A comparative analysis of medication counting methods to assess polypharmacy in medico-administrative databases

Background: The variety of methods for counting medications may lead to confusion when attempting to compare the extent of polypharmacy across different populations. Objective: To compare the prevalence estimates of polypharmacy derived from medico-administrative databases, using different methods for counting medications. Methods: Data were drawn from the Qu & eacute;bec Integrated Chronic Disease Surveillance System. A random sample of 110,000 individuals aged >65 was selected, including only those who were alive and covered by the public drug plan during the one-year follow-up. We used six methods to count medications: #1-cumulative one-year count, #2-average of four quarters' cumulative counts, #3-count on a single day, #4-count of medications used in first and fourth quarters, #5-count weighted by duration of exposure, and #6-count of uninterrupted medication use. Polypharmacy was defined as >= 5 medications. Cohen's Kappa was calculated to assess the level of agreement between the methods. Results: A total of 93,516 (85 %) individuals were included. The prevalence of polypharmacy varied across methods. The highest prevalence was observed with cumulative methods (#1:74.1 %; #2:61.4 %). Single day count (#3:47.6 %), first and fourth quarters count (#4:49.5 %), and weighted count (#5:46.6 %) yielded similar results. The uninterrupted use count yielded the lowest estimate (#6:35.4 %). The weighted method (#5) showed strong agreement with the first and fourth quarters count (#4). Cumulative methods identified higher proportions of younger, less multimorbid individuals compared to other methods. Conclusion: Counting methods significantly affect polypharmacy prevalence estimates, necessitating their consideration when comparing and interpretating results.