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Prevalence and therapeutic intensity of dispensed drug groups for individuals with multiple medications: a register-based study of 2.2 million individuals
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.ORCID iD: 0000-0002-6648-8702
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. (eHälsoinstitutet ; eHealth Institute)ORCID iD: 0000-0002-4295-7201
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
2010 (English)In: Journal of Pharmaceutical Health Services Research, ISSN 1759-8885, Vol. 1, no 4, p. 145-155Article in journal (Refereed) Published
Abstract [en]

Objectives  To assess the prevalence and the therapeutic intensity of dispensed drug groups for individuals receiving multiple medications.

Methods  The individual-based data of all dispensed outpatient prescriptions in Sweden in 2006 were analysed. Five or more dispensed drugs (DP ≥ 5) during a 12-month period were applied as an indicator of multiple medications. The drugs were categorized according to the second level of the World Health Organization's Anatomic, Therapeutic, Chemical classification. The defined daily dosage per individual during 12 months was applied as an indicator of the therapeutic intensity.

Key findings  For the 2.2 million individuals with DP ≥ 5, the drug groups with the highest prevalences were antibacterials (48.2%), analgesics (40.3%), psycholeptics (35.9%), antithrombotic agents (33.4%) and beta-blocking agents (31.7%). As examples, the level of prevalence increased with age for analgesics, psycholeptics, antithrombotic agents and diuretics, and decreased with age for antibacterials, drugs for obstructive airway diseases and antihistamines for systemic use. Substantial differences in the level of prevalence between women and men were observed for several drug groups; for example, thyroid therapy (13.3 vs 3.6%), psychoanaleptics (26.3 vs 18.2%), drugs used in diabetes (9.1 vs 15.7%) and lipid-modifying agents (18.1 vs 30.7%). Generally, the therapeutic intensity increased with the increasing number of dispensed drugs. For a third of the most common drug groups, the therapeutic intensity increased with an increasing age above the 60–69-year age group.

Conclusion  The number of drugs taken not only increases the potential risks associated with multiple drug use, but also increases the potential burden of an increased therapeutic intensity, especially for older people. The reported findings may enlighten physicians and healthcare stakeholders concerning the complex patterns of multiple drug use in the entire population and the associated expenses. The findings may also be used as a base for interventions aiming to bring about the most appropriate and balanced prescription of medicines to individuals with multiple diseases.

Place, publisher, year, edition, pages
Royal Pharmaceutical Society , 2010. Vol. 1, no 4, p. 145-155
Keywords [en]
Aged, Drug therapy, Drug utilization, Prescription drugs, Polypharmacy, Registries
National Category
Pharmacology and Toxicology
Research subject
Biomedical Sciences, Pharmacology
Identifiers
URN: urn:nbn:se:lnu:diva-2268DOI: 10.1111/j.1759-8893.2010.00029.xScopus ID: 2-s2.0-79953733150OAI: oai:DiVA.org:lnu-2268DiVA, id: diva2:309343
Available from: 2010-04-07 Created: 2010-04-07 Last updated: 2018-01-12Bibliographically approved
In thesis
1. On drug use, multiple medication and polypharmacy in a national population
Open this publication in new window or tab >>On drug use, multiple medication and polypharmacy in a national population
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The application of multiple medications has successively increased during a number of years and has thereby increased the potential risks of adverse drug reactions, interactions and non-adherence to drug therapy. This may result in unnecessary health expenditure, directly due to redundant drug sales, and indirectly due to the increased hospitalization caused by drug-related problems. The overall aim of this thesis was to investigate the occurrence and development of drug use, multiple medication, and polypharmacy in an entire national population by using individual-based data on dispensed drugs. The studies (I-V) in the thesis are based on data of dispensed prescription drugs for up to 6.2 million individuals obtained from the Swedish Prescribed Drug Register. The data in the studies cover different periods of time between July 2005-Sept 2008, and the data have been analyzed on the basis of epidemiological measures and statistical methods. The major conclusions of the studies are: the prevalence of dispensed drugs and multiple medications was extensive in all age groups and was higher for females than for males. Multiple medications should be regarded as a risk in terms of potential drug-drug interactions and adverse drug reactions in all age groups (I). Regional differences in the prevalence of polypharmacy were observed and partly explained by the regional age distribution in Sweden. The use of a novel weighted polypharmacy index indicated regional differences in drug therapy for individuals with polypharmacy (II). The number of drugs used by an individual not only increased the potential risks associated with multiple drug use, but also the potential burden of an increased therapeutic intensity, especially for elderly (III). Individuals with ten or more drugs accounted for almost fifty percent of the total acquisition costs of dispensed drugs. Therefore, interventions with a focus on the reduction of the number of prescription drugs for the small group of patients with a large number of different drugs may also result in a substantial reduction in the total drug costs (IV). In spite of national and regional efforts to reduce polypharmacy, the prevalence of polypharmacy and excessive polypharmacy and the mean number of drugs per individual continued to increase in Sweden 2005-2008 (V). The observed year-by-year increase in polypharmacy underlines the importance of monitoring the development of drug use in all ages. Individual-based registers studies of dispensed drugs provide high quality data and could serve as the basis for further research and also in terms of training health care personnel. It can also be used as a base for interventions and the evaluation of drug use. To enable better comparisons on drug use and its consequences, there is a need for standards concerning measurements, classification and criteria which encompass all types of medications. For clinicians, there is a need for information concerning the patient’s actual use of all different types of medications.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2010. p. 66
Series
Linnaeus University Dissertations ; 15
Keywords
drug use, multiple medication, polypharmacy, register, prevalence, therapeutic intensity, acquisition cost.
National Category
Natural Sciences
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:lnu:diva-2336 (URN)978-91-86491-20-8 (ISBN)
Public defence
2010-05-18, Sal N 2007, Smålandsgatan 26 B, Kalmar, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2010-04-09 Created: 2010-04-07 Last updated: 2017-05-30Bibliographically approved

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Hovstadius, BoTågerud, SvenPetersson, GöranÅstrand, Bengt

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