Rachamin Yael, Jäger Levy, Meier Rahel, Grischott Thomas, Senn Oliver, Burgstaller Jakob M, Markun Stefan
Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland.
Front Pharmacol. 2022 Feb 14;13:832994. doi: 10.3389/fphar.2022.832994. eCollection 2022.
The frequency of medication prescribing and polypharmacy has increased in recent years in different settings, including Swiss general practice. We aimed to describe patient age- and sex-specific rates of polypharmacy and of prescriptions of the most frequent medication classes, and to explore practitioner variability in prescribing. Retrospective cross-sectional study based on anonymized electronic medical records data of 111 811 adult patients presenting to 116 Swiss general practitioners in 2019. We used mixed-effects regression analyses to assess the association of patient age and sex with polypharmacy (≥5 medications) and with the prescription of specific medication classes (second level of the Anatomical Therapeutic Chemical Classification System). Practitioner variability was quantified in terms of the random effects distributions. The prevalence of polypharmacy increased with age from 6.4% among patients aged 18-40 years to 19.7% (41-64 years), 45.3% (65-80 years), and 64.6% (81-92 years), and was higher in women than in men, particularly at younger ages. The most frequently prescribed medication classes were (21.6% of patients), (19.9%), (18.7%), and (18.3%). Men were more often prescribed agents targeting the cardiovascular system, whereas most other medications were more often prescribed to women. The highest practitioner variabilities were observed for , for and for . Based on practitioner variability, prevalence, and risk potential, antiinflammatory drugs and polypharmacy in older patients appear to be the most pressing issues in current drug prescribing routines.
近年来，在包括瑞士全科医疗在内的不同环境中，药物处方的频率和多重用药情况有所增加。我们旨在描述按患者年龄和性别划分的多重用药率以及最常见药物类别的处方率，并探讨从业者在处方方面的差异。基于2019年116名瑞士全科医生接诊的111811名成年患者的匿名电子病历数据进行回顾性横断面研究。我们使用混合效应回归分析来评估患者年龄和性别与多重用药（≥5种药物）以及特定药物类别（解剖治疗化学分类系统第二级）处方之间的关联。根据随机效应分布对从业者的差异进行量化。多重用药的患病率随年龄增长而增加，从18 - 40岁患者中的6.4%增至41 - 64岁患者中的19.7%、65 - 80岁患者中的45.3%以及81 - 92岁患者中的64.6%，且女性高于男性，尤其是在较年轻年龄段。最常处方的药物类别是[具体药物类别1]（占患者的21.6%）、[具体药物类别2]（19.9%）、[具体药物类别3]（18.7%）和[具体药物类别4]（18.3%）。男性更常被处方针对心血管系统的药物，而大多数其他药物更常被处方给女性。在[具体药物类别1]、[具体药物类别2]和[具体药物类别3]方面观察到最高的从业者差异。基于从业者差异、患病率和潜在风险，老年患者的抗炎药物和多重用药似乎是当前药物处方常规中最紧迫的问题。
