Profile, cost and pattern of prescriptions for polymedicated patients in Catalonia, Spain

OBJECTIVES: Polypharmacy is one of the main management issues in public health policies because of its financial impact and the increasing number of people involved. The polymedicated population according to their demographic and therapeutic profile and the cost for the public healthcare system were characterised. DESIGN: Cross-sectional study. SETTING: Primary healthcare in Barcelona Health Region, Catalonia, Spain (5 105 551 inhabitants registered). PARTICIPANTS: All insured polymedicated patients. Polymedicated patients were those with a consumption of ≥16 drugs/month. MAIN OUTCOMES MEASURES: The study variables were related to age, gender and medication intake obtained from the 2008 census and records of prescriptions dispensed in pharmacies and charged to the public health system. RESULTS: There were 36 880 polymedicated patients (women: 64.2%; average age: 74.5±10.9 years). The total number of prescriptions billed in 2008 was 2 266 830 (2 272 920 total package units). The most polymedicated group (up to 40% of the total prescriptions) was patients between 75 and 84 years old. The average number of prescriptions billed monthly per patient was 32±2, with an average cost of 452.7±27.5. The total cost of those prescriptions corresponded to 2% of the drug expenditure in Catalonia. The groups N, C, A, R and M represented 71.4% of the total number of drug package units dispensed to polymedicated patients. Great variability was found between the medication profiles of men and women, and between age groups; greater discrepancies were found in paediatric patients (5-14 years) and the elderly (≥65 years). CONCLUSIONS: This study provides essential information to take steps towards rational drug use and a structured approach in the polymedicated population in primary healthcare.

Pork Barrel politics in semi-democracies: the Spanish 'Parlamentary roads', 1874-1915

This paper analyzes the effects of parliamentary representation on road infrastructure expenditure during the Spanish Restoration. Using a panel dataset of Spanish provinces in 1880-1914 we find that the allocation of administrative resources among provinces depended both on the delegation characteristics (such as the share of MPs with party leadership positions, and their degree of electoral independence), and the regime"s global search for stability. These results point to the importance of electoral dynamics within semi-democratic political systems, and offer an example of the influence of government tactics on infrastructure allocation.

Pork Barrel politics in semi-democracies: the Spanish 'Parlamentary roads', 1874-1915

This paper analyzes the effects of parliamentary representation on road infrastructure expenditure during the Spanish Restoration. Using a panel dataset of Spanish provinces in 1880-1914 we find that the allocation of administrative resources among provinces depended both on the delegation characteristics (such as the share of MPs with party leadership positions, and their degree of electoral independence), and the regime"s global search for stability. These results point to the importance of electoral dynamics within semi-democratic political systems, and offer an example of the influence of government tactics on infrastructure allocation.