Identification and evaluation of cases of polypharmacy and irrational pharmacotherapy in Georgia

BACKGROUND: Medical practice sometimes involves the prescription of multiple medications (5 or more) at once, known as polypharmacy. Most frequently it occurs when a patient receives care from multiple doctors as a result of poly morbidity. The study aimed to identify polypharmacy cases (prescribing 5 or more than 5 medications) and irrational pharmacotherapy. METHODS: Polypharmacy and irrational pharmacotherapy cases in Georgia from 1 July to 30 September 2021 were evaluated using an electronic prescription system. The total number of polypharmacy was 7665, where 5 or more medications were prescribed. Out of 7665 cases, 612 (8%) were irrational pharmacotherapy that was assessed according to Beers criteria (American Geriatrics Association, 2015) and STOP/START criteria (recommendations of the Great Britain National Health Organization, NHS, 2014). RESULTS: Out of 612 cases 95 (15.6%) indicated irrational prescription (2 or more drugs) containing the same active ingredient under different trade names, which represented 1.2% of the total number of prescriptions; out of 612 cases 72% (440) and 5.9% out of a total number of cases the simultaneous appointment of drugs of the same and/or similar pharmacological group was detected. In 9.4% of cases (57) non-rational pharmacotherapy (an incompatibility of drugs) was revealed that was 0.8% of the total cases; out of 612 cases 20, or 3%, and 0.3% of the total cases showed that the prescription contained more than 2 antibiotics. CONCLUSIONS: Medical polypharmacy is widespread in Georgia, especially in co-morbid elderly patients, which further increases their morbidity and mortality rates. The obtained results could be used to increase the efficiency of treatment, improve the population's health and reduce treatment costs. KEY MESSAGES: • The selection drug or combination of drugs is a complex process and requires justification of the appropriateness of the prescription for a particular patient. • A major goal of the best clinical practice is to optimize the use of medical preparations, improve quality of life and reduce expenses on drugs.