Polypharmacy in Primary Care Practices among Chronic Elderly Patients in Gaza Strip


Introduction: The increasing number of elderly, and drug use among the elderly, emphasizes the need for continuous monitoring of drug utilization. Chronic diseases are frequent among the older population; the rate of drug related problems and drug-drug interactions (DDIs) with the medical and financial consequences are enormous. Polypharmacy (PP) is defined as the concomitant use of 5 or more medications. We studied PP among chronic elderly patients in Gaza Strip and its distri- bution among primary health care clinics in different areas. Materials and Methods: This study is a descriptive analytical study, analyzing prescription data from general practices during a 3-month time period, to measure the prevalence of PP and medication errors among chronic elderly pa- tients. Data were collected directly from the prescriptions and medical records, which contain per- sonal data for patients like patient age and gender, included the current illness, drug treatment for the current illness, chronic disease/s and drug treatment for chronic disease/s. SPSS software was used to analyze the obtained data. Results: Percent of major PP was the highest among patients aged 60 - 69 years when compared with other ages categories of study population but not reached to be statisticaly significant (0.012). Major PP was higher in female patients than that in male patients but difference wasn’t statistically significant (0.5). The average number of drug per prescription was 3.4 drug; and the minimum value per prescription was 1 meanwhile maximum value was 9 (SD + 1.7). Conclusion: PP (use of five drugs or more) is more prevalent among elderly patients with multiple diseases. Female patients consume more drugs than male do. There were some regional differences in drug utilization not explained by morbidity, suggesting some varia- tions in prescribing behaviors.

Share and Cite:

