From pharmaco-therapy to pharmaco-prevention: trends in prescribing to older adults in Ontario, Canada, 1997-2006
1 Undergraduate Medical Education, Faculty of Medicine, University of Toronto, Trillium Health Centre, CA Building 3rd Floor, 100 Queensway West, Mississauga, ON L5B 1B8 Canada
2 Department of Pharmacy, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room E3-05, Toronto, ON M4N 3M5 Canada
3 Primary Care Research Unit, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room E3-49, Toronto, ON M4N 3M5 Canada
4 Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON M5S 3M2 Canada
5 Department of Family and Community Medicine, University of Toronto, 263 McCaul St., 5th Floor, Toronto, ON M5T 1W7 Canada
6 Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Room G1-06, Toronto, ON M4N 3M5 Canada
7 School of Kinesiology and Health Science, York University, 344 Bethune College, Toronto, ON M3J 1P3 Canada
8 University of Toronto Joint Centre for Bioethics, 155 College St., Suite 754, Toronto, ON M5T 1P8 Canada
9 Dalla Lana School of Public Health, University of Toronto, 155 College St., 6th Floor, Toronto, ON M5T 3M7 Canada
BMC Family Practice 2010, 11:75 doi:10.1186/1471-2296-11-75Published: 7 October 2010
The developed world is undergoing a demographic transition with greater numbers of older adults and higher rates of chronic disease. Most elder care is now provided by primary care physicians, who prescribe the majority of medications taken by these patients. Despite these significant trends, little is known about population-level prescribing patterns to primary care patients aged 65+.
We conducted a population-based retrospective cohort study to examine 10-year prescribing trends among family physicians providing care to patients aged 65+ in Ontario, Canada.
Both crude number of prescription claims and prescription rates (i.e., claims per person) increased dramatically over the 10-year study period. The greatest change was in prescribing patterns for females aged 85+. Dramatic increases were observed in the prescribing of preventive medications, such as those to prevent osteoporosis (+2,347%) and lipid-lowering agents (+697%). And lastly, the number of unique classes of medications prescribed to older persons has increased, with the proportion of older patients prescribed more than 10 classes of medications almost tripling during the study period.
Prescribing to older adults by family physicians increased substantially during the study period. This raises important concerns regarding quality of care, patient safety, and cost sustainability. It is evident that further research is urgently needed on the health outcomes (both beneficial and harmful) associated with these dramatic increases in prescribing rates.