Prevalence of Outpatient Use of Medicines by the Elderly Population in Portugal: A Cross-Sectional Study

Authors

  • Ana Carmona Araújo Direção de Informação e Planeamento Estratégico. Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED). Lisboa; Instituto de Investigação do Medicamento (iMed.ULisboa). Faculdade de Farmácia. Universidade de Lisboa. Lisboa.
  • Elisabete Fernandes Direção de Informação e Planeamento Estratégico. Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED). Lisboa.
  • Inês Franco Ruivo NOVA School of Science and Technology. Universidade NOVA de Lisboa. Lisboa.
  • Maria do Céu Machado Faculdade de Medicina. Universidade de Lisboa. Lisboa.
  • António Faria Vaz Direção de Informação e Planeamento Estratégico. Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED). Lisboa; Comissão de Ética para a Saúde. Administração Regional de Saúde de Lisboa e Vale do Tejo. Lisboa. 
  • Cláudia Furtado Direção de Informação e Planeamento Estratégico. Autoridade Nacional do Medicamento e Produtos de Saúde, I.P. (INFARMED). Lisboa; NOVA National School of Public Health. Universidade NOVA de Lisboa. Lisboa. 

DOI:

https://doi.org/10.20344/amp.19254

Keywords:

Aged, Drug Prescriptions, Outpatients, Portugal

Abstract

Introduction: Like in other countries, the age pyramid in Portugal has been changing considerably, with a substantial increase in the size of the older population and a significant reduction in the number of young people. With aging, co-occurrence of several conditions becomes frequent, often leading to the use of multiple medications (polypharmacy). Polypharmacy in the older population is particularly relevant considering the physiological changes of the ageing process, which increase the risk of drug interactions, poor adherence to treatment, and adverse drug reactions, especially in the oldest-old population (85 years or older). As the size of the older population is likely to increase significantly, it is important to characterize the pattern of medicines’ use by the elderly while also identifying cases of polypharmacy in order to obtain evidence that can be used to develop specific measures to tackle the high prevalence of use and its associated risks. To this end, the aim of this study was to characterize medication use by older individuals in Portugal.
Methods: Cross-sectional study with data from the National Health System’s Control and Monitoring Center on reimbursed medicines that were prescribed and dispensed to individuals aged 65 years or older in 2019 in all community pharmacies of the Portuguese mainland. We performed a demographic and geographic analysis of the data by international nonproprietary name and therapeutic group. The number of reimbursed packages and the number of reimbursed packages per capita were the metrics used (data from Instituto Nacional de Estatística).
Results: A higher consumption of medicines was observed in women, increasing with age, except in the oldest olds, in which the sex difference tended to shrink. Use per capita showed an opposite trend, with the oldest-old men surpassing the oldest-old women (mean reimbursed packages: 55.5 in men versus 55.1 in women). In women, consumption was led by cardiovascular medicines (31%), followed by central nervous system medications (30%) and antidiabetics (13%); in men, 37% of TOP 10 consumption was due to cardiovascular medications, antidiabetics (16%) and drugs for benign prostatic hypertrophy (14%).
Conclusion: In the elderly, there were sex differences in the pattern of medicines’ use, and there were also significant age-related differences in 2019. To the best of our knowledge, our study is the first nationwide analysis of reimbursed medicines’ consumption data in the elderly, which is essential to characterize the use of medicines in this age group in Portugal.

Downloads

Download data is not yet available.

References

Carmona-Torres JM, Cobo-Cuenca AI, Recio-Andrade B, Laredo-Aguilera JA, Martins MM, Rodríguez-Borrego MA. Prevalence and factors associated with polypharmacy in the older people: 2006-2014. J Clin Nurs.2018;27:2942-52. DOI: https://doi.org/10.1111/jocn.14371

Unutmaz GD, Soysal P, Tuven B, Isik AT. Costs of medication in older patients: before and after comprehensive geriatric assessment. Clin Interv Aging. 2018;13:607-13. DOI: https://doi.org/10.2147/CIA.S159966

Mosca C, Correia P. O medicamento no doente idoso. Acta Farm Port. 2012;1:75-81.

Committee for Medicinal Products for Human Use. Reflection paper on physical frailty: instruments for baseline characterisation of older populations in clinical trials. EMA/CHMP/778709/2015, European Medicines Agency, 2018. [consultado 2022 maio 09]. Disponível em: https://www.ema.europa.eu/en/documents/scientific-guideline/reflection-paper-physical-frailty-instruments-baseline-characterisation-older-populations-clinical_en.pdf.

Wastesson JW, Cedazo Minguez A, Fastbom J, Maioli S, Johnell K. The composition of polypharmacy: a register-based study of Swedes aged 75 years and older. PLoS One. 2018;13:e0194892. DOI: https://doi.org/10.1371/journal.pone.0194892

Suzuki Y, Sakakibara M, Shiraishi N, Hirose T, Akishita M, Kuzuya M. Prescription of potentially inappropriate medications to older adults. A nationwide survey at dispensing pharmacies in Japan. Arch Gerontol Geriatr. 2018;77:8-12. DOI: https://doi.org/10.1016/j.archger.2017.12.010

Hurmuz MZ, Janus SI, van Manen JG. Changes in medicine prescription following a medication review in older high-risk patients with polypharmacy. Int J Clin Pharm. 2018;40:480-7. DOI: https://doi.org/10.1007/s11096-018-0602-3

Onder G, Marengoni A, Russo P, Degli Esposti L, Fini M, Monaco A, et al. Advanced age and medication prescription: more years, less medications? A nationwide report from the Italian Medicines Agency. J Am Med Dir Assoc. 2016;17:168-72. DOI: https://doi.org/10.1016/j.jamda.2015.08.009

The Medicines Utilisation Monitoring Centre. National report on medicines use in older adults in Italy. Year 2019. Rome: Italian Medicines Agency (AIFA); 2021.

