정신건강의학과 외래치료를 받고 있는 노인환자들의 다중약물요법과 연관된 약물사용양상과 요인들
Patterns of Drug Use and Factors Associated with Polypharmacy in Elderly Patients Visiting Psychiatric Outpatient Clinic
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정신과 외래를 방문하는 노인환자의 대부분은 타과 약물을 복용하고 있었고, 무려 57.1%의 대상자가 다중약물요법을시행 받고 있었다. 이 중 16.6%는 10개 이상의 약물을, 2.8%는 15가지를 초과하는 약물을 복용하고 있었다. 따라서 외래환자를 보는 경우 여러 약물과의 상호작용을 늘 염두에 두어야 할 것이다. 다중약물요법이 시행되는 요인에는 보다 빠르고 신속한 치료효과를 원하는 임상가 요인 및 약물 변경의 과정 등 여러 가지가 있겠지만, 이것이 효과적이라는 근거1,26)는상당히 제한적이다. 따라서 의료진이 우선적으로 다중약물요법에 대한 주의를 가지고 현재 처방되고 있는 약물의 적절성을 주기적으로 평가하는 것이 중요할 것으로 보인다. 우리나라 노인들의 경우, 권위자에 대한 의존도가 높은 경향성25)을가지므로 더욱 그러하다. 향후에도 다중약물요법에 대한 실태, 효과, 안정성 등을 포함한 연구가 지속되어야 할 것이며,이를 통해 노인환자의 약물상호작용의 부작용을 낮출 수 있도록 노력해야 할 것이다.
Abstract
Objectives The objective of this study was to investigate the patterns and recent trends in polypharmacy among elderly patients visiting psychiatric outpatient clinic. Methods 289 elderly patients visiting psychiatric outpatient clinic were interviewed and their medical records were thoroughly reviewed. Inclusion criteria were as follows : 1) 65 years and older age patients, 2) diagnosed with one or more psychiatric disorder according to ICD-10 criteria, 3) who were willing to participate in this research. Demographic data and clinical data, including prevalence of polypharmacy, doses and types of drugs both prescribed and self-administered, were analyzed. Polypharmacy was defined as the long-term simultaneous use of six or more drugs. Data were statistically analyzed by t-test, analysis of variance, and simple regression analysis. Results 57.1% of the patients were prescribed with more than six drugs simultaneously. Mean number [±standard deviation (SD)] of psychiatric drug was 3.42±1.41. Prevalence of polyphamacy was different among psychiatric disorder groups, bipolar disorder group being the highest (mean±SD drug used=5.17±0.98). Regarding sedative-hypnotics, 59.5% of patients were prescribed (mean±SD drug used=2.02±1.07). Visual Analogue Scale (VAS) and total number of drugs prescribed were positively correlated (p<0.05). Herb medicine/dietary supplement had no influence on total number of used drugs. Conclusion Elderly patients are suffering from many comorbidities and vulnerable to multiple drug use that can be potentially harmful, so it is important and essential to be aware of the possibility of polypharmacy and prescribe appropriate drugs to improve their quality of life.
참고문헌 (26)
- Stahl SM, "A critical review of atypical antipsychotic utilization:comparing monotherapy with polypharmacy and augmentation", Curr Med Chem, 11, pp.313~327 (2004)
- Fulton MM, "Polypharmacy in the elderly: a literature review", J Am Acad Nurse Pract, 17, pp.123~132 (2005)
- Jyrkkä J, "Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis", Drugs Aging, 26, pp.493~503 (2009)
- Kuijpers MA, "Relationship between polypharmacy and underprescribing", Br J Clin Pharmacol, 65, pp.130~133 (2008)
- Zubenko GS, "Geriatric psychopharmacology: why does age matter?", Harv Rev Psychiatry, 7, pp.311~333 (2000)
- Gören JL, "When is antipsychotic polypharmacy supported by research evidence? Implications for QI", Jt Comm J Qual Patient Saf, 34, pp.571~582 (2008)
- Beers MH, "Explicit criteria for determining inappropriate medication use in nursing home residents", UCLA Division of Geriatric Medicine. Arch Intern Med, 151, pp.1825~1832 (1991)
- Gallagher PF, "Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers’ Criteria", Age Ageing, 37, pp.96~101 (2008)
- Barry PJ, "Inappropriate prescribing in the elderly: a comparison of the Beers criteria and the improved prescribing in the elderly tool (IPET) in acutely ill elderly hospitalized patients", J Clin Pharm Ther, 31, pp.617~626 (2006)
- Skrbo A, "Classification of drugs using the ATC system (Anatomic, Therapeutic, Chemical Classification) and the latest changes", Med Arh, 58(1 Suppl 2), pp.138~141 (2004)
- 김성희, "Clopidogrel 약물 상호 작용이 심혈관계 질환 예방 효과 및 부작용에 미치는 영향", 한국임상약학회지, 15(1), pp.1~8 (2005), 한국임상약학회
- 김미혜, "만성질환 노인의 의료비부담 관련요인에 관한 연구", 한국사회복지학, 48, pp.150~178 (2002), 한국사회복지학회
- 유해선, "3년간 치료를 지속한 정신과 외래 노인 환자에서의 다제요법에 대한 연구", 노인정신의학, 14(1), pp.50~57 (2010), 대한노인정신의학회
- Mojtabai R, "National trends in psychotropic medication polypharmacy in office-based psychiatry", Arch Gen Psychiatry, 67, pp.26~36 (2010)
- Glezer A, "Polypharmacy prevalence rates in the treatment of unipolar depression in an outpatient clinic", J Affect Disord, 117, pp.18~23 (2009)
- Schuler J, "Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria", Wien Klin Wochenschr, 120, pp.733~741 (2008)
- Blumstein T, "Lerner-Geva L.Prevalence and correlates of psychotropic medication use among older adults in Israel: cross-sectional and longitudinal findings from two cohorts a decade apart", Aging Ment Health, 16, pp.636~647 (2012)
- Craig D, "Crawford VL, et al. Factors influencing prescription of CNS medications in different elderly populations", Pharmacoepidemiol Drug Saf, 12, pp.383~387 (2003)
- Peacey J, "Sleep medication in acute psychiatric illness: patient’s knowledge and prescription patterns in New Zealand", J Nerv Ment Dis, 200, pp.83~87 (2012)
- Fick DM, "Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts", Arch Intern Med, 163, pp.2716~2724 (2003)
- Mundt A, "Pharmacoepidemiology of patients hospitalized for somatoform disorders in psychiatric hospitals and departments", Pharmacoepidemiol Drug Saf, 19, pp.687~693 (2010)
- Bikowski RM, "Physician-patient congruence regarding medication regimens", J Am Geriatr Soc, 49, pp.1353~1357 (2001)
- Fugh-Berman A, "Herb-drug interactions: review and assessment of report reliability", Br J Clin Pharmacol, 52, pp.587~595 (2001)
- Yoon JL, "Appropriate pharmacotherapy in elderly patients", J Korean Med Assoc, 48, pp.f24~33 (2005)
- Kim BR, "A survey on medicine use in the elderly", J Korean Gerontol Nurs, 3, pp.208~216 (1999)
- Stahl SM, "Antipsychotic polypharmacy, Part 1: Therapeutic option or dirty little secret?", J Clin Psychiatry, 60, pp.425~426 (1999)