title: Polypharmacy patterns: unravelling systematic associations between prescribed medications.
abstract: OBJECTIVE
  The aim of this study was to demonstrate the existence of systematic associations in drug prescription that lead to the establishment of patterns of polypharmacy, and the clinical interpretation of the associations found in each pattern.
  
  
  METHODS
  A cross-sectional study was conducted based on information obtained from electronic medical records and the primary care pharmacy database in 2008. An exploratory factor analysis of drug dispensing information regarding 79,089 adult patients was performed to identify the patterns of polypharmacy. The analysis was stratified by age and sex.
  
  
  RESULTS
  Seven patterns of polypharmacy were identified, which may be classified depending on the type of disease they are intended to treat: cardiovascular, depression-anxiety, acute respiratory infection (ARI), chronic obstructive pulmonary disease (COPD), rhinitis-asthma, pain, and menopause. Some of these patterns revealed a clear clinical consistency and included drugs that are prescribed together for the same clinical indication (i.e., ARI and COPD patterns). Other patterns were more complex but also clinically consistent: in the cardiovascular pattern, drugs for the treatment of known risk factors-such as hypertension or dyslipidemia-were combined with other medications for the treatment of diabetes or established cardiovascular pathology (e.g., antiplatelet agents). Almost all of the patterns included drugs for preventing or treating potential side effects of other drugs in the same pattern.
  
  
  CONCLUSIONS
  The present study demonstrated the existence of non-random associations in drug prescription, resulting in patterns of polypharmacy that are sound from the pharmacological and clinical viewpoints and that exist in a significant proportion of the population. This finding necessitates future longitudinal studies to confirm some of the proposed causal associations. The information discovered would further the development and/or adaptation of clinical patient guidelines to patients with multimorbidity who are taking multiple drugs.
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain ; Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain ; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain ; Teaching Unit of Preventive Medicine and Public Health, Aragón Health Sciences Institute (IACS), IIS Aragón, Zaragoza, Spain.
authors.forename: Amaia
authors.initials: A
authors.lastname: Calderón-Larrañaga
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain ; San Pablo Health Centre, Zaragoza, Spain ; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.
authors.forename: Luis A
authors.initials: LA
authors.lastname: Gimeno-Feliu
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain ; Delicias Sur Health Centre, Zaragoza, Spain ; Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain.
authors.forename: Francisca
authors.initials: F
authors.lastname: González-Rubio
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain ; Teaching Unit of Preventive Medicine and Public Health, Aragón Health Sciences Institute (IACS), IIS Aragón, Zaragoza, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Poblador-Plou
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Lairla-San José
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain ; Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain ; Department of Health Wellbeing and Family, Government of Aragón, Zaragoza, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Abad-Díez
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain ; Primary Care Directorate, Aragón Health Service, Zaragoza, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Poncel-Falcó
authors.affiliation: EpiChron Research Group on Chronic Diseases, Aragón Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain ; Department of Microbiology, Preventive Medicine and Public Health, University of Zaragoza, Zaragoza, Spain ; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carlos III Health Institute, Madrid, Spain ; Teaching Unit of Preventive Medicine and Public Health, Aragón Health Sciences Institute (IACS), IIS Aragón, Zaragoza, Spain.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Prados-Torres
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D057286:Electronic Health Records / Q000706:statistics & numerical data; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012737:Sex Factors; D013030:Spain / Q000453:epidemiology