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Assessing polypharmacy in the general older population: Comparison of findings from a health survey and health insurance data

Johan Van Der Heyden, Francoise Renard, Finaba Berete, Jean Tafforeau and Brecht Devleesschauwer UGent (2018) Revue d'Épidémiologie et de Santé Publique. 66.
abstract
Introduction Polypharmacy (i.e. the use of multiple drugs administered to the same patient) is common in the older population and an important public health problem. Usually polypharmacy measures are based on billing data, and only reimbursed medicines are considered. In Belgium, however, polypharmacy is also assessed through a systematic recording of all medicines used in the past 24 hours among respondents of the national Health Interview Survey (HIS). This method has two major advantages. First, it is based on actual use of medicines, not on the prescription of medicines. Moreover, it also takes into account non-reimbursed medicines, such as e.g. benzodiazepines. The method also has disadvantages. It is based on a population sample, hence a selection bias is possible. Furthermore, the completeness of the information depends on the willingness of respondents to show to the interviewer all medicines that were used in the past 24 hours. Finally, the method does not allow taking into account the chronicity and the volume of the use of medicines. In this study a HIS based polypharmacy indicator was compared with a similar indicator based on health insurance data. Methods Data from the Belgian HIS 2008 were linked with data from the Belgian mandatory health insurance. Only the population of 65 years and older was considered (n = 2722). From both data sources an indicator was created with 3 categories: no polypharmacy (0–4 medicines), polypharmacy (5–8 medicines) and excessive polypharmacy (9+ medicines). Information on the date of dispensary of the medicine, the number of packages supplied, the quantity per package and the daily defined dose were used to define an active medicine in the health insurance database on the date of the interview. To assess the selection bias an indicator was created from a completely random sample of the health insurance (n = 46,376). For each individual in this sample, polypharmacy was calculated at a random date in 2008 in the same way as in the linked HIS sample. Determinants of polypharmacy were explored through a generalized ordered logit model. Agreement between the HIS and the insurance-based indicator was assessed with kappa statistics and a conditional logistic regression model. Results The insurance-based estimates for polypharmacy and excessive polypharmacy were, respectively, 25% and 4.4% in the HIS sample, and 23% and 4.2% in the random health insurance sample. The HIS based method yielded estimates of respectively 25% and 8.4%. Age, suffering from a chronic disease, region, number of contacts with a general practitioner and a hospitalisation in the past year were significantly associated with polypharmacy, regardless of the measurement method. Educational attainment was only a significant determinant of the HIS based polypharmacy indicator. The weighted kappa, assessing the agreement between the indicators calculated by both methods, was 0.369 (95% confidence interval [95% CI] 0.363–0.397). The odds of classifying excessive polypharmacy and polypharmacy versus no polypharmacy was 1.38 (95% CI: 1.08–1.76) times higher for the HIS than for the insurance-based indicator. For excessive polypharmacy versus polypharmacy and no polypharmacy this was 2.56 (95% CI: 1.55–4.23) times. Conclusions The HIS based method yielded higher rates of polypharmacy in the general older population than an indicator based on billing data. This higher rate was not the result of a selection bias but could have been due to the fact that the HIS based method also takes into account non-reimbursed medicines. As a HIS based indicator considers medicines that are actually consumed, rather than those that are prescribed, it is a more relevant indicator from a public health perspective. Although the systematic collection of information on medicines that are taken during a national health survey increases the burden of the fieldwork, it is an added value for the assessment of polypharmacy in the general population.
Please use this url to cite or link to this publication:
author
organization
year
type
conference (meetingAbstract)
publication status
published
subject
in
Revue d'Épidémiologie et de Santé Publique
Rev Epidemiol Sante Publique
volume
66
issue title
European Congress of Epidemiology “Crises, epidemiological transitions and the role of epidemiologists”
article number
P11-13
pages
S430 -
publisher
Elsevier BV
conference name
European Congress of Epidemiology “Crises, epidemiological transitions and the role of epidemiologists”
conference location
Lyon
conference start
2018-07-04
conference end
2018-07-06
ISSN
0398-7620
DOI
10.1016/j.respe.2018.05.533
language
English
UGent publication?
yes
classification
U
copyright statement
I have transferred the copyright for this publication to the publisher
id
8568886
handle
http://hdl.handle.net/1854/LU-8568886
date created
2018-07-09 17:09:03
date last changed
2018-07-09 17:09:03
@inproceedings{8568886,
  abstract     = {Introduction
Polypharmacy (i.e. the use of multiple drugs administered to the same patient) is common in the older population and an important public health problem. Usually polypharmacy measures are based on billing data, and only reimbursed medicines are considered. In Belgium, however, polypharmacy is also assessed through a systematic recording of all medicines used in the past 24 hours among respondents of the national Health Interview Survey (HIS). This method has two major advantages. First, it is based on actual use of medicines, not on the prescription of medicines. Moreover, it also takes into account non-reimbursed medicines, such as e.g. benzodiazepines. The method also has disadvantages. It is based on a population sample, hence a selection bias is possible. Furthermore, the completeness of the information depends on the willingness of respondents to show to the interviewer all medicines that were used in the past 24 hours. Finally, the method does not allow taking into account the chronicity and the volume of the use of medicines. In this study a HIS based polypharmacy indicator was compared with a similar indicator based on health insurance data.

