{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T09:08:36Z","timestamp":1778749716120,"version":"3.51.4"},"reference-count":54,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T00:00:00Z","timestamp":1771891200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005274","name":"North-West University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005274","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Clin Pharm"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Middle-aged adults (45\u201364\u00a0years), who constitute a large proportion of the population, are at risk of potentially inappropriate medicine (PIM) prescribing due to their high prevalence of multimorbidity. Drug class duplication, the concurrent prescription of two or more medicines from the same pharmacological class, is a commonly reported PIM criterion in studies using the PRescribing Optimally in Middle-aged People\u2019s Treatments (PROMPT) criteria.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To determine the prevalence of drug class duplication, stratified by sex and age group, and its associated factors among middle-aged adults using a South African pharmaceutical benefit management (PBM) company\u2019s medicine claims database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      A cross-sectional study was conducted using data from 1 January 2023\u201331 December 2023. Drug class duplication was assessed across 14 pharmacological drug classes. Prevalence of drug class duplications was analysed by sex and age group, with associations tested using Pearson\u2019s chi-square test. Spearman\u2019s correlation coefficient (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      ) was used to assess the correlation between drug class duplication and potential associated factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Of the 195,446 patients analysed (51.9% female; mean age 53.69\u00a0years [standard deviation (SD) 5.41, 95% confidence interval (CI) 53.665\u201353.713]), 48.8% experienced one or more drug class duplication. Duplication was similar between sexes (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.1685) and higher in older age groups (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001, Cram\u00e9r\u2019s\n                      <jats:italic>V<\/jats:italic>\n                      \u2009=\u20090.2). The most prevalent drug class duplications were 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) (n\u2009=\u200936,887, 18.9%); non-steroidal anti-inflammatory drugs (NSAIDs) (n\u2009=\u200930,829, 15.8%); angiotensin-converting enzyme (ACE) inhibitors (n\u2009=\u200925,646, 13.1%); angiotensin II receptor blockers (ARBs) (n\u2009=\u200922,411, 11.5%); calcium-channel blockers (CCBs) (n\u2009=\u200915,716, 8.0%); selective serotonin reuptake inhibitors (SSRIs) (n\u2009=\u200912,139, 6.2%); and beta-receptor blockers (\u03b2-blockers) (n\u2009=\u200911,577, 5.9%). Strong correlations were observed between drug class duplication and the number of Chronic Disease List (CDL) conditions per patient (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      \u2009=\u20090.680, 95% CI 0.678\u20130.683), and number of prescriptions per patient (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      \u2009=\u20090.638, 95% CI 0.636\u20130.641). Correlation with the number of medicine items per prescription per patient was moderate (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      \u2009=\u20090.391, 95% CI 0.388\u20130.400), and weak with age (\n                      <jats:italic>r<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>s<\/jats:italic>\n                      <\/jats:sub>\n                      \u2009=\u20090.232, 95% CI 0.227\u20130.236) (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.0001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Drug class duplication was common, highlighting that targeted interventions may be useful to improve patient safety.