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Polypharmacy, defined as the concurrent use of multiple medications, is a growing concern among the elderly, especially in low-income and middle-income countries such as Iran. This study aims to explore the prevalence and patterns of polypharmacy among the elderly in Iran, using health insurance claims data to identify common drug classes and coprescribed medications, with a focus on informing policy decisions and improving medication management.
Retrospective population-based observational study.
Nationwide data from the Iran Health Insurance Organization (IHIO) across 24 provinces.
1 876 527 individuals aged 65 years and older, insured by the IHIO from 2014 to 2017. Individuals with incomplete demographic information or lacking medication records in the database were excluded from the analysis.
Prevalence and patterns of polypharmacy, demographic factors associated with polypharmacy, and common drug classes used. Medications were classified using the Anatomical Therapeutic Chemical system. Polypharmacy was defined as the use of five or more medications, with cumulative polypharmacy considering total drug use over time, and consecutive polypharmacy focusing on the frequency of monthly drug use. Logistic regression and association rule mining were applied to explore demographic factors and medication patterns associated with polypharmacy.
Of the study population, 74.9% experienced cumulative polypharmacy over 6 months and 64.6% over 1 month, with 7.6% experiencing consecutive polypharmacy. Females and those aged 75–79 were more prone to polypharmacy. Systemic glucocorticoids were the most commonly used medications (50.02%), followed by HMG-CoA reductase inhibitors (42.73%) and platelet aggregation inhibitors (41.92%). Polypharmacy was most strongly associated with medications related to the alimentary tract and metabolism, cardiovascular system, nervous system and blood and blood-forming organs.
Polypharmacy is highly prevalent among the elderly in Iran, with significant variations by gender, age, insurance fund and region. The findings highlight the need for targeted interventions to manage polypharmacy and improve medication safety in this population.
The COVID-19 outbreak at the end of 2019 severely impacted global healthcare systems, especially primary healthcare services. This paper aimed to identify the implications derived from the strengths and weaknesses observed in Iran’s primary healthcare (PHC) programmes during the pandemic.
This was a qualitative study conducted in 2021. 13 semistructured interviews were held with Iranian healthcare policymakers and executive managers, selected via snowball sampling, using the World Health Organization’s analytical framework. Finally, a thematic analysis was conducted on the interview data.
The thematic analysis of the findings yielded five major themes: revision of healthcare financing, redefining education and research in primary healthcare, redefinition of primary healthcare, development of a new model for family medicine, and community engagement.
Addressing vertical inequality in Iran’s healthcare system was delineated to be crucial. Meanwhile, multiple strategies including enhancing family physicians’ knowledge and skills, decentralising decision-making, empowering them and involving communities in healthcare planning were presented to improve PHC and family medicine. Further empirical research is needed.
This study aims to explore the negative emotions experienced by nurses following medication errors.
Mixed-method systematic review.
A systematic search was conducted in PubMed, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Google Scholar for studies published in English between January 2013 and October 2024. The Joanna Briggs Institute critical appraisal tool was used to assess article quality and data were analysed through qualitative content analysis.
From 1619 screened studies, 19 were selected: 14 qualitative, 3 quantitative and 2 mixed-method. The negative emotions experienced by nurses, as second victims of medication errors, can be categorised into 8 groups: Fear, anger, disturbance, sadness, shame, guilt, low self-esteem and depression. Additionally, the following 11 types of fear were identified: Fear of judgement, disrespect, losing one's job, getting scolded and contempt, retaliation and punishment, reaction, consequences, disciplinary actions and lawsuits, patient's well-being, reporting a medication error and losing patient's/their families' trust. Furthermore, two types of shame were identified: Internal and external shame.
The negative emotions that nurses experience as second victims can persist long after the error occurs. It underscores the need for structured psychological support systems to foster a culture of ‘responsibility without blame’.
Addressing nurses' emotional challenges as second victims enhances their well-being and improves global healthcare safety and quality.
These findings highlight the need for healthcare leaders and policymakers to implement interventions that foster a supportive, non-punitive workplace with the aim of improving the emotional well-being of nurses following medication errors.
The study adhered to PRISMA guidelines.
None.
Prospero code: CRD42023439304.
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