Taleb, M. , Abed, A. , Dahudi, A. , Najim, A. and Ahmed, A. (2014) Polypharmacy in Primary Care Practices among Chronic Elderly Patients in Gaza Strip. Pharmacology & Pharmacy, 5, 291-297. doi: 10.4236/pp.2014.53036.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Veehof, L., Stewart, R.E. and Haaijer-Ruskamp, F.M. (2000) The Development of Polypharmacy. A Longitudinal Study. Family Practice, 17, 261-267. http://dx.doi.org/10.1093/fampra/17.3.261
[2] Kennerfalk, A., Ruigomez, A. and Wallander, M.A. (2002) Geriatric Drug Therapy and Healthcare Utilization in the United Kingdom. Annals of Pharmacotherapy, 36, 797-803. http://dx.doi.org/10.1345/aph.1A226
[3] Fialova, D., Topinkova, E. and Gambassi, G. (2005) Potentially Inappropriate Medication Use Among Elderly Home Care Patients in Europe. Journal of the American Medical Association, 293, 1348-1358.
[4] Avorn, J. (2004) Polypharmacy. A New Paradigm for Quality Drug Therapy and Healthcare Utilization among the Elderly. Annals of Pharmacotherapy, 35, 1004-1009.
[5] Barat, I, Andreasen, F. and Damsgaard, E. (2000) The Consumption of Drugs by 75-Year-Old Individuals Living in Their Own Homes. European Journal of Clinical Pharmacology, 56, 501-509.
[6] Perry, B. and Turner, L. (2001) Aprediction Model for Polypharmacy: Are Older, Educated Women More Susceptible to an Adverse Drug Event? Journal of Women Aging, 13, 39-51. http://dx.doi.org/10.1300/J074v13n04_04
[7] Odubanjo, E., Bennett, K. and Feely, J. (2004) Influence of Socioeconomic Status on the Quality of Prescribing in the Elderly. A population Based Study. British Journal of Clinical Pharmacology, 58, 496-502.
[8] Linjakumpu, T., Hartikainen, S., Klaukka, T., Veijola, J., Kivela”, S. and Isoaho, R. (2002) Use of Medications and Polypharmacy Are Increasing among the Elderly. Journal of Clinical Epidemiology, 55, 809-817.
[9] Al-Windi, A. (2005) Determinants of Medicine Use in a Swedish Primary Health Care Practice Population. Pharmacoepidemiology and Drug Safety, 14, 47-51. http://dx.doi.org/10.1002/pds.1047
[10] Bjerrum, L., Sogaard, J., Hallas, J. and Kragstrup, J. (1999) Polypharmacy in General Practice: Differences between Practitioners. British Medical Journal, 49, 195-198.
[11] Hessel, A., Gunzelmann, T., Geyer, M. and Brahler, E. (2000) Utilization of Medical Services and Medication Intake of Patients over 60 in Germany. Zeitschrift für Gerontologie und Geriatrie, 33, 289-299.
[12] Little, P., Dorward, M., Warner, G., Stephens, K., Senior, J. and Moore, M. (2004) Importance of Patient Pressure and Perceived Pressure and Perceived Medical Need for Investigations, Referral, and Prescribing in Primary Care: Nested Observational Study. British Medical Journal, 328, 444-447. http://dx.doi.org/10.1136/bmj.38013.644086.7C
[13] Perkins, A., Kroenke, K. and Unutzer, J. (2004) Common Co-Morbidity Scales Were Similar in Their Ability to Predict Health Care Costs and Mortality. Journal of Clinical Epidemiology, 57, 1040-1048.
[14] WHO (2003) Medicines Strategy: Framework for Action in Essential Drugs and Medicines Policy 2000-2003. World Health Organization, Geneva, No. (WHO/EDM/2000.1).
[15] Wilkinson, G.R. (1997) The Effects of Diet, Aging and Disease-States on Presystemic Elimination and Oral Drug Bioavailability in Humans. Advanced Drug Delivery Reviews, 27, 129-159.
[16] (1997) Joint National Committee the Sixth Report of the Joint National Committee (JNC VI) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Archives of Internal Medicine, 157, 2413-2446.
[17] Tamblyn, R., Huang, A. and Perreault, R. (2003) The Medical Office of the 21st Century (MOXXI): Effectiveness of Computerized Decision-Making Support in Reducing Inappropriate Prescribing in Primary Care. Canadian Medical Association Journal, 169, 549-556.
[18] Burns, S. and Grove, K. (1997) The Practice of Nursing Research. W.B Saunders.
[19] WHO (1985) The Rational Use of Drugs: Report of the Conference of Experts. Geneva, World Health Organization, Geneva.
[20] Bjerrum, L., Rosholm, J.U. and Hallas, J. (1997) Methods for Estimating the Occurrence of Polypharmacy by Means of a Prescription Database. European Journal of Clinical Pharmacology, 53, 7-11.
[21] Helling, D.K., Lemke, J.H., Semla, T.P., Wallace, R.B., Lipson, D. P. and Cornoni-Huntley, J. (1987). Medication use characteristics in the elderly: The Iowa 65+ Rural Health Study. Journal of the American Geriatrics Society, 35, 4-12.
[22] Heerdink, E.R., Leufkens, H.G., Koppedraaijer, C. and Bakker, A. (1995) Information on Drug Use in the Elderly: A Comparison of Pharmacy, General-Practitioner and Patient Data. Pharmacy World and Science, 17, 20-24.
[23] Nolan, L. and O’Malley, K. (1987) Age-Related Prescribing Patterns in General Practice. Comprehensive Gerontology. Section A, 1, 97-101.
[24] Nolan, L. and O’Malley, K. (1988) Prescribing for the elderly: Part II. Prescribing Patterns: Differences Due to Age. Journal of the American Geriatrics Society, 36, 245-254.
[25] Population Reference Bureau (2007) World Population Data Sheet. Demographic Data and Estimates for the Countries and Regions of the World.
[26] Garfinkel, D., Zur-Gil, S. and Ben-Israel, J. (2007) The War against Polypharmacy: A New Cost-Effective Geriatric-Palliative Approach for Improving Drug Therapy in Disabled Elderly People. IMAJ, 9, 430-434.
[27] Kalchthaler, T., Coccaro, E. and Lichtiger, S. (1977) Incidence of Polypharmacy in a Long-Term Care Facility. Journal of the American Geriatrics Society, 25, 308-313.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.