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11096-026-02091-6","type":"journal-article","created":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:48:06Z","timestamp":1771933686000},"page":"960-969","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Drug class duplication patterns among South African middle-aged adults: findings from a medicine claims database"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0535-169X","authenticated-orcid":false,"given":"Danielle Hope","family":"Fourie","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1740-5675","authenticated-orcid":false,"given":"Johanita Ri\u00e9tte","family":"Burger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9189-393X","authenticated-orcid":false,"given":"Jesslee Melinda","family":"du Plessis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7611-6171","authenticated-orcid":false,"given":"Martha Susanna","family":"Lubbe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,2,24]]},"reference":[{"key":"2091_CR1","unstructured":"World Health Organization. Medication without harm: policy brief. Geneva: World Health Organization; 2023. https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/1eacccb6-838e-4787-bfd9-4bdeb4debfcf\/content. Accessed 13 Oct 2025."},{"issue":"10","key":"2091_CR2","doi-asserted-by":"publisher","first-page":"1921","DOI":"10.1111\/bcp.14094","volume":"86","author":"AC Drenth-van Maanen","year":"2020","unstructured":"Drenth-van Maanen AC, Wilting I, Jansen PAF. Prescribing medicines to older people\u2014how to consider the impact of ageing on human organ and body functions. Br J Clin Pharmacol. 2020;86(10):1921\u201330. https:\/\/doi.org\/10.1111\/bcp.14094.","journal-title":"Br J Clin Pharmacol"},{"issue":"8","key":"2091_CR3","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.26910","volume":"6","author":"F Tian","year":"2023","unstructured":"Tian F, Chen Z, Zeng Y, et al. Prevalence of use of potentially inappropriate medications among older adults worldwide: a systematic review and meta-analysis. JAMA Netw Open. 2023;6(8):e2326910. https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.26910.","journal-title":"JAMA Netw Open"},{"issue":"5","key":"2091_CR4","doi-asserted-by":"publisher","first-page":"e290","DOI":"10.1016\/S2666-7568(21)00054-4","volume":"2","author":"PA Rochon","year":"2021","unstructured":"Rochon PA, Petrovic M, Cherubini A, et al. Polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens. Lancet Healthy Longev. 2021;2(5):e290\u2013300. https:\/\/doi.org\/10.1016\/S2666-7568(21)00054-4.","journal-title":"Lancet Healthy Longev"},{"key":"2091_CR5","doi-asserted-by":"publisher","first-page":"201010582311814","DOI":"10.1177\/20101058231181478","volume":"32","author":"CS Lee","year":"2023","unstructured":"Lee CS, Tan NC, Goh KLS, et al. Factors associated with potentially inappropriate prescribing among older persons in primary care settings: systematic review. Proc Singap Healthc. 2023;32:20101058231181480. https:\/\/doi.org\/10.1177\/20101058231181478.","journal-title":"Proc Singap Healthc"},{"key":"2091_CR6","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s40267-021-00884-5","volume":"38","author":"M Naughton","year":"2022","unstructured":"Naughton M, Moriarty F, Bailey J, et al. A systematic review of the prevalence, determinants, and impact of potentially inappropriate prescribing in middle\u2011aged adults. Drugs Ther Perspect. 