Johnell K, Weitoft GR, Fastbom J. Sex differences in inappropriate drug use: a register-based study of over 600,000 older people. Ann Pharmacother. 2009;43:1233-8. DOI: https://doi.org/10.1345/aph.1M147

Auvray L, Sermet C, Consommations et prescriptions pharmaceutiques chez les personnes âgées. Un état des lieux. Gerontol Soc. 2002;25:13-27. DOI: https://doi.org/10.3917/gs.103.0013

Venturini CD, Engroff P, Ely LS, Zago LF, Schroeter G, Gomes I, et al. Gender differences, polypharmacy, and potential pharmacological interactions in the elderly. Clinics. 2011;66:1867-72.

Simões PA, Santiago LM, Maurício K, Simões JA. prevalence of potentially inappropriate medication in the older adult population within primary care in Portugal: a nationwide cross-sectional study. Patient Prefer Adherence. 2019;13:1569-76. DOI: https://doi.org/10.2147/PPA.S219346

Comissão Europeia. The 2018 Ageing Report. Institutional Paper 065. 2017. [consultado 2022 maio 11]. Disponível em: https://economy-finance.ec.europa.eu/publications/2018-ageing-report-underlying-assumptions-and-projection-methodologies_en.

Ministério da Saúde. Retrato da Saúde, Portugal. 2018. [consultado 2022 maio 05]. Disponível em: https://www.sns.gov.pt/wp-content/uploads/2018/04/RETRATO-DA-SAUDE_2018_compressed.pdf.

Instituto Nacional de Estatística. Projeções de População Residente – 2015-2080. 2017. [consultado 2022 maio 12]. Disponível em: https://www.ine.pt/xportal/xmainxpid=INE&xpgid=ine_destaques&DESTAQUESdest_boui=277695619&DESTAQUESmodo=2&xlang=pt.

Organização Mundial da Saúde. European Health Report 2018. 2018. [consultado 2022 maio 05]. Disponível em: https://www.euro.who.int/__data/assets/pdf_file/0003/380478/HEALTH_REPORT_HIGHLIGHTS_2018_EN.PDF.

Instituto Nacional de Estatística. Estatísticas da Saúde 2019. 2021. [consultado 2022 maio 26]. Disponível em: https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_publicacoes&PUBLICACOESpub_boui=257483090&PUBLICACOESmodo=2.

Instituto Nacional de Estatística. Causas de morte 2019 (dados provisórios). 2021. [consultado 2022 maio 26]. Disponível em: https://www.ine.pt/ngt_server/attachfileu.jsp?look_parentBoui=484469261&att_display=n&att_download=y.

Instituto Nacional de Estatística. Inquérito Nacional de Saúde 2014. 2016. [consultado 2022 jun 10]. Disponível em: https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_publicacoes&PUBLICACOESpub_boui=263714091&PUBLICACOESmodo=2.

Conselho Nacional de Saúde. Sem mais tempo a perder – Saúde mental em Portugal: um desafio para a próxima década. 2019. [consultado 2022 jun 02]. Disponível em: http://www.cns.min-saude.pt/wp-content/uploads/2019/12/SEM-MAIS-TEMPO-A-PERDER.pdf.

United Nations. World Drug Report 2017. Global overview of drug demand and supply - latest trends, cross-cutting issues. 2017. [consultado 2022 jul 01]. Disponível em: https://www.unodc.org/wdr2017/en/drug-demand-and-supply.html.

Ramos I. Utilização de benzodiazepinas e análogos. Infarmed;2017. [consultado 2022 jun 15]. Disponível em: http://www.infarmed.pt/documents/15786/2219894/Utliliza%C3%A7%C3%A3o+de+Benzodiazepinas+e+an%C3%A1logos/adb100fa-4a77-4eb7-9e67-99229e13154f.

OECD/European Union. Health at a Glance: Europe 2020: State of Health in the EU Cycle. 2020. [consultado 2022 jun 02]. Disponível em: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe-2020_82129230-en.

Infarmed. Relatório do Infarmed “Medicamentos não sujeitos a receita médica – monitorização das vendas fora das farmácias”. 2019. [consultado 2022 maio 11]. Disponível em: https://www.infarmed.pt/web/infarmed/profissionais-de-saude/utilizacao-e-despesa/relatorios/mnsrm.

Published

2023-07-07

How to Cite

1.
Carmona Araújo A, Fernandes E, Franco Ruivo I, Machado M do C, Faria Vaz A, Furtado C. Prevalence of Outpatient Use of Medicines by the Elderly Population in Portugal: A Cross-Sectional Study. Acta Med Port [Internet]. 2023 Jul. 7 [cited 2024 Apr. 22];36(12):792-801. Available from: https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/19254

Issue

Section

Original