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노인의 부적절한 다약제 사용 관리 기준 마련

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Type
Research report
Author(s)
윤상헌김동숙채정미최연미조호진
Issued Date
2023-01
Keyword
다약제노인잠재적으로 부적절한 의약품polypharmacythe elderlypotentially inappropriate medicines(PIMs)HIRAHealth Insurance Review & Assessment Service
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.
Publisher
건강보험심사평가원
URI
https://repository.hira.or.kr/handle/2019.oak/3086
Alternative Title
Establishment of criteria for managing inappropriate polypharmacy in the elderly
Table Of Contents
제1장 서론 ······························································································ 3
1. 연구 배경 ······························································································ 3
2. 연구 목적 ······························································································ 6
3. 연구 내용 및 방법 ·················································································· 6

제2장 부적절한 다약제 기준 설정 ······························································································ 11
1. 개요 ···································································································· 11
가. 임상사례 ·································································································· 14
나. 부적절 다약제 정의 ·················································································· 19
다. 부적절 다약제 기준 설정을 위한 전문가 의견 수렴 ······································ 19
2. 부적절한 다약제의 일반 기준 ································································· 21
가. 동시복용 의약품의 개수 및 복용 기간 ························································ 21
나. 환자의 상태 ····························································································· 21
다. 객관적 지표 ····························································································· 22
라. 검토 결과 ································································································ 25
3. 부적절한 다약제의 약물 기준 ································································· 27
가. 개요 ········································································································ 27
나. 노인의 응급실 내원에 영향을 주는 약물 목록 도출 ······································ 27
다. 노인의 부적절 다약제 후보 목록 검토 ························································ 45
라. 검토 결과 ································································································ 48
4. 노인 부적절 다약제 기준(안) ·································································· 51

제3장 부적절한 다약제 사용현황 및 건강결과 분석 ······························································································ 55
1. 개요 ···································································································· 55
2. 노인의 부적절한 다약제 사용 현황 ························································· 56
가. 분석 대상 및 분석 방법 ············································································ 56
나. 2017년 다약제 사용 노인 코호트의 일반특성 ·············································· 60
다. 다약제 사용 노인의 부적절한 약물 사용 현황 ·············································· 65
3. 노인의 부적절한 다약제 사용에 따른 건강결과 평가 ································· 71
가. 부적절한 다약제 사용 현황 및 특성 ··························································· 71
나. 부적절한 다약제 사용에 따른 건강결과 평가 ················································ 75

제4장 노인 부적절 다약제 관리 방안 ······························································································ 83
1. 노인 부적절 다약제 관리 국내외 사례 ···················································· 83
가. 국외 사례 ································································································ 83
나. 국내 사례 ································································································ 97
2. 노인 부적절 다약제 사용 관리 방안 ····················································· 106
가. 국내 노인 다약제 관리의 문제점 ······························································ 106
나. 선행연구 검토 ························································································ 108
다. 노인 부적절 다약제 사용 저감을 위한 국가 차원의 실효성 있는 관리 방안 ········ 111

제5장 결론 및 고찰 ······························································································ 127
1. 결론 ································································································ 127
2. 고찰 ································································································ 130

◾ 참고 문헌 ····················································································· 133
◾ 부록 ····························································································· 140
◾ ABSTRACT ················································································· 199
Publisher
건강보험심사평가원
Location
KOR
Citation
윤상헌. (2023-01). 노인의 부적절한 다약제 사용 관리 기준 마련.
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