2022;38:21\u201332. https:\/\/doi.org\/10.1007\/s40267-021-00884-5.","journal-title":"Drugs Ther Perspect"},{"issue":"9836","key":"2091_CR7","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","volume":"380","author":"K Barnett","year":"2012","unstructured":"Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012;380(9836):37\u201343. https:\/\/doi.org\/10.1016\/S0140-6736(12)60240-2.","journal-title":"Lancet"},{"issue":"5","key":"2091_CR8","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0269081","volume":"17","author":"RA Roomaney","year":"2022","unstructured":"Roomaney RA, van Wyk B, Cois A, et al. One in five South Africans are multimorbid: an analysis of the 2016 demographic and health survey. PLoS ONE. 2022;17(5):e0269081. https:\/\/doi.org\/10.1371\/journal.pone.0269081.","journal-title":"PLoS ONE"},{"key":"2091_CR9","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2022.1082587","volume":"10","author":"RA Roomaney","year":"2023","unstructured":"Roomaney RA, van Wyk B, Cois A, et al. Multimorbidity patterns in South Africa: a latent class analysis. Front Public Health. 2023;10:1082587. https:\/\/doi.org\/10.3389\/fpubh.2022.1082587.","journal-title":"Front Public Health"},{"key":"2091_CR10","doi-asserted-by":"publisher","DOI":"10.1038\/s41572-022-00376-4","volume":"8","author":"ST Skou","year":"2022","unstructured":"Skou ST, Mair FS, Fortin M, et al. Multimorbidity. Nat Rev Dis Primers. 2022;8:48. https:\/\/doi.org\/10.1038\/s41572-022-00376-4.","journal-title":"Nat Rev Dis Primers"},{"key":"2091_CR11","unstructured":"World Health Organization. Medication safety in polypharmacy. Geneva: World Health Organization; 2019. https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/be139493-0474-49cd-9767-b72069bf42d6\/content. Accessed 13 Oct 2025."},{"issue":"708","key":"2091_CR12","doi-asserted-by":"publisher","first-page":"e491","DOI":"10.3399\/BJGP.2020.1048","volume":"71","author":"A Khatter","year":"2021","unstructured":"Khatter A, Moriarty F, Ashworth M, et al. Prevalence and predictors of potentially inappropriate prescribing in middle-aged adults: a repeated cross-sectional study. Br J Gen Pract. 2021;71(708):e491\u20137. https:\/\/doi.org\/10.3399\/BJGP.2020.1048.","journal-title":"Br J Gen Pract"},{"issue":"10","key":"2091_CR13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-016562","volume":"7","author":"F Moriarty","year":"2017","unstructured":"Moriarty F, Cahir C, Bennett K, et al. Potentially inappropriate prescribing and its association with health outcomes in middle-aged people: a prospective cohort study in Ireland. BMJ Open. 2017;7(10):e016562. https:\/\/doi.org\/10.1136\/bmjopen-2017-016562.","journal-title":"BMJ Open"},{"key":"2091_CR14","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-014-0484-6","volume":"14","author":"JA Cooper","year":"2014","unstructured":"Cooper JA, Ryan C, Smith SM, et al. The development of the PROMPT (PRescribing Optimally in Middle-aged People\u2019s Treatments) criteria. BMC Health Serv Res. 2014;14:484. https:\/\/doi.org\/10.1186\/s12913-014-0484-6.","journal-title":"BMC Health Serv Res"},{"issue":"7","key":"2091_CR15","doi-asserted-by":"publisher","first-page":"3404","DOI":"10.1111\/bcp.15295","volume":"88","author":"R Jayesinghe","year":"2022","unstructured":"Jayesinghe R, Moriarty F, Khatter A, et al. Cost outcomes of potentially inappropriate prescribing in middle\u2010aged adults: a Delphi consensus and cross\u2010sectional study. Br J Clin Pharmacol. 2022;88(7):3404\u201320. https:\/\/doi.org\/10.1111\/bcp.15295.","journal-title":"Br J Clin Pharmacol"},{"issue":"2","key":"2091_CR16","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1111\/psyg.12940","volume":"23","author":"M Schulze Westhoff","year":"2023","unstructured":"Schulze Westhoff M, Schr\u00f6der S, Groh A, et al. Sedatives and analgesics are major contributors to potentially inappropriate duplicate prescriptions in geriatric psychiatry. Psychogeriatrics. 2023;23(2):354\u201363. https:\/\/doi.org\/10.1111\/psyg.12940.","journal-title":"Psychogeriatrics"},{"key":"2091_CR17","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1007\/s40266-024-01145-6","volume":"41","author":"T Erhan","year":"2024","unstructured":"Erhan T, Wastesson JW, Fastbom J. Trends in drug duplications in Swedish older adults: a nationwide register study from 2006 to 2021. Drugs Aging. 