Detecting factors associated with polypharmacy in general practitioners' prescriptions: A data mining approach

Document Type : Article

Authors

1 - Department of Industrial Engineering, Sharif University of Technology, Tehran, Iran - Faculty of Industrial Engineering, Urmia University of Technology, Urmia, Iran

2 Department of Industrial Engineering, Sharif University of Technology, Tehran, Iran

3 Faculty of Industrial and Systems Engineering, Tarbiat Modares University, Tehran, Iran

Abstract

Prescribing and consuming drugs more than necessary is considered as polypharmacy, which is both wasteful and harmful. The purpose of this paper is to establish an innovative data mining framework for analyzing physicians’ prescriptions regarding polypharmacy. The approach consists of three main steps: pre-modeling, modeling, and post-modeling. In the first step, after collecting and cleaning the raw data, several novel physicians’ features are extracted. In the modeling step, two popular decision trees, i.e., C4.5 and Classification and Regression Tree (CART), are applied to generate a set of If-Then rules in a tree-shaped structure to detect and describe physicians’ features associated with polypharmacy. In a novel approach, the response surface method (RSM) as a tool for hyper-parameter tuning is simultaneously applied along with correlation-based feature selection (CFS) to enhance the performance of the algorithms. In the post-modeling step, the discovered knowledge is visualized to make the results more perceptible, then is presented to domain experts to evaluate whether they make sense or not. The framework has been applied to a real-world dataset of prescriptions. The results have been confirmed by the experts, which demonstrates the capabilities of the data mining framework in the detection and analysis of polypharmacy.

