[en] PURPOSE: To explore differences in the prevalence and determinants of polypharmacy in the older general population in Belgium between self-reported and prescription based estimates and assess the relative merits of each data source.
METHODS: Data were used from participants aged ≥65 years of the Belgian national health survey 2013 (n = 1950). Detailed information was asked on the use of medicines in the past 24 h and linked with prescription data from the Belgian compulsory health insurance (BCHI). Agreement between polypharmacy (use or prescription ≥5 medicines) and excessive polypharmacy (≥10 medicines) between both sources was assessed with kappa statistics. Multinomial logistic regression was used to study determinants of moderate (5-9 medicines) and excessive polypharmacy (≥10 medicines) and over- and underestimation of prescription based compared to self-reported polypharmacy.
RESULTS: Self-reported and prescription based polypharmacy prevalence estimates were respectively 27% and 32%. Overall agreement was moderate, but better in men (kappa 0.60) than in women (0.45). Determinants of moderate polypharmacy did not vary substantially by source of outcome indicator, but restrictions in activities of daily living (ADL), living in an institution and a history of a hospital admission was associated with self-reported based excessive polypharmacy only.
CONCLUSIONS: Surveys and prescription data measure polypharmacy from a different perspective, but overall conclusions in terms of prevalence and determinants of polypharmacy do not differ substantially by data source. Linking survey data with prescription data can combine the strengths of both data sources resulting in a better tool to explore polypharmacy at population level.
Disciplines :
Public health, health care sciences & services
Author, co-author :
Van der Heyden, Johan; Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
Berete, Finaba ; Université de Liège - ULiège > Unité de recherche Santé publique, épidémiologie et économie de la santé (URSAPES) ; Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
Renard, Françoise; Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
Devleesschauwer, Brecht; Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium ; Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
De Ridder, Karin; Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
BRUYERE, Olivier ; Université de Liège - ULiège > Département des sciences de la santé publique > Santé publique, Epidémiologie et Economie de la santé
Language :
English
Title :
Assessing polypharmacy in the older population: Comparison of a self-reported and prescription based method.
INAMI - Institut National d'Assurance Maladie-Invalidité [BE]
Funding text :
This work did not receive any specific grant from funding agencies in the public, commercial, or not‐for‐profit sectors. The Belgian Health Interview Survey (BHIS) is financed by the Federal and Inter‐Federated Belgian Public Health authorities. The linkage between BHIS data and the Belgian Compulsory Health Insurance data is financed by the National Institute for Health and Disability Insurance.
Uijen AA, van de Lisdonk EH. Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 2008;14(Suppl 1):28-32. https://doi.org/10.1080/13814780802436093
King DE, Xiang J, Pilkerton CS. Multimorbidity trends in United States adults, 1988-2014. J Am Board Fam Med. 2018;31(4):503-513. https://doi.org/10.3122/jabfm.2018.04.180008
Lebenbaum M, Zaric GS, Thind A, Sarma S. Trends in obesity and multimorbidity in Canada. Prev Med. 2018;116:173-179. https://doi.org/10.1016/j.ypmed.2018.08.025
Li J, Green M, Kearns B, et al. Patterns of multimorbidity and their association with health outcomes within Yorkshire, England: baseline results from the Yorkshire Health Study. BMC Public Health. 2016;16:649. https://doi.org/10.1186/s12889-016-3335-z
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37-43. https://doi.org/10.1016/S0140-6736(12)60240-2
Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430-439. https://doi.org/10.1016/j.arr.2011.03.003
Mortazavi SS, Shati M, Keshtkar A, Malakouti SK, Bazargan M, Assari S. Defining polypharmacy in the elderly: a systematic review protocol. BMJ Open. 2016;6(3):e010989. https://doi.org/10.1136/bmjopen-2015-010989
Sönnichsen A, Trampisch US, Rieckert A, et al. Polypharmacy in chronic diseases-Reduction of Inappropriate Medication and Adverse drug events in older populations by electronic Decision Support (PRIMA-eDS): study protocol for a randomized controlled trial. Trials. 2016;17:57. https://doi.org/10.1186/s13063-016-1177-8
Mair A, Wilson M, Dreischulte T. Addressing the challenge of polypharmacy. Annu Rev Pharmacol Toxicol. 2020;60:661-681. https://doi.org/10.1146/annurev-pharmtox-010919-023508
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatr. 2017;17(1):230. https://doi.org/10.1186/s12877-017-0621-2
Sirois C, Laroche M-L, Guénette L, Kröger E, Cooper D, Émond V. Polypharmacy in multimorbid older adults: protocol for a systematic review. Syst Rev. 2017;6(1):104. https://doi.org/10.1186/s13643-017-0492-9
Richardson K, Kenny RA, Peklar J, Bennett K. Agreement between patient interview data on prescription medication use and pharmacy records in those aged older than 50 years varied by therapeutic group and reporting of indicated health conditions. J Clin Epidemiol. 2013;66(11):1308-1316. https://doi.org/10.1016/j.jclinepi.2013.02.016
Hales CM, Servais J, Martin CB, Kohen D. Prescription drug use among adults aged 40-79 in the United States and Canada. NCHS Data Brief. 2019;347:1-8.
