INTRODUCTION: Multi-dose dispensing (MDD) is a medication management system in Sweden that pre-packages regularly used prescription medicines into unit doses. Despite widespread use, there are no recent national estimates of MDD prevalence in Sweden, and little is known about how use evolved through the coronavirus disease 2019 (COVID-19) pandemic or which patient groups account for most MDD utilisation. OBJECTIVE: The purpose of this study was to describe the prevalence of multi-dose dispensing in older adults in Sweden from 2014 to 2023, spanning the COVID-19 pandemic, and describe trends by patient subgroups. METHODS: We conducted a repeated cross-sectional study of older adults aged ≥ 70 years old in Sweden, 2014-2023. We used nationwide data from the Swedish Prescribed Drug Register linked at the individual level with several other administrative and healthcare registers. The primary outcome was annual period prevalence of MDD, stratified by age, sex, education level, living status, civil status, health status and geography. RESULTS: Prevalence of MDD amongst adults aged 70 years or older increased by 1.5 percentage points between 2014 and 2023, reaching 12.1% in 2023, and there was no additional increase during the COVID-19 pandemic (2020-2022). In nursing home residents, MDD use approached near-universal levels (from 84.2 to 96.1%). Uptake also increased across other subgroups, most notably amongst people with a dementia diagnosis (+ 45.3 percentage points), those receiving home help services (+ 21.4 percentage points) and those with five or more chronic conditions (+ 15.3 percentage points). Over time, the characteristics of MDD users shifted towards community-dwelling adults receiving home help services, younger older adults (70-79 years old) and individuals with higher education. CONCLUSIONS: Our nationwide study indicates that MDD has become an established standard of medication management in Swedish nursing homes and is progressively extending into community settings amongst older adults with complex health needs. Prescribing of MDD remained stable during the COVID-19 pandemic. Future studies should quantify risks and benefits of MDD use especially in vulnerable, older, and frail populations.
Shepherd et al. (Mon,) studied this question.