Elsevier

Epilepsy & Behavior

Volume 126, January 2022, 108428
Epilepsy & Behavior

Polypharmacy composition and patient- and provider-related variation in patients with epilepsy

https://doi.org/10.1016/j.yebeh.2021.108428Get rights and content
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open access

Highlights

  • We performed a retrospective analysis of patients with epilepsy in Medicare.

  • Polypharmacy was common (median 12 medications, 60% CNS polypharmacy).

  • Hydrocodone/acetaminophen was the second most common medication.

  • Provider differences explained more variation than patient differences in fills.

  • Future work should study drivers of high-prescribing practices.

Abstract

Objective

To describe polypharmacy composition, and the degree to which patients versus providers contribute to variation in medication fills, in people with epilepsy.

Methods

We performed a retrospective study of Medicare beneficiaries with epilepsy (antiseizure medication plus diagnostic codes) in 2014 (N = 78,048). We described total number of medications and prescribers, and specific medications. Multilevel models evaluated the percentage of variation in two outcomes (1. number of medications per patient-provider dyad, and 2. whether a medication was filled within thirty days of a visit) due to patient-to-patient differences versus provider-to-provider differences.

Results

Patients filled a median of 12 (interquartile range [IQR] 8–17) medications, from median of 5 (IQR 3–7) prescribers. Twenty-two percent filled an opioid, and 61% filled at least three central nervous system medications. Levetiracetam was the most common medication (40%), followed by hydrocodone/acetaminophen (27%). The strongest predictor of medications per patient was Charlson comorbidity index (7.5 [95% confidence interval (CI) 7.2–7.8] additional medications for index 8+ versus 0). Provider-to-provider variation explained 36% of variation in number of medications per patient, whereas patient-to-patient variation explained only 2% of variation. Provider-to-provider variation explained 57% of variation in whether a patient filled a medication within 30 days of a visit, whereas patient-to-patient variation explained only 30% of variation.

Conclusion

Patients with epilepsy fill a large number of medications from a large number of providers, including high-risk medications. Variation in medication fills was substantially more related to provider-to-provider rather than patient-to-patient variation. The better understanding of drivers of high-prescribing practices may reduce avoidable medication-related harms.

Keywords

Epilepsy
Epidemiology
Opioids
Polypharmacy

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