Walckiers D, Van der Heyden J, Tafforeau J. Factors associated with excessive polypharmacy in older people. Arch Public Health. 2015;73:50. https://doi.org/10.1186/s13690-015-0095-7
Demarest S, Van der Heyden J, Charafeddine R, Drieskens S, Gisle L, Tafforeau J. Methodological basics and evolution of the Belgian Health Interview Survey 1997-2008. Arch Public Health. 2013;71(1):24. https://doi.org/10.1186/0778-7367-71-24
Van der Heyden J, Demarest S, Van Herck K, De Bacquer D, Tafforeau J, Van Oyen H. Association between variables used in the field substitution and post-stratification adjustment in the Belgian health interview survey and non-response. Int J Public Health. 2014;59(1):197-206. https://doi.org/10.1007/s00038-013-0460-7
Onder G, Liperoti R, Fialova D, et al. Polypharmacy in nursing home in Europe: results from the SHELTER study. J Gerontol A Biol Sci Med Sci. 2012;67(6):698-704. https://doi.org/10.1093/gerona/glr233
Répertoire. CBIP. https://www.cbip.be/fr/chapters. Accessed August 30, 2020.
O'Dwyer M, Peklar J, McCallion P, McCarron M, Henman MC. Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study. BMJ Open. 2016;6(4):e010505. https://doi.org/10.1136/bmjopen-2015-010505
Fincke BG, Snyder K, Cantillon C, et al. Three complementary definitions of polypharmacy: methods, application and comparison of findings in a large prescription database. Pharmacoepidemiol Drug Saf. 2005;14(2):121-128. https://doi.org/10.1002/pds.966
Fortin M, Hudon C, Haggerty J, van den Akker M, Almirall J. Prevalence estimates of multimorbidity: a comparative study of two sources. BMC Health Serv Res. 2010;10(1):111. https://doi.org/10.1186/1472-6963-10-111
Eurostat. European Health Interview Survey (EHIS Wave 2). Methodological Manual. Luxembourg: European Union; 2013.
Oehlert G. A note on the delta method. Am Stat. 1992;46:27-29.