2024;41:775\u201381. https:\/\/doi.org\/10.1007\/s40266-024-01145-6.","journal-title":"Drugs Aging"},{"key":"2091_CR18","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1007\/s00228-015-2003-z","volume":"72","author":"JA Cooper","year":"2016","unstructured":"Cooper JA, Moriarty F, Ryan C, et al. Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria. Eur J Clin Pharmacol. 2016;72:583\u201391. https:\/\/doi.org\/10.1007\/s00228-015-2003-z.","journal-title":"Eur J Clin Pharmacol"},{"key":"2091_CR19","unstructured":"Council for Medical Schemes. CMS Industry report 2023. 2024. https:\/\/www.medicalschemes.co.za\/the-cms-2023-industry-report-is-here\/. Accessed 13 Oct 2025."},{"key":"2091_CR20","unstructured":"Snyman JR, editor. Monthly Index of Medical Specialities (MIMS\u00ae). Cape Town: CTP Printers; 2023."},{"key":"2091_CR21","unstructured":"Republic of South Africa. Medical Schemes Act 131 of 1998, as amended. Pretoria: Government Printer; 1998. https:\/\/www.gov.za\/documents\/medical-schemes-act. Accessed 13 Oct 2025."},{"key":"2091_CR22","unstructured":"Council for Medical Schemes. What are prescribed minimum benefits? 2025. https:\/\/www.medicalschemes.co.za\/resources\/pmb\/. Accessed 13 Oct 2025."},{"issue":"2","key":"2091_CR23","doi-asserted-by":"publisher","first-page":"144","DOI":"10.4097\/kjae.2017.70.2.144","volume":"70","author":"SG Kwak","year":"2017","unstructured":"Kwak SG, Kim JH. Central limit theorem: the cornerstone of modern statistics. Korean J Anesthesiol. 2017;70(2):144\u201356. https:\/\/doi.org\/10.4097\/kjae.2017.70.2.144.","journal-title":"Korean J Anesthesiol"},{"key":"2091_CR24","unstructured":"Steyn H. Manual for the determination of effect size indices and practical significance. Potchefstroom: North-West University; 2012. https:\/\/natural-sciences.nwu.ac.za\/scs\/effect. Accessed 12 Oct 2025."},{"issue":"5","key":"2091_CR25","doi-asserted-by":"publisher","first-page":"1763","DOI":"10.1213\/ANE.0000000000002864","volume":"126","author":"P Schober","year":"2018","unstructured":"Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126(5):1763\u20138. https:\/\/doi.org\/10.1213\/ANE.0000000000002864.","journal-title":"Anesth Analg"},{"issue":"2","key":"2091_CR26","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0264343","volume":"17","author":"R Vos","year":"2022","unstructured":"Vos R, Boesten J, van den Akker M. Fifteen-year trajectories of multimorbidity and polypharmacy in Dutch primary care\u2014a longitudinal analysis of age and sex patterns. PLoS ONE. 2022;17(2):e0264343. https:\/\/doi.org\/10.1371\/journal.pone.0264343.","journal-title":"PLoS ONE"},{"key":"2091_CR27","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-024-00715-z","volume":"43","author":"Y Ng","year":"2024","unstructured":"Ng Y, Low AJA, Chan C, et al. Healthcare utilisation patterns and contributory factors among middle-aged adults: a scoping review. J Health Popul Nutr. 2024;43:218. https:\/\/doi.org\/10.1186\/s41043-024-00715-z.","journal-title":"J Health Popul Nutr"},{"issue":"5","key":"2091_CR28","doi-asserted-by":"publisher","first-page":"e282","DOI":"10.1016\/S2468-2667(24)00053-7","volume":"9","author":"V Patwardhan","year":"2024","unstructured":"Patwardhan V, Gil GF, Arrieta A, et al. Differences across the lifespan between females and males in the top 20 causes of disease burden globally: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Public Health. 2024;9(5):e282\u201394. https:\/\/doi.org\/10.1016\/S2468-2667(24)00053-7.","journal-title":"Lancet Public Health"},{"key":"2091_CR29","unstructured":"Republic of South Africa. Medicines and Related Substances Act 101 of 1965, as amended. Pretoria: Government Printer; 1965. https:\/\/www.gov.za\/documents\/drugs-control-act-7-jul-1965-0000. Accessed 13 Oct 2025."},{"issue":"3","key":"2091_CR30","doi-asserted-by":"publisher","first-page":"128","DOI":"10.7196\/sajp.474","volume":"19","author":"R Emsley","year":"2013","unstructured":"Emsley R, Colin F, Flisher AJ, et al. The South African Society of Psychiatrists (SASOP) treatment guidelines for psychiatric disorders. S Afr J Psychiatr. 