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Polypharmacy has been defined as the use of ≥5 medications concomitantly (independent of number taken daily) by a patient, with chronic disease or elderly sharing the same definition with a different number of medications [37]. This concept is more or less problematic. Most of the time all the components needed to define polypharmacy are not found, or this latter is defined although never checked [38]. In fact, a recent study showed that a wide variation of threshold values for non-communicable diseases (NCDs), based on diseases, drugs, or medical conditions, is used worldwide to define or exclude polypharmacy particularly in terms of medications or drug classes. In addition, the time span needed to define polypharmacy differs for NCDs and polypharmacy (a minimum of five medications over at least six months was proposed, but others suggested a more prolonged time span of nine months) [37]. Data on medications are largely missing in many population-based studies, which limits the assessment of polypharmacy [38]. In our study, polypharmacy was defined as the concurrent use of at least five medications. When compared with our study to that of Kivistö et al., the results are largely the same. For example, in NCD patients visiting PHC centers, polypharmacy was reported in 23.63% of patients

The other variable considered was the number of medications listed on the prescription or in the medical record. The number of medications is the most common measure of polypharmacy. In fact, the majority of studies, and even guidelines, have defined polypharmacy in relation to the number of medications, including the number of prescribed medications by a prescriber.

In line with the above, we used the number of medications in our analysis because it is easy to be readily available and has been the predominant measure used in pharmacogenetics and pharmacogenomics studies.

In our study, the number of medications exceeded the recommended limit of five medications for around one-third (33.19%) of NCD patients visiting the PHC centers Figure 1. An overview of the methodology used in this study. d2c66b5586