Multiple Drug Initiations Common Despite Limited Evidence

TOPLINE:

Primary care physicians (PCPs) frequently initiated multiple medications simultaneously, with rates varying between 14.0% and 27.2% across institutions. Analysis showed that only 0.6% of the most common combinations were recommended to be started together.

METHODOLOGY:

• Researchers conducted this retrospective cohort study to assess how often PCPs prescribe multiple medications simultaneously, evaluate the evidence for the necessity of concurrent prescriptions, and examine variability in prescribing across PCPs and clinical sites.
• They analyzed outpatient prescribing data from four healthcare institutions between January 2017 and December 2018 and included PCPs specializing in internal medicine and family medicine with at least 100 patient encounters during the study period.
• All patients aged 18 years or older who received care from these PCPs at each institution and who were prescribed at least one medication during the study period were identified.
• Multiple medications were defined as two or more new prescriptions initiated on the same date by the same PCP; the patient must not have received these medications from any PCP in the last 2 years leading up to the date of the current prescription.
• Analysis focused on 4646 PCPs who wrote 8,656,454 new prescriptions.

TAKEAWAY:

• Varying rates of multiple concurrent drug initiations were observed across institutions: Veterans Health Administration (27.2%), Northwestern Medicine (19.7%), Brigham and Women’s Hospital in Boston (16.1%), and University of Illinois Chicago (14.0%).
• Within each health system, significant variation existed in the average frequency of physicians prescribing two or more new medications concurrently, with some rarely doing so and others prescribing multiple medications in over 25% of cases.
• Among the most common medication combinations, only 0.6% had strong evidence for concurrent initiation, whereas 16.8% were recommended for use together, and 71.5% were considered reasonable to take together but lacked evidence for simultaneous initiation.
• Researchers identified 11.1% of concurrent medication initiations as potentially problematic (10.4%) or contraindicated (0.7%) due to drug interactions or overlapping side effects.

IN PRACTICE:

“Based on our rating of the necessity of these concurrent starts, many could benefit from a more cautious approach that weighs the harms vs benefits of such simultaneous starts and considers alternate potentially safer prescribing strategies,” the authors wrote.

SOURCE:

The study was led by Tewodros Eguale, PhD, Massachusetts College of Pharmacy and Health Sciences, Boston. It was published online on March 28, 2025, in the Journal of General Internal Medicine.

LIMITATIONS:

This study was unable to confirm with certainty that a prescribed medication was genuinely new for the patient. The authors acknowledged that they could not conduct detailed chart reviews for each encounter, which limited their ability to fully assess the appropriateness of concurrent prescribing in individual cases. Data on clinical outcomes were lacking, which could have helped assess whether the multiple medication initiations were harmful or beneficial.

DISCLOSURES:

The study was supported by a grant from the Gordon and Betty Moore Foundation. The authors reported no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.