2013;19(3):128\u201399. https:\/\/doi.org\/10.7196\/sajp.474.","journal-title":"S Afr J Psychiatr"},{"key":"2091_CR31","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-023-03021-3","volume":"21","author":"A Prior","year":"2023","unstructured":"Prior A, Vestergaard CH, Vedsted P, et al. Healthcare fragmentation, multimorbidity, potentially inappropriate medication, and mortality: a Danish nationwide cohort study. BMC Med. 2023;21:305. https:\/\/doi.org\/10.1186\/s12916-023-03021-3.","journal-title":"BMC Med"},{"key":"2091_CR32","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-023-09718-8","volume":"23","author":"R Khatri","year":"2023","unstructured":"Khatri R, Endalamaw A, Erku D, et al. Continuity and care coordination of primary health care: a scoping review. BMC Health Serv Res. 2023;23:750. https:\/\/doi.org\/10.1186\/s12913-023-09718-8.","journal-title":"BMC Health Serv Res"},{"key":"2091_CR33","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1007\/s11096-014-0042-7","volume":"37","author":"DS Kim","year":"2015","unstructured":"Kim DS, Je NK, Kim GJ, et al. Therapeutic duplicate prescribing in Korean ambulatory care settings using the National Health Insurance claim data. Int J Clin Pharm. 2015;37:76\u201385. https:\/\/doi.org\/10.1007\/s11096-014-0042-7.","journal-title":"Int J Clin Pharm"},{"issue":"10","key":"2091_CR34","doi-asserted-by":"publisher","first-page":"e048676","DOI":"10.1136\/bmjopen-2021-048676","volume":"11","author":"RA Roomaney","year":"2021","unstructured":"Roomaney RA, van Wyk B, Turawa EB, et al. Multimorbidity in South Africa: a systematic review of prevalence studies. BMJ Open. 2021;11(10):e048676. https:\/\/doi.org\/10.1136\/bmjopen-2021-048676.","journal-title":"BMJ Open"},{"key":"2091_CR35","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-021-04150-6","volume":"12","author":"C Masilela","year":"2022","unstructured":"Masilela C, Adeniyi OV, Benjeddou M. Prevalence, patterns and determinants of dyslipidaemia among South African adults with comorbidities. Sci Rep. 2022;12:337. https:\/\/doi.org\/10.1038\/s41598-021-04150-6.","journal-title":"Sci Rep"},{"key":"2091_CR36","unstructured":"Statistics South Africa. Non-communicable diseases in South Africa: findings from death notifications, 2008\u20132018. Pretoria: Statistics South Africa; 2023. https:\/\/www.statssa.gov.za\/publications\/Report-03-08-01\/Report-03-08-012018.pdf. Accessed 12 Oct 2025."},{"issue":"6","key":"2091_CR37","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0234000","volume":"15","author":"YG Tefera","year":"2020","unstructured":"Tefera YG, Alemayehu M, Mekonnen GB. Prevalence and determinants of polypharmacy in cardiovascular patients attending outpatient clinic in Ethiopia University Hospital. PLoS ONE. 2020;15(6):e0234000. https:\/\/doi.org\/10.1371\/journal.pone.0234000.","journal-title":"PLoS ONE"},{"key":"2091_CR38","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-022-02872-7","volume":"22","author":"P Mohsenzadeh","year":"2022","unstructured":"Mohsenzadeh P, Ardekani A, Poustchi H, et al. Population-based pattern of medication use and prevalence of polypharmacy among patients with cardiovascular diseases: results of the Pars cohort study from Iran. BMC Cardiovasc Disord. 2022;22:435. https:\/\/doi.org\/10.1186\/s12872-022-02872-7.","journal-title":"BMC Cardiovasc Disord"},{"issue":"11","key":"2091_CR39","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1007\/s11906-020-01109-2","volume":"22","author":"J An","year":"2020","unstructured":"An J, Derington CG, Luong T, et al. Fixed-dose combination medications for treating hypertension: a review of effectiveness, safety, and challenges. Curr Hypertens Rep. 2020;22(11):95. https:\/\/doi.org\/10.1007\/s11906-020-01109-2.","journal-title":"Curr Hypertens Rep"},{"issue":"3","key":"2091_CR40","doi-asserted-by":"publisher","first-page":"168","DOI":"10.24304\/kjcp.2023.33.3.168","volume":"33","author":"W Choi","year":"2023","unstructured":"Choi W, Koo H, Jeong KH, et al. Therapeutic duplication as a medication error risk in fixed-dose combination drugs for dyslipidemia: a nationwide study. Korean J Clin Pharm. 