Methods
Data from the Belgian HIS 2008 were linked with data from the Belgian mandatory health insurance. Only the population of 65 years and older was considered (n = 2722). From both data sources an indicator was created with 3 categories: no polypharmacy (0--4 medicines), polypharmacy (5--8 medicines) and excessive polypharmacy (9+ medicines). Information on the date of dispensary of the medicine, the number of packages supplied, the quantity per package and the daily defined dose were used to define an active medicine in the health insurance database on the date of the interview. To assess the selection bias an indicator was created from a completely random sample of the health insurance (n = 46,376). For each individual in this sample, polypharmacy was calculated at a random date in 2008 in the same way as in the linked HIS sample. Determinants of polypharmacy were explored through a generalized ordered logit model. Agreement between the HIS and the insurance-based indicator was assessed with kappa statistics and a conditional logistic regression model.

Results
The insurance-based estimates for polypharmacy and excessive polypharmacy were, respectively, 25\% and 4.4\% in the HIS sample, and 23\% and 4.2\% in the random health insurance sample. The HIS based method yielded estimates of respectively 25\% and 8.4\%. Age, suffering from a chronic disease, region, number of contacts with a general practitioner and a hospitalisation in the past year were significantly associated with polypharmacy, regardless of the measurement method. Educational attainment was only a significant determinant of the HIS based polypharmacy indicator. The weighted kappa, assessing the agreement between the indicators calculated by both methods, was 0.369 (95\% confidence interval [95\% CI] 0.363--0.397). The odds of classifying excessive polypharmacy and polypharmacy versus no polypharmacy was 1.38 (95\% CI: 1.08--1.76) times higher for the HIS than for the insurance-based indicator. For excessive polypharmacy versus polypharmacy and no polypharmacy this was 2.56 (95\% CI: 1.55--4.23) times.

Conclusions
The HIS based method yielded higher rates of polypharmacy in the general older population than an indicator based on billing data. This higher rate was not the result of a selection bias but could have been due to the fact that the HIS based method also takes into account non-reimbursed medicines. As a HIS based indicator considers medicines that are actually consumed, rather than those that are prescribed, it is a more relevant indicator from a public health perspective. Although the systematic collection of information on medicines that are taken during a national health survey increases the burden of the fieldwork, it is an added value for the assessment of polypharmacy in the general population.},
  articleno    = {P11-13},
  author       = {Van Der Heyden, Johan and Renard, Francoise and Berete, Finaba and Tafforeau, Jean and Devleesschauwer, Brecht},
  booktitle    = {Revue d'{\'E}pid{\'e}miologie et de Sant{\'e} Publique},
  issn         = {0398-7620},
  language     = {eng},
  location     = {Lyon},
  publisher    = {Elsevier BV},
  title        = {Assessing polypharmacy in the general older population: Comparison of findings from a health survey and health insurance data},
  url          = {http://dx.doi.org/10.1016/j.respe.2018.05.533},
  volume       = {66},
  year         = {2018},
}

Chicago
Van Der Heyden, Johan, Francoise Renard, Finaba Berete, Jean Tafforeau, and Brecht Devleesschauwer. 2018. “Assessing Polypharmacy in the General Older Population: Comparison of Findings from a Health Survey and Health Insurance Data.” In Revue d’Épidémiologie Et De Santé Publique, 66:S430. Elsevier BV.
APA
Van Der Heyden, J., Renard, F., Berete, F., Tafforeau, J., & Devleesschauwer, B. (2018). Assessing polypharmacy in the general older population: Comparison of findings from a health survey and health insurance data. Revue d’Épidémiologie et de Santé Publique (Vol. 66, p. S430). Presented at the European Congress of Epidemiology “Crises, epidemiological transitions and the role of epidemiologists,” Elsevier BV.
Vancouver
1.
Van Der Heyden J, Renard F, Berete F, Tafforeau J, Devleesschauwer B. Assessing polypharmacy in the general older population: Comparison of findings from a health survey and health insurance data. Revue d’Épidémiologie et de Santé Publique. Elsevier BV; 2018. p. S430.
MLA
Van Der Heyden, Johan, Francoise Renard, Finaba Berete, et al. “Assessing Polypharmacy in the General Older Population: Comparison of Findings from a Health Survey and Health Insurance Data.” Revue d’Épidémiologie Et De Santé Publique. Vol. 66. Elsevier BV, 2018. S430. Print.