노인의 부적절한 다약제 사용 관리 기준 마련

Abstract

As the elderly often suffer from multiple diseases simultaneously, they must often take several drugs prescribed by various physicians for a long time. Polypharmacy in the elderly is likely to result in negative health outcomes such as emergency room visits or hospitalization and increased medical costs. This does not mean that all polypharmacy is entirely negative or harmful. Since it may be inevitable in some cases, it is necessary to distinguish between appropriate and inappropriate polypharmacy for each patient by considering existing co-morbidities, the patient's clinical condition, and potential drug interactions. This study was conducted to define the criteria for inappropriate polypharmacy in the elderly, analyze its health consequences, and prepare a customizable management plan that promotes changes in prescription and medical usage patterns of medical institutions and patients. We reviewed clinical cases and suggested the inappropriate polypharmacy criteria as follows. ⅰ) the aged 65 years or older who had taken 10 or more medications for 90 days or more, and ⅱ) any of the drugs taken were included in the 77-ingredient list derived from this study or in the overlapping prescriptions or concomitant contraindications. Using health insurance claims data, we analyzed the status of inappropriate polypharmacy in the elderly and its consequent health outcomes, such as hospitalization, emergency room visits, and death. The inappropriate polypharmacy group comprised 245,477 patients, which accounted for 16.0% of the total polypharmacy group. After adjusting for variables affecting negative health outcomes, the probabilities of hospitalization, emergency room visit, and death were 1.32 to 1.35 times higher. This suggested that among polypharmacy patients, patients under inappropriate polypharmacy have a higher chance of experiencing negative health results. The problems and implications of polypharmacy in the elderly in Korea were identified by case review. Based on this, with expert advice, an effective management plan to reduce inappropriate polypharmacy in the elderly was presented. This study is meaningful in that it presented the inappropriate polypharmacy criteria in the elderly in consideration of the clinical situation, including the importance of policies, realistic validity, and applicability, empirically analyzed the current status and further presented realistic and specific management plans at the national level.