Prescribing differences among older adults with differing health cover and socioeconomic status: a cohort study
Introduction: As health reforms move Ireland from a mixed public-private system toward universal healthcare, it is important to understand variations in prescribing practice for patients with differing health cover and socioeconomic status. This study aims to determine how prescribing patterns for patients aged ≥ 65 years in primary care in Ireland differ between patients with public and private health cover.
Methods: This was an observational study using anonymised data collected as part of a larger study from 44 general practices in Ireland (2011-2018). Data were extracted from electronic records relating to demographics and prescribing for patients aged ≥ 65 years. The cohort was divided between those with public health cover (via the General Medical Services (GMS) scheme) and those without. Standardised rates of prescribing were calculated for pre-specified drug classes. We also analysed the number of medications, polypharmacy, and trends over time between groups, using multilevel linear regression adjusting for age and sex, and hospitalisations.
Results: Overall, 42,456 individuals were included (56% female). Most were covered by the GMS scheme (62%, n = 26,490). The rate of prescribing in all drug classes was higher for GMS patients compared to non-GMS patients, with the greatest difference in benzodiazepine anxiolytics. The mean number of unique medications prescribed to GMS patients was 10.9 (SD 5.9), and 8.1 (SD 5.8) for non-GMS patients. The number of unique medications prescribed to both GMS and non-GMS cohorts increased over time. The increase was steeper in the GMS group where the mean number of medications prescribed increased by 0.67 medications/year. The rate of increase was 0.13 (95%CI 0.13, 0.14) medications/year lower for non-GMS patients, a statistically significant difference.
Conclusion: Our study found a significantly larger number of medications were prescribed to patients with public health cover, compared to those without. Increasing medication burden and polypharmacy among older adults may be accelerated for those of lower socioeconomic status. These findings may inform planning for moves towards universal health care, and this would provide an opportunity to evaluate the effect of expanding entitlement on prescribing and medications use.
Sláintemedicines – a roadmap to essential medicines entitlement for universal healthcoverage | Funder: Health Research Board / HRB | Grant ID: ILP-HSR-2019-006
Emerging Investigator Award grant from the HRB (grant number EIA-2019-09)
CommentsThe original article is available at https://www.medrxiv.org/ Published version is available in BMC Geriatrics. https://doi.org/10.1186/s12877-023-04441-9 and RCSI Repository https://hdl.handle.net/10779/rcsi.24787824.v1
Published CitationPrendergast C. et al.Prescribing differences among older adults with differing health cover and socioeconomic status: a cohort study. medRxiv 2023.
Publication Date3 Apr 2023
- General Practice
- School of Pharmacy and Biomolecular Sciences
- Health Professions Education
- Population Health and Health Services
PublisherCold Spring Harbor Laboratory
- Submitted Version (Preprint)