Baek Y-H, Shin J-Y. Trends in polypharmacy over 12 years and changes in its social gradients in South Korea. PLoS ONE. 2018;13(9):e0204018. https://doi.org/10.1371/journal.pone.0204018
Bjerrum L, Søgaard J, Hallas J, Kragstrup J. Polypharmacy: correlations with sex, age and drug regimen. A prescription database study. Eur J Clin Pharmacol. 1998;54(3):197-202. https://doi.org/10.1007/s002280050445
Franchi C, Cartabia M, Risso P, et al. Geographical differences in the prevalence of chronic polypharmacy in older people: eleven years of the EPIFARM-Elderly Project. Eur J Clin Pharmacol. 2013;69(7):1477-1483. https://doi.org/10.1007/s00228-013-1495-7
Grimmsmann T, Himmel W. Polypharmacy in primary care practices: an analysis using a large health insurance database. Pharmacoepidemiol Drug Saf. 2009;18(12):1206-1213. https://doi.org/10.1002/pds.1841
Hovstadius B, Petersson G. The impact of increasing polypharmacy on prescribed drug expenditure—A register-based study in Sweden 2005–2009. Health Policy. 2013;109(2):166-174. https://doi.org/10.1016/j.healthpol.2012.09.005
Neutel CI, Skurtveit S, Berg C. Polypharmacy of potentially addictive medication in the older persons—quantifying usage. Pharmacoepidemiol Drug Saf. 2012;21(2):199-206. https://doi.org/10.1002/pds.2214
Sørensen HT, Johnsen SP, Nørgård B. Methodological issues in using prescription and other databases in pharmacoepidemiology. Nor Epidemiol. 2001;11(1):13-18.
Bjerrum L, Rosholm JU, Hallas J, Kragstrup J. Methods for estimating the occurrence of polypharmacy by means of a prescription database. Eur J Clin Pharmacol. 1997;53(1):7-11. https://doi.org/10.1007/s002280050329
Colley CA, Lucas LM. Polypharmacy: the cure becomes the disease. J Gen Intern Med. 1993;8(5):278-283. https://doi.org/10.1007/BF02600099
Midão L, Giardini A, Menditto E, Kardas P, Costa E. Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr. 2018;78:213-220. https://doi.org/10.1016/j.archger.2018.06.018
Castioni J, Marques-Vidal P, Abolhassani N, Vollenweider P, Waeber G. Prevalence and determinants of polypharmacy in Switzerland: data from the CoLaus study. BMC Health Serv Res. 2017;17(1):840-848. https://doi.org/10.1186/s12913-017-2793-z
Moen J, Antonov K, Larsson CA, et al. Factors associated with multiple medication use in different age groups. Ann Pharmacother. 2009;43(12):1978-1985. https://doi.org/10.1345/aph.1M354
Pappa E, Kontodimopoulos N, Papadopoulos AA, Tountas Y, Niakas D. Prescribed-drug utilization and polypharmacy in a general population in Greece: association with sociodemographic, health needs, health-services utilization, and lifestyle factors. Eur J Clin Pharmacol. 2011;67(2):185-192. https://doi.org/10.1007/s00228-010-0940-0
Hafferty JD, Campbell AI, Navrady LB, et al. Self-reported medication use validated through record linkage to national prescribing data. J Clin Epidemiol. 2018;94:132-142. https://doi.org/10.1016/j.jclinepi.2017.10.013
Nielsen MW, Søndergaard B, Kjøller M, Hansen EH. Agreement between self-reported data on medicine use and prescription records vary according to method of analysis and therapeutic group. J Clin Epidemiol. 2008;61(9):919-924. https://doi.org/10.1016/j.jclinepi.2007.10.021
Haider SI, Johnell K, Thorslund M, Fastbom J. Analysis of the association between polypharmacy and socioeconomic position among elderly aged > or =77 years in Sweden. Clin Ther. 2008;30(2):419-427. https://doi.org/10.1016/j.clinthera.2008.02.010
Jörgensen T, Johansson S, Kennerfalk A, Wallander M-A, Svärdsudd K. Prescription drug use, diagnoses, and healthcare utilization among the elderly. Ann Pharmacother. 2001;35(9):1004-1009. https://doi.org/10.1345/aph.10351
Onder G, Vetrano DL, Cherubini A, et al. Prescription drug use among older adults in Italy: a country-wide perspective. J Am Med Dir Assoc. 2014;15(7):531.e11-531.e15. https://doi.org/10.1016/j.jamda.2014.04.005
Cherubini A, Corsonello A, Lattanzio F. Polypharmacy in nursing home residents: what is the way forward? J Am Med Dir Assoc. 2016;17(1):4-6. https://doi.org/10.1016/j.jamda.2015.07.008
