Legacy drug prescribing patterns in primary care
Open accessAbstract
PURPOSE Polypharmacy is a key clinical challenge for primary care. Drugs that should be prescribed for an intermediate term (longer than 3 months, but not indefinitely) that are not appropriately discontinued could contribute to polypharmacy. We named this type of prescribing legacy prescribing. Commonly prescribed drugs with legacy prescribing potential include antidepressants, bisphosphonates, and proton pump inhibitors (PPIs). We evaluated the proportion of legacy prescribing within these drug classes. METHODS We conducted a population-based retrospective cohort study using prospectively collected data from the McMaster University Sentinel and Information Collaboration (MUSIC) Primary Care Practice Based Research Network, located in Hamilton, Ontario. All adult patients (aged 18 or older) in the MUSIC data set during 2010-2016 were included (N = 50,813). We calculated rates of legacy prescribing of antidepressants (prescription longer than 15 months), bisphosphonates (longer than 5.5 years), and PPIs (longer than 15 months). RESULTS The proportion of patients having a legacy prescription at some time during the study period was 46% (3,766 of 8,119) for antidepressants, 14% (228 of 1,592) for bisphosphonates, and 45% (2,885 of 6,414) for PPIs. Many of these patients held current prescriptions. The mean duration of prescribing for all legacy prescriptions was significantly longer than that for non–legacy prescriptions (P <.001). Concurrent legacy prescriptions for both antidepressants and PPIs was common, signaling a potential prescribing cascade. CONCLUSIONS The phenomenon of legacy prescribing appears prevalent. These data demonstrate the potential of legacy prescribing to contribute to unnecessary polypharmacy, providing an opportunity for system-level intervention in primary care with enormous potential benefit for patients.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A Canadian primary care study of 8119 patients found that antidepressants were prescribed longer than needed, 15 months or longer with a mean duration of 4.8 years, for 46% of patients.
“A Canadian primary care study (n = 8119) found that antidepressants were prescribed longer than needed (15 months or longer, with a mean duration of 4.8 years) for 46% of patients (Mangin 2018).”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Mangin 2018
The Abstract and Main Study Findings report that 3,766 of 8,119 patients prescribed antidepressants (46%) met the legacy-prescribing threshold of longer than 15 months; their mean prescription duration was 4.8 years. But the Strengths and Limitations section says some prescriptions meeting the criteria may have been clinically appropriate and that individual appropriateness was beyond the study’s scope. Thus the study does not establish that treatment was longer than needed for every patient in the 46%. Page numbers were not provided in our copy. (LLM, conf=0.87)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 47 · Cited by 51
- Authors
- Mangin, D., Lawson, J., Cuppage, J., Shaw, E., Ivanyi, K., Davis, A., & Risdon, C.
- Affiliations
- University of Otago (NZ)
- McMaster University (CA)
- University of Toronto (CA)
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2018-11
- Volume
- 16
- Issue
- 6
- Pages
- 515-520
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC6231929
- OpenAlex
- W2901481540
- Semantic Scholar
- 41e4e031bbed65f78ef9b89689433e9149899998
- Cited by
- 51
- References
- 47
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 6 · 2023: 4 · 2022: 2 · 2021: 15 · 2020: 5 · 2019: 3 · 2018: 3
- FWCI
- 3.60
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- polypharmacy, antidepressants, bisphosphonates, proton pump inhibitors, prescription duration, prescribing cascades, primary care, drug discontinuation
- MeSH terms
- Adolescent, Adult, Aged, Antidepressive Agents, Diphosphonates, Female, Humans, Male, Middle Aged, Ontario, Practice Patterns, Physicians', Drug Prescriptions, Primary Health Care, Prospective Studies, Retrospective Studies, Prevalence, Polypharmacy, Bone Density Conservation Agents, Proton Pump Inhibitors, Young Adult, Inappropriate Prescribing
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
