Geographical Variation in Medication Prescriptions: A Multiregional Drug-Utilization Study: Frontiers in Pharmacology

V. Russo, V. Orlando, V.M. Monetti, F. Galimberti, M. Casula, E. Olmastroni, E. Tragni, E. Menditto, EDU.RE.DRUG Group

Research output: Contribution to journalArticlepeer-review


Background: Studies have emphasized the importance of geographical factors and general practitioner (GP) characteristics in influencing drug prescriptions. Objectives: To: (i) ascertain the prevalence rate (PR) of use of drugs in six therapeutic categories used for chronic conditions; (ii) assess how geographical characteristics and GP characteristics may influence drug prescribing. Methods: This study is part of the EDU.RE.DRUG Project, a national collaborative project founded by Italian Medicine Agency (AIFA). Cross-sectional analyses were undertaken employing the pharmacy-claim databases of four local health units (LHUs) located in two Italian regions: Lombardy and Campania. Six drug categories were evaluated: proton-pump inhibitors; antibiotics; respiratory-system drugs; statins; agents acting on the renin−angiotensin system; psychoanaleptic drugs. The PR was estimated according to drug categories at the LHU level. A linear multivariate regression analysis was undertaken to evaluate the association between the PR and geographical area, age and sex of GPs, number of patients, and percentage of patients aged >65 per GP. Results: LHUs in Campania showed a PR that was significantly higher than that in Lombardy. Antibiotics showed the highest PR in all the LHUs assessed, ranging from 32.5% in Lecco (Lombardy) to 59.7% in Naples-2 (Campania). Multivariate linear regression analysis confirmed the association of the PR with geographical area for all drug categories. Being located in Campania increased the possibility of receiving a drug prescription from the categories considered, with estimates more marked for antibiotics, proton-pump-inhibitors, and respiratory-system drugs. Conclusions: This study provides information about the PR of medications used for treating common and costly conditions in Italy and highlighted a significant geographical variation. These insights could help to develop area-specific strategies to optimize prescribing behavior. © Copyright © 2020 Russo, Orlando, Monetti, Galimberti, Casula, Olmastroni, Tragni and Menditto and EDU.RE.DRUG Group.
Original languageEnglish
JournalFront. Pharmacol.
Publication statusPublished - 2020


  • drug use
  • drug-utilization
  • general practitioner
  • geographical difference
  • pharmacy claims
  • prevalence
  • angiotensin receptor antagonist
  • antibiotic agent
  • antidepressant agent
  • central stimulant agent
  • dipeptidyl carboxypeptidase inhibitor
  • hydroxymethylglutaryl coenzyme A reductase inhibitor
  • proton pump inhibitor
  • respiratory tract agent
  • serotonin uptake inhibitor
  • adult
  • age
  • aged
  • Article
  • controlled study
  • cross-sectional study
  • drug utilization
  • female
  • geography
  • human
  • Italy
  • major clinical study
  • male
  • middle aged
  • prescription
  • retrospective study
  • sex


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