다학제 팀의료에 의한 노인의료센터 입원환자의 항콜린약물부담 감소효과 분석
Impacts of Pharmacist-involved Multidisciplinary Geriatric Team Services on Reducing Anticholinergic Burden
0
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background: Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. Methods: We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. Results: The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26- 3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. Conclusions: This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.
Abstract
Background: Reducing the total anticholinergic burden (AB) in older adults is recommended owing to the several peripheral and central adverse effects. This study aimed to identify the AB status of patients admitted to geriatric centers for assessing the influence of the pharmacist-involved multidisciplinary geriatric team care on reducing the AB. Methods: We retrospectively reviewed the medical records of 328 older patients hospitalized in geriatric centers from July 1, 2018 to June 30, 2019, who received comprehensive geriatric assessment and pharmaceutical interventions from a multidisciplinary geriatric team. We measured the total AB scores for the medications at the time of admission and upon hospital discharge using the Korean Anticholinergic Burden Scale (KABS). The pre-admission factors associated with high AB (KABS score ≥3) at the time of admission were identified. Results: The proportion of patients with high AB significantly decreased from 41.8% (136/328) at the time of admission to 25.0% (82/328) on discharge (p<0.001). The pre-admission AB of patients transferred from skilled nursing facilities (odds ratio[OR]: 2.85, 95% CI: 1.26- 3.75), taking more than 10 medications (OR: 3.70, 95% CI: 1.55-8.82), suffering from delirium (OR: 2.80, 95% CI: 1.04-7.50), or depression (OR: 2.78, 95% CI: 1.04-7.41) were significantly high. Antipsychotics were the most frequent classes of drugs that contributed to the total KABS score at the time of admission, followed by antihistamines. Conclusions: This study demonstrated that the multidisciplinary teams for geriatric care are effective at reducing AB in older adults. The factors associated with high AB should be considered when targeting pharmaceutical care in geriatric individuals.
참고문헌 (21)
- Carnahan RM, "The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden : associations with serum anticholinergic activity", J Clin Pharmacol, 46, pp.1481~1486 (2006)
- Lechevallier-Michel N, "Drugs with anticholinergic properties and cognitive performance in the elderly : results from the PAQUID Study", Br J Clin Pharmacol, 59, pp.143~151 (2005)
- Landi F, "Anticholinergic drugs and physical function among frail elderly population", Clin Pharmacol Ther, 81, pp.235~241 (2007)
- Corsonello A, "Age-related pharmacokinetic and pharmacodynamic changes and related risk of adverse drug reactions", Curr Med Chem, 17, pp.571~584 (2010)
- Gurwitz JH, "Polypharmacy: a new paradigm for quality drug therapy in the elderly?", Arch Intern Med, 164, pp.1957~1959 (2004)
- Hajjar ER, "Polypharmacy in elderly patients", Am J Geriatr Pharmacother, 5, pp.345~351 (2007)
- Koh Y, "Drug-related problems in hospitalized patients on polypharmacy : the influence of age and gender", Ther Clin Risk Manag, 1, pp.39~48 (2005)
- Lund BC, "Inappropriate prescribing predicts adverse drug events in older adults", Ann Pharmacother, 44, pp.957~963 (2010)
- Durán CE, "Systematic review of anticholinergic risk scales in older adults", Eur J Clin Pharmacol, 69, pp.1485~1496 (2013)
- Boustani M, "Impact of anticholinergics on the aging brain : a review and practical application", Aging Health, 4, pp.311~320 (2008)
- Campbell NL, "The 2012 update to the anticholinergic cognitive burden scale", J Am Geriatr Soc, 61, pp.S142~S143 (2013)
- Jun K, "Development of an Anticholinergic Burden Scale specific for Korean older adults", Geriatr Gerontol Int, 19, pp.628~634 (2019)
- Rankin A, "Interventions to improve the appropriate use of polypharmacy for older people", Cochrane Database Syst Rev, 9, pp.Cd008165~ (2018)
- Brown W, "Medication therapy management : teaming with pharmacists for improved patient care", JAAPA, 26, pp.40~43 (2013)
- De Vreese LP, "Anticholinergic burden in adult and elderly people with intellectual disabilities : Results from an Italian multicenter crosssectional study", PLOS ONE, 13, pp.e0205897~ (2018)
- Kumpula EK, "Anticholinergic drug use and mortality among residents of long-term care facilities : a prospective cohort study", J Clin Pharmacol, 51, pp.256~263 (2011)
- Parkinson L, "Anticholinergic burden in older women: not seeing the wood for the trees?", Med J Aust, 202, pp.91~94 (2015)
- Lowry E, "Clinical and demographic factors associated with antimuscarinic medication use in older hospitalized patients", Hosp Pract, 39, pp.30~36 (2011)
- Tay HS, "Minimizing anticholinergic drug prescribing in older hospitalized patients : a full audit cycle", Ther Adv Drug Saf, 5, pp.121~128 (2014)
- Moga DC, "Optimizing medication appropriateness in older adults : a randomized clinical interventional trial to decrease anticholinergic burden", Alzheimers Res Ther, 9, pp.36~ (2017)
- By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel, "American Geriatrics Society 2019 Updated AGS Beers Criteria(R)for potentially inappropriate medication use in older adults", J Am Geriatr Soc, 67, pp.674~694 (2019)