Keywords


References:
1. Lu, Y., Hernandez, P., Abegunde, D., et al. "Medicine expenditures", In The World Medicines Situation 2011., 3th Edn., pp. 35-38, World Health Organization, Geneva, Switzerland (2011).
2. Ofori-Asenso, R. "A closer look at the World Health Organization's prescribing indicators", J. Pharmacol. Pharmacother., 7(1), p. 51 (2016).
3. Mao, W., Vu, H., Xie, Z., et al. "Systematic review on irrational use of medicines in China and Vietnam", PLoS One, 10(3), pp. 1-16 (2015).
4. Holloway, K. and Van Dijk, L. "Rational use of medicines", In The World Medicines Situation 2011., 3th Edn., World Health Organization, Geneva, Switzerland (2011).
5. Holloway, K.A. and Henry, D. "WHO essential medicines policies and use in developing and transitional countries: An analysis of reported policy implementation and medicines use surveys", PLoS Med., 11(9), pp. 1-16 (2014).
6. WHO "TheWorld Health Report 2002: reducing risks, promoting healthy life", World Health Organization, Geneva, Switzerland (2002).
7. WHO, "How to investigate drug use in health facilities: selected drug use indicators", WHO/DAP/93.1, World Health Organization (1993).
8. Rambhade, S., Shrivastava, A., Rambhade, A., et al. "A survey on polypharmacy and use of inappropriate medications", Toxicol. Int., 19(1), pp. 68-73 (2012).
9. WHO "The world medicines situation", (No. WHO/ EDM/PAR/2004.5), World Health Organization, Geneva, Switzerland (2004).
10. Jokanovic, N., Tan, E.C.K., Dooley, M.J., et al. "Prevalence and factors associated with polypharmacy in long-term care facilities: A systematic review", J. Am. Med. Dir. Assoc., 16(6), pp. 535-e1 (2015).
11. Qi, K., Reeve, E., Hilmer, S.N., et al. "Older peoples' attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia", Int. J. Clin. Pharm., 37(5), pp. 949-957 (2015).
12. Reeve, E., Wiese, M.D., Hendrix, I., et al. "People's attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe", J. Am. Geriatr. Soc., 61(9), pp. 1508-1514 (2013).
13. Galazzi, A., Lusignani, M., Chiarelli, M.T., et al. Attitudes towards polypharmacy and medication withdrawal among older inpatients in Italy", Int. J. Clin. Pharm., 38(2), pp. 454-461 (2016).
14. Quinn, K.J. and Shah, N.H. "A dataset quantifying polypharmacy in the United States", Sci. Data, 4, p. 167 (2017).
15. Hovstadius, B. and Petersson, G. "Factors leading to excessive polypharmacy", Clin. Geriatr. Med., 28(2), pp. 159-172 (2012).
16. Bjerrum, L., Sgaard, J., Hallas, J., et al. "Polypharmacy in general practice: differences between practitioners", 49(440), pp. 195-198 (1999).
17. Anthierens, S., Tansens, A., Petrovic, M., et al. "Qualitative insights into general practitioners views on polypharmacy", BMC Fam. Pract., 11(1), p. 65 (2010).
18. O'Dwyer, M., Peklar, J., McCallion, P., et al. "Factors associated with polypharmacy and excessive polypharmacy in older people with intellectual disability differ from the general population: a cross-sectional observational nationwide study", BMJ Open, 6(4), e010505 (2016).
19. Ie, K., Felton, M., Springer, S., et al. "Physician factors associated with polypharmacy and potentially inappropriate medication use", J. Am Board Fam Med., 30(4), pp. 528-536 (2017). DOI: 10.3122/jabfm.2017.04.170121.
20. Slater, N., White, S., Venables, R., et al. "Factors associated with polypharmacy in primary care: a crosssectional analysis of data from the english longitudinal study of ageing (ELSA )", BMJ Open, 8(3), e020270 (2018).
21. Hogerzeil, H.V. "Promoting rational prescribing: an international perspective", Br. J. Clin. Pharmacol., 39(1), pp. 1-6 (1995).
22. Kumari, R., Idris, M.Z., Bhushan, V., et al. "Assessment of prescription pattern at the public health facilities of Lucknow district", Indian J. Pharmacol., 40(6), pp. 243-247 (2008).
23. Desalegn, A.A. "Assessment of drug use pattern using WHO prescribing indicators at Hawassa University teaching and referral hospital, south Ethiopia: A crosssectional study", BMC Health Serv. Res., 13(1), p. 170 (2013).
24. Atif, M., Sarwar, M.R., Azeem, M., et al. "Assessment of core drug use indicators using WHO/INRUD methodology at primary healthcare centers in Bahawalpur, Pakistan", BMC Health Serv. Res., 16(1), p. 684 (2016).
25. Bastani, P., Barfar, E., Rezapour, A., et al. "Rational prescription of drug in Iran: Statistics and trends for policymakers", JHMI J. Heal. Manag. Informatics, 5(April), pp. 35-40 (2018).
26. Cerrito, P. "Application of data mining for examining polypharmacy and adverse effects in cardiology patients", Cardiovasc. Toxicol., 1(3), pp. 177-179 (2001).
27. Ji, Y., Ying, H., Tran, J., et al. "A functional temporal association mining approach for screening potential drug-drug interactions from electronic patient databases", Informatics Heal. Soc. Care, 41(4), pp. 387-404 (2016).