2023;33(3):168\u201377. https:\/\/doi.org\/10.24304\/kjcp.2023.33.3.168.","journal-title":"Korean J Clin Pharm"},{"issue":"3","key":"2091_CR41","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1136\/heartjnl-2018-313492","volume":"105","author":"F Moriarty","year":"2019","unstructured":"Moriarty F, Bennett K, Fahey T. Fixed-dose combination antihypertensives and risk of medication errors. Heart. 2019;105(3):204\u20139. https:\/\/doi.org\/10.1136\/heartjnl-2018-313492.","journal-title":"Heart"},{"issue":"17","key":"2091_CR42","doi-asserted-by":"publisher","first-page":"3288","DOI":"10.1093\/cvr\/cvac020","volume":"118","author":"M Ruscica","year":"2022","unstructured":"Ruscica M, Ferri N, Banach M, et al. Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications. Cardiovasc Res. 2022;118(17):3288\u2013304. https:\/\/doi.org\/10.1093\/cvr\/cvac020.","journal-title":"Cardiovasc Res"},{"issue":"5","key":"2091_CR43","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1007\/s10557-021-07199-7","volume":"36","author":"S Talic","year":"2022","unstructured":"Talic S, Marquina C, Ofori-Asenso R, et al. Switching, persistence and adherence to statin therapy: a retrospective cohort study using the Australian National Pharmacy Data. Cardiovasc Drugs Ther. 2022;36(5):867\u201377. https:\/\/doi.org\/10.1007\/s10557-021-07199-7.","journal-title":"Cardiovasc Drugs Ther"},{"key":"2091_CR44","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.640120","volume":"12","author":"T Soeiro","year":"2021","unstructured":"Soeiro T, Lacroix C, Pradel V, et al. Early detection of prescription drug abuse using doctor shopping monitoring from claims databases: illustration from the experience of the French Addictovigilance Network. Front Psychiatry. 2021;12:640120. https:\/\/doi.org\/10.3389\/fpsyt.2021.640120.","journal-title":"Front Psychiatry"},{"key":"2091_CR45","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1007\/s40267-019-00700-1","volume":"36","author":"T Smeaton","year":"2020","unstructured":"Smeaton T, McElwaine P, Cullen J, et al. A prospective observational pilot study of adverse drug reactions contributing to hospitalization in a cohort of middle\u2011aged adults aged 45\u201364 years. Drugs Ther Perspect. 2020;36:123\u201330. https:\/\/doi.org\/10.1007\/s40267-019-00700-1.","journal-title":"Drugs Ther Perspect"},{"key":"2091_CR46","doi-asserted-by":"publisher","DOI":"10.1017\/S146342361900094X","volume":"21","author":"M Adan","year":"2020","unstructured":"Adan M, Gillies C, Tyrer F, et al. The multimorbidity epidemic: challenges for real-world research. Prim Health Care Res Dev. 2020;21:e6. https:\/\/doi.org\/10.1017\/S146342361900094X.","journal-title":"Prim Health Care Res Dev"},{"issue":"11","key":"2091_CR47","doi-asserted-by":"publisher","first-page":"584","DOI":"10.11622\/smedj.2019109","volume":"61","author":"KY Ong","year":"2020","unstructured":"Ong KY, Lee PSS, Lee ES. Patient-centred and not disease-focused: a review of guidelines and multimorbidity. Singap Med J. 2020;61(11):584\u201390. https:\/\/doi.org\/10.11622\/smedj.2019109.","journal-title":"Singap Med J"},{"key":"2091_CR48","unstructured":"World Health Organization. Multimorbidity: technical series on safer primary care. Geneva: World Health Organization; 2016. https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/695cc0ce-75ea-4163-8bb5-3bc9733fa63f\/content. Accessed 13 Oct 2025."