외래 노인 심부전 환자에서 약사 주도 다제약물 관리의 역할 평가
Assessment of the Role of Pharmacist-led Polypharmacy Management in Elderly Chronic Heart Failure Outpatients
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Background : Polypharmacy is prevalent among elderly patients with chronic heart failure (CHF) due to the necessity of managing multiple comorbidities alongside standard CHF treatments. Inappropriate polypharmacy can result in adverse events, increased hospitalizations, diminished quality of life, greater economic burdens, and prescribing cascades. This study aimed to analyze drug-related problems (DRPs) and assess the effectiveness of pharmacist-led polypharmacy management in elderly CHF outpatients. Methods : The medical records of 54 outpatients with CHF who participated in the pharmacist-led polypharmacy management program at a tertiary hospital from April 2023 to April 2024 were reviewed retrospectively. DRPs were classified by problem types, causes, and interventions using the Pharmaceutical Care Network Europe Classification for Drug-Related Problems version 9.1. Additionally, DRPs were analyzed based on the categories of medications involved. Results : A total of 159 DRP cases were identified in 47 patients (87%), with a median of 3 DRPs per patient. Of these, 100 problems (62.9%) were related to treatment safety. Regarding medication categories, 88 DRPs (55.3%) were associated with non-cardiovascular medications. Among the 169 identified causes of DRPs, 59 cases (34.9%) were patient-related, while 50 cases (29.6%) resulted from inappropriate drug selection. Out of 201 interventions performed for DRPs, 57 (28.4%) involved patient counseling and education. Additionally, 46 interventions were directed at prescribers in 21 patients (38.9%), with 37 (80.4%) of those accepted. Conclusion : In managing polypharmacy for elderly CHF outpatients, pharmacist-led medication reviews and patient-centered counseling are crucial for identifying and resolving DRPs, particularly those related to non-cardiovascular medications. Pharmacists can effectively serve as patient-centered medication counselors and coordinators for elderly patients, enhancing medication safety and therapeutic outcomes. To promote the wider implementation of pharmacist-led polypharmacy management, supportive health policies and further research are essential.
Abstract
Background : Polypharmacy is prevalent among elderly patients with chronic heart failure (CHF) due to the necessity of managing multiple comorbidities alongside standard CHF treatments. Inappropriate polypharmacy can result in adverse events, increased hospitalizations, diminished quality of life, greater economic burdens, and prescribing cascades. This study aimed to analyze drug-related problems (DRPs) and assess the effectiveness of pharmacist-led polypharmacy management in elderly CHF outpatients. Methods : The medical records of 54 outpatients with CHF who participated in the pharmacist-led polypharmacy management program at a tertiary hospital from April 2023 to April 2024 were reviewed retrospectively. DRPs were classified by problem types, causes, and interventions using the Pharmaceutical Care Network Europe Classification for Drug-Related Problems version 9.1. Additionally, DRPs were analyzed based on the categories of medications involved. Results : A total of 159 DRP cases were identified in 47 patients (87%), with a median of 3 DRPs per patient. Of these, 100 problems (62.9%) were related to treatment safety. Regarding medication categories, 88 DRPs (55.3%) were associated with non-cardiovascular medications. Among the 169 identified causes of DRPs, 59 cases (34.9%) were patient-related, while 50 cases (29.6%) resulted from inappropriate drug selection. Out of 201 interventions performed for DRPs, 57 (28.4%) involved patient counseling and education. Additionally, 46 interventions were directed at prescribers in 21 patients (38.9%), with 37 (80.4%) of those accepted. Conclusion : In managing polypharmacy for elderly CHF outpatients, pharmacist-led medication reviews and patient-centered counseling are crucial for identifying and resolving DRPs, particularly those related to non-cardiovascular medications. Pharmacists can effectively serve as patient-centered medication counselors and coordinators for elderly patients, enhancing medication safety and therapeutic outcomes. To promote the wider implementation of pharmacist-led polypharmacy management, supportive health policies and further research are essential.