국내 요양병원에서 노인 환자들의 다제약물복용 실태와 2003/2012년 Beers Criteria에 따른 처방약물의 적절성 분석

Abstract

As the population is aging, the prevalence of chronic diseases is increasing and polypharmacy is becoming essential in the elderly. The unnecessary medication use can increase the risk of potentially inappropriate medications (PIMs), resulting in adverse drug reaction. Beers Criteria published by The American Geriatrics Society (AGS) are used to identify and assess the appropriateness of prescription drugs in elderly patients. The aim of this study was to provide a optimal drug therapy which secures effectiveness and safeness in elderly patients by analyzing polypharmacy and the appropriateness of prescription drugs according to Beers Criteria 2003 and 2012. This study was conducted with patients aged over 65 years who received two or more medications in a long term care facility from March 2014 to August 2015. This study was retrospectively conducted through electronic medical record (EMR). Prescription drugs of the patients were investigated on 14th day after their hospitalization. We defined polypharmacy as taking two or more medications. PIMs were confirmed by the Beers Criteria 2003/2012 and subsequently the PIMs were compared and analyzed by ARS and FRMS. We investigated drug interactions among all prescription drugs by Micromedex. Of the total 544 patients, 216 patients were selected and the average number of medication was 5.3 (±2.7). We found that the number of comorbidity increased in accordance with the number of polypharmacy (p<0.001). The patients who received PIMs by the Beers Criteria 2003 and 2012 were 151 (69.9%) and 185 (85.6%), respectively. We found an association between polypharmacy and PIMs (p<0.001). The patients who received PIMs by ARS among the patients taking PIMs by the Beers Criteria 2003 and 2012 were 110 (72.8%) and 129 (69.7%), respectively. The patients who received PIMs by FRMS among the PIMs-taken patients by the Beers Criteria 2003 and 2012 were 79 (52.3%) and 96 (51.9%), respectively (p<0.001). The drug interactions that can cause potential risks were identified in 18 cases. The use of medication in elderly patients should be monitored carefully because polypharmacy can increase the risk of PIMs, leading to adverse drug reaction. This study was conducted in one specific long term care facility, which means that it does not represent the whole long term care facility. Thus, a follow-up study is required to provide an optimal therapy which secures effectiveness and safeness in elderly patients.