The role of health system in the development of polypharmacy in Iranian older adults: a content analysis study

Background. Polypharmacy was defined as the concurrent use of at least four medications daily over the past six months, with at least one of the medications being a prescription-only drug used without a proper indication. This study aimed to investigate the role of the healthcare system in the development of polypharmacy among the elderly in Iran. Methods. This qualitative study employed inductive content analysis using the Graneheim and Lundman approach. Through in-depth and semi-structured interviews with 24 participants, including elderly patients, caregivers, and physicians, the researchers explored their experiences. Results. The results revealed several key factors contributing to polypharmacy, including the disorganized referral system, difficulty accessing physicians, poor health data management, an insecure drug market, and poor drug distribution practices. Issues such as the low quality of Iranian medications, lack of coordination between physicians and pharmacists, and easy access to non-prescription drugs were identified as major contributors to inappropriate and unnecessary drug use. The study also suggested improvements, including the creation of electronic health records, better communication between healthcare providers, and enhancing the quality of domestically produced medications. Conclusion. The research underscores the need for structural reforms in the healthcare system to reduce polypharmacy among the elderly. Practical Implications. This research suggests that improving the referral and access system for physicians, health data management, and drug production and distribution can help prevent or reduce polypharmacy in the elderly.