half of the sample were men. Medication use more than doubled over the 7-year study period, from a mean of 2.0 to 5.3 medications per patient (p < 0.001), and 57 patients (20%) increased their total drug use by six or more medications. Vitamins, minerals and cardiovascular medications were the most commonly prescribed medications at follow-up, and accounted for approximately half of the total increase in medication use. On multivariable logistic regression analyses, decline in self-rated health was the strongest predictor of above-median increases in medication use (odds ratio [OR] 3.2; 95% CI 1.8, 6.2). The only nonclinical predictor of above-median increases in medication use was good social engagement at baseline (OR 1.8; 95% CI 1.1, 3.1).

CONCLUSION

Medication use in Jerusalem elders grew rapidly over the 1990s, more than doubling in volume over a 7-year period. While health status was the factor most strongly predictive of the degree of change, the magnitude of increase for elders as a whole suggests major changes in prescribing practices over this interval.

Age and gender effect on the use of herbal medicine products and food supplements among the elderly

OBJECTIVE

To describe the users of herbal medicine products and food supplements with regard to age and gender specifically among persons aged > or = 60 years.

DESIGN

A descriptive study with baseline data from a longitudinal study of the elderly, stratified into different age cohorts (60-69, 70-79, 80-89, and > or = 90 years).

SETTING

Blekinge county, situated in south-eastern Sweden.

SUBJECTS

In total 1380 persons aged 60-96 years (median age 78 years).

MAIN OUTCOME MEASURES

Current use of herbal medicine products and the use of food supplements.

RESULTS

Of the participants, 264/1380 (19.1%) used at least one herbal medicine product, 184/1380 (13.3%) used at least one food supplement and 382/1380 (27.7%) used herbal medicine products and/or food supplements. In all regression models, women had a higher probability of using herbal medicine and/or food supplements in comparison with men. Focusing on the use of herbal medicine products alone and the combination of using herbal medicine and/or food supplements, decreased use was seen with increasing age. However, 27.9% were still users of herbal medicine products and/or food supplements in the age group 80-89 years. In comparison, 14% were users in the age group > or = 90 years. Age did not have an impact on the probability of taking food supplements.

CONCLUSION

General practitioners need to consider the high use of herbal medicine products and food supplements among the elderly when making decisions on treatment.