28. Held, F., Le Couteur, D.G., Blyth, F.M., et al. "Polypharmacy in older adults: Association rule and frequent-set analysis to evaluate concomitant medication use", Pharmacol. Res., 116(April), pp. 39-44 (2017).
29. Poluzzi, E., Raschi, E., Piccinni, C., et al. "Data mining techniques in pharmacovigilance: Analysis of the publicly accessible FDA Adverse Event Reporting System (AERS)", In Data Mining Applications in Engineering and Medicine, Karahoca, A., Ed., BoD (2012).
30. Vilar, S., Friedman, C., and Hripcsak, G. "Detection of drug-drug interactions through data mining studies using clinical sources, scientific literature and social media", Brief. Bioinform., 19(5), pp. 1-15 (2018).
31. Sohail, M.N., Jiadong, R., Uba, M.M., et al. "A comprehensive looks at data mining techniques contributing to medical data growth: A survey of researcher reviews", Recent Dev. Intell. Comput. Commun. Devices, 752, pp. 21-26 (2019).
32. Kann, I.C., Lundqvist, C., and Luras, H. "Polypharmacy among the elderly in a list-patient system", Drugs-Real World Outcomes, 2(3), pp. 193-198 (2015).
33. IBM, "ASUM-DM", URL http://gforge.icesi.edu.co/ ASUM-DM External/index.htm. (2015).
34. Han, J., Kamber, M., and Pei, J., Data Mining: Concepts and Techniques, Elsevier (2011).
35. WHO "WHO methods and data sources for global burden of disease estimates 2000-2016", World Health Organization, Geneva, Switzerland (2018).
36. Wu, X., Kumar, V., Quinlan, J.R., et al. "Top 10 algorithms in data mining", Knowl. Inf. Syst., 14(1), pp. 1-37 (2008).
37. Guidotti, R., Monreale, A., Ruggieri, S., et al. "A survey of methods for explaining black box models" (2018). https://doi.org/10.48550/arXiv.1802.01933.
38. Quinlan, J.R., C4. 5 Programs for Machine Learning, Morgan Kaufmann, San Mateo, USA (2014).
39. Witten, I.H., Frank, E., Hall, M.A., et al., Data Mining: Practical Machine Learning Tools and Techniques, 3rd Edn., Morgan Kaufmann (2016).
40. Lamy, J.B., Ellini, A., Ebrahiminia, V., et al. "Use of the C4.5 machine learning algorithm to test a clinical guideline-based decision support system", Stud. Health Technol. Inform., 136, pp. 223-228 (2008).
41. Tu, M.C., Shin, D., and Shin, D. "A comparative study of medical data classification methods based on decision tree and bagging algorithms", 8th IEEE Int. Symp. Dependable, Auton. Secur. Comput. DASC 2009, Chengdu, China, pp. 183-187 (2009).
42. Lavanya, D. and Rani, K.U. "Performance evaluation of decision tree classifiers on medical datasets", Int. J. Comput. Appl., 26(4), pp. 1-4 (2011).
43. Solanki, A.V. "Data mining techniques using WEKA classification for sickle cell disease", Int. J. Comput. Sci. Inf. Technol., 5(4), pp. 5857-5860 (2014).
44. Wiharto, W., Kusnanto, H., and Herianto, H. "Interpretation of clinical data based on C4.5 algorithm for the diagnosis of coronary heart disease", Healthc. Inform. Res., 22(3), pp. 186-195 (2016).
45. Pecchia, L., Melillo, P., and Bracale, M. "Remote health monitoring of heart failure with data mining via CART method on HRV features", IEEE Trans. Biomed. Eng., 58(3), pp. 800-804 (2011).
46. Diessner, J., Wischnewsky, M., Stuber, T., et al. "Evaluation of clinical parameters influencing the development of bone metastasis in breast cancer", BMC Cancer, 16(1), pp. 307-320 (2016).
47. Zimmerman, R.K., Balasubramani, G.K., Nowalk, M.P., et al. "Classification and regression tree (CART) analysis to predict in
uenza in primary care patients", BMC Infect. Dis., 16(1), pp. 503-519 (2016).
48. Cheng, Z., Nakatsugawa, M., Hu, C., et al. "Evaluation of classification and regression tree (CART) model in weight loss prediction following head and neck cancer radiation therapy", Adv. Radiat. Oncol., 3(3), pp. 346- 355 (2018).
49. Mburu, J.W., Kingwara, L., Ester, M., et al. "Use of classification and regression tree (CART), to identify hemoglobin A1C (HbA1C) cut-off thresholds predictive of poor tuberculosis treatment outcomes and associated risk factors", J. Clin. Tuberc. Other Mycobact. Dis., 11(1), pp. 10-16 (2018).
50. Lujan-Moreno, G.A., Howard, P.R., Rojas, O.G., et al. "Design of experiments and response surface methodology to tune machine learning hyperparameters, with a random forest case-study", Expert Syst. Appl., 109(1), pp. 195-205 (2018).
51. Myers, R.H., Montgomery, D.C., and Anderson-Cook, C.M., Response Surface Methodology: Process and Product Optimization Using Designed Experiments, 4th Edn., John Wiley & Sons, New York, USA (2016).
52. Montgomery, D.C., Design and Analysis of Experiments, 10th Edn., John Wiley & Sons, USA (2019).
53. Hall, M.A. and Holmes, G. "Benchmarking attribute selection techniques for data mining", IEEE Trans. Knowl. Data Eng., 15(6), pp. 1437-1447 (2003).