},{"issue":"3","key":"2091_CR49","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1093\/jphsr\/rmab038","volume":"12","author":"D Kroon","year":"2021","unstructured":"Kroon D, Steutel NF, Vermeulen H, et al. Effectiveness of interventions aiming to reduce inappropriate drug prescribing: an overview of interventions. J Pharm Health Serv Res. 2021;12(3):423\u201333. https:\/\/doi.org\/10.1093\/jphsr\/rmab038.","journal-title":"J Pharm Health Serv Res"},{"key":"2091_CR50","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.2147\/JMDH.S309938","volume":"14","author":"SA Rahayu","year":"2021","unstructured":"Rahayu SA, Widianto S, Defi IR, et al. Role of pharmacists in the interprofessional care team for patients with chronic diseases. J Multidiscip Healthc. 2021;14:1701\u201310. https:\/\/doi.org\/10.2147\/JMDH.S309938.","journal-title":"J Multidiscip Healthc"},{"key":"2091_CR51","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.777655","volume":"12","author":"DA Rodrigues","year":"2022","unstructured":"Rodrigues DA, Pl\u00e1cido AI, Mateos-Campos R, et al. Effectiveness of interventions to reduce potentially inappropriate medication in older patients: a systematic review. Front Pharmacol. 2022;12:777655. https:\/\/doi.org\/10.3389\/fphar.2021.777655.","journal-title":"Front Pharmacol"},{"key":"2091_CR52","doi-asserted-by":"publisher","DOI":"10.11606\/S1518-8787.2019053000781","volume":"53","author":"NSD Santos","year":"2019","unstructured":"Santos NSD, Marengo LL, Moraes FDS, et al. Interventions to reduce the prescription of inappropriate medicines in older patients. Rev Saude Publica. 2019;53:7. https:\/\/doi.org\/10.11606\/S1518-8787.2019053000781.","journal-title":"Rev Saude Publica"},{"issue":"10","key":"2091_CR53","doi-asserted-by":"publisher","first-page":"173","DOI":"10.5897\/AJPP2022.5329","volume":"16","author":"E Bronkhorst","year":"2022","unstructured":"Bronkhorst E, Schellack N, Gous AGS. Clinical pharmacy in South Africa: qualitative investigation of perspectives of practicing pharmacists. Afr J Pharm Pharmacol. 2022;16(10):173\u201382. https:\/\/doi.org\/10.5897\/AJPP2022.5329.","journal-title":"Afr J Pharm Pharmacol"},{"key":"2091_CR54","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2023.1207602","volume":"5","author":"C Zharima","year":"2023","unstructured":"Zharima C, Griffiths F, Goudge J. Exploring the barriers and facilitators to implementing electronic health records in a middle-income country: a qualitative study from South Africa. Front Digit Health. 2023;5:1207602. https:\/\/doi.org\/10.3389\/fdgth.2023.1207602.","journal-title":"Front Digit Health"}],"container-title":["International Journal of Clinical Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11096-026-02091-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11096-026-02091-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11096-026-02091-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T08:15:54Z","timestamp":1778746554000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11096-026-02091-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,24]]},"references-count":54,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["2091"],"URL":"https:\/\/doi.org\/10.1007\/s11096-026-02091-6","relation":{},"ISSN":["2210-7711"],"issn-type":[{"value":"2210-7711","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,24]]},"assertion":[{"value":"15 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was approved by the North-West University\nHealth Research Ethics Committee (NWU-00179-14-A1-16)\nand goodwill permission to conduct the study was obtained\nfrom the board of directors of the PBM company. To maintain anonymity and confidentiality, depersonalised medicine claims data were received from the PBM company. As\nsuch, patient consent was waived. This study was compiled\nin accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"As depersonalised medicine claims data were used where no individual patient could be identified, patient consent was waived.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}}]}}