Multiple drug therapy and coordination of drug prescription for the elderly

From the literature we know that the use of drugs in general and the occurrence of polypharmacy (usually defined as concomitant use of five or more drugs) in particular, has increased dramatically among elderly in the population. Often hospitals, private practising specialists and general practitioners are all involved in the treatment of the old patient, and lack of coordination between the different providers may increase the likelihood of adverse drug events. Coordination of health care services for pa tients with complex health care needs is given priority in Norwegian health policy, and one important aim with the Regular General Practitioners Scheme introduced in 2001 was to strengthen the GPs role as coordinators of care for patients on their lists. Based on data from the Regular General Practitioner (RGP) database, the GPs volumes of service provision during the consultation are analysed in an extensive way. However, the registered data are not suitable for analysing the GPs role as coordinators of care for patients on their lists, i.e. their role in sickness certifications, referrals and prescriptions. The Norwegian Prescription Database (NorPD) contains drug information from all prescription drugs dispensed at pharmacies to individual patients liv ing outside institutions. The database also identifies the prescriber, but the database is unsuitable for identifying whether the regular GP was the prescriber or whether another general practitioner or a medical specialist did the prescribing. By means o f merging these two databases (the NorPD and the RGP database) we are able to identify the regular GP, and on basis of this merged dataset we can study the coordination of the drug prescription for old people with complex health care needs, and in particu lar the GPs role as a coordinator in the prescription process. The proposed project is an active collaboration between three experienced research groups.