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\begin{document}

\title{The Prevalence of Polypharmacy In Older Europeans: A Multi-country
Database Study of General Practitioner Prescribing}



\author[1]{Marion Bennie}%
\author[2]{Yared Santa-Ana-Tellez}%
\author[3]{Githa Fungie Galistiani}%
\author[4]{Julien Trehony}%
\author[4]{Johanna Despres}%
\author[4]{Sophie Jouaville}%
\author[5]{Elisabetta Poluzzi}%
\author[6]{Lucas Morin}%
\author[7]{Ingrid Schubert}%
\author[8]{Sean MacBride-Stewart}%
\author[9]{Monique Elseviers}%
\author[4]{Paola Nasuti}%
\author[10]{Katja Taxis}%
\affil[1]{Strathclyde Institute of Pharmacy and Biomedical Sciences}%
\affil[2]{Utrecht University}%
\affil[3]{Universitas Muhammadiyah Purwokerto}%
\affil[4]{IQVIA Ltd}%
\affil[5]{University of Bologna}%
\affil[6]{Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP}%
\affil[7]{Affiliation not available}%
\affil[8]{NHS Greater Glasgow and Clyde}%
\affil[9]{UGent}%
\affil[10]{University of Groningen, PharmacoTherapy, Epidemiology and Economics}%


\vspace{-1em}



  
  \date{May 20, 2024}


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\begin{abstract}
Aim: To measure the prevalence of polypharmacy and describe the
prescribing of potentially inappropriate medication (PIM) in older
people with polypharmacy in primary care. Methods: A multi-country
retrospective cohort study across six countries: Belgium, France,
Germany, Italy, Spain, UK. We used anonymized longitudinal patient level
information from general practice databases hosted by IQVIA. Patients
[?]65 years were included. Polypharmacy was defined as having 5-9, and [?]10
distinct drug classes (ATC Level 3) prescribed during a 6-month period.
PIM defined: opioids, antipsychotics, proton pump inhibitors (PPI),
benzodiazepines (ATC Level 5). We included country experts on the health
care context to interpret findings. Results: Age and gender distribution
was similar across the six countries (mean age 75-76 years; 54-56\%
female). The prevalence of polypharmacy of 5-9 drugs was 22.8\% (UK) to
58.3\% (Germany); [?]10 drugs from 11.3\% (UK) to 28.5\% (Germany). In the
polypharmacy population prescribed [?]5 drugs, opioid prescribing ranged
from 11.5\% (France) to 27.5\% (Spain). Prescribing of PPI was highest
with almost half of patients receiving a PPI, 42.3\% (Germany) to 65.5\%
(Spain). Benzodiazepine prescribing showed a marked variation between
countries, 2.7\% (UK) to 34.9\% (Spain). The health care context
information explained possible underreporting for PIM. Conclusion: We
have found a high prevalence of polypharmacy with more than half of the
older population being prescribed [?]5 drugs in four of the six countries.
Whilst polypharmacy may be appropriate in many patients, worrying high
usage of PIM (PPIs and benzodiazepines) supports current efforts to
improve polypharmacy management across Europe.%
\end{abstract}%



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\textbf{Hosted file}

\verb`BJCP-  EuroDURG manuscript 25-09-2023 - MB final -IG edit.docx`  available at \url{https://authorea.com/users/674010/articles/672559-the-prevalence-of-polypharmacy-in-older-europeans-a-multi-country-database-study-of-general-practitioner-prescribing}

\textbf{Hosted file}

\verb`BJCP Tables-polypharmacy_manuscript version 11-09-2023 - MB    .docx`  available at \url{https://authorea.com/users/674010/articles/672559-the-prevalence-of-polypharmacy-in-older-europeans-a-multi-country-database-study-of-general-practitioner-prescribing}

\textbf{Hosted file}

\verb`BJCP Figures-polypharmacy_manuscript version 11-09-2023  MB_.docx`  available at \url{https://authorea.com/users/674010/articles/672559-the-prevalence-of-polypharmacy-in-older-europeans-a-multi-country-database-study-of-general-practitioner-prescribing}

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