Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan
Objectives: Target populations with persistent polypharmacy should be identified prior to implementing strategies against inappropriate medication use, yet limited information regarding such populations is available. The main objectives were to explore the trends of excessive polypharmacy, whether t...
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doaj-82670ef77df54e159fcd783929ed484c2020-11-24T23:19:36ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122018-02-01910.3389/fphar.2018.00120345191Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in TaiwanYi-Jen Wang0Shu-Chiung Chiang1Shu-Chiung Chiang2Pei-Chen Lee3Yu-Chun Chen4Yu-Chun Chen5Yu-Chun Chen6Li-Fang Chou7Yueh-Ching Chou8Yueh-Ching Chou9Tzeng-Ji Chen10Tzeng-Ji Chen11Tzeng-Ji Chen12Department of Family Medicine, Taipei Veterans General Hospital, Taipei, TaiwanInstitute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, TaiwanDepartment of Financial Engineering and Actuarial Mathematics, Soochow University, Taipei, TaiwanDepartment of Pharmacy, Taipei Veterans General Hospital, Taipei, TaiwanDepartment of Family Medicine, Taipei Veterans General Hospital, Taipei, TaiwanInstitute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanDepartment of Public Finance, National Chengchi University, Taipei, TaiwanDepartment of Pharmacy, Taipei Veterans General Hospital, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanDepartment of Family Medicine, Taipei Veterans General Hospital, Taipei, TaiwanInstitute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, TaiwanSchool of Medicine, National Yang-Ming University, Taipei, TaiwanObjectives: Target populations with persistent polypharmacy should be identified prior to implementing strategies against inappropriate medication use, yet limited information regarding such populations is available. The main objectives were to explore the trends of excessive polypharmacy, whether transient or persistent, at the individual level. The secondary objectives were to identify the factors associated with persistently excessive polypharmacy and to estimate the probabilities for repeatedly excessive polypharmacy.Methods: Retrospective cohort analyses of excessive polypharmacy, defined as prescription of ≥ 10 medicines at an ambulatory visit, from 2001 to 2013 were conducted using a nationally representative claims database in Taiwan. Survival analyses with log-rank test of adult patients with first-time excessive polypharmacy were conducted to predict the probabilities, stratified by age and sex, of having repeatedly excessive polypharmacy.Results: During the study period, excessive polypharmacy occurred in 5.4% of patients for the first time. Among them, 63.9% had repeatedly excessive polypharmacy and the probabilities were higher in men and old people. Men versus women, and old versus middle-aged and young people had shorter median excessive polypharmacy-free times (9.4 vs. 5.5 months, 5.3 vs. 10.1 and 35.0 months, both p < 0.001). Overall, the probabilities of having no repeatedly excessive polypharmacy within 3 months, 6 months, and 1 year were 59.9, 53.6, and 48.1%, respectively.Conclusion: Although male and old patients were more likely to have persistently excessive polypharmacy, most cases of excessive polypharmacy were transient or did not re-appear in the short run. Systemic deprescribing measures should be tailored to at-risk groups.http://journal.frontiersin.org/article/10.3389/fphar.2018.00120/fullpolypharmacymedication managementdrug prescriptionsdrug utilizationnational health programs |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yi-Jen Wang Shu-Chiung Chiang Shu-Chiung Chiang Pei-Chen Lee Yu-Chun Chen Yu-Chun Chen Yu-Chun Chen Li-Fang Chou Yueh-Ching Chou Yueh-Ching Chou Tzeng-Ji Chen Tzeng-Ji Chen Tzeng-Ji Chen |
spellingShingle |
Yi-Jen Wang Shu-Chiung Chiang Shu-Chiung Chiang Pei-Chen Lee Yu-Chun Chen Yu-Chun Chen Yu-Chun Chen Li-Fang Chou Yueh-Ching Chou Yueh-Ching Chou Tzeng-Ji Chen Tzeng-Ji Chen Tzeng-Ji Chen Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan Frontiers in Pharmacology polypharmacy medication management drug prescriptions drug utilization national health programs |
author_facet |
Yi-Jen Wang Shu-Chiung Chiang Shu-Chiung Chiang Pei-Chen Lee Yu-Chun Chen Yu-Chun Chen Yu-Chun Chen Li-Fang Chou Yueh-Ching Chou Yueh-Ching Chou Tzeng-Ji Chen Tzeng-Ji Chen Tzeng-Ji Chen |
author_sort |
Yi-Jen Wang |
title |
Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan |
title_short |
Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan |
title_full |
Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan |
title_fullStr |
Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan |
title_full_unstemmed |
Is Excessive Polypharmacy a Transient or Persistent Phenomenon? A Nationwide Cohort Study in Taiwan |
title_sort |
is excessive polypharmacy a transient or persistent phenomenon? a nationwide cohort study in taiwan |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Pharmacology |
issn |
1663-9812 |
publishDate |
2018-02-01 |
description |
Objectives: Target populations with persistent polypharmacy should be identified prior to implementing strategies against inappropriate medication use, yet limited information regarding such populations is available. The main objectives were to explore the trends of excessive polypharmacy, whether transient or persistent, at the individual level. The secondary objectives were to identify the factors associated with persistently excessive polypharmacy and to estimate the probabilities for repeatedly excessive polypharmacy.Methods: Retrospective cohort analyses of excessive polypharmacy, defined as prescription of ≥ 10 medicines at an ambulatory visit, from 2001 to 2013 were conducted using a nationally representative claims database in Taiwan. Survival analyses with log-rank test of adult patients with first-time excessive polypharmacy were conducted to predict the probabilities, stratified by age and sex, of having repeatedly excessive polypharmacy.Results: During the study period, excessive polypharmacy occurred in 5.4% of patients for the first time. Among them, 63.9% had repeatedly excessive polypharmacy and the probabilities were higher in men and old people. Men versus women, and old versus middle-aged and young people had shorter median excessive polypharmacy-free times (9.4 vs. 5.5 months, 5.3 vs. 10.1 and 35.0 months, both p < 0.001). Overall, the probabilities of having no repeatedly excessive polypharmacy within 3 months, 6 months, and 1 year were 59.9, 53.6, and 48.1%, respectively.Conclusion: Although male and old patients were more likely to have persistently excessive polypharmacy, most cases of excessive polypharmacy were transient or did not re-appear in the short run. Systemic deprescribing measures should be tailored to at-risk groups. |
topic |
polypharmacy medication management drug prescriptions drug utilization national health programs |
url |
http://journal.frontiersin.org/article/10.3389/fphar.2018.00120/full |
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