외래 노인포괄평가의 약물사용 및 약제비 절감에 미치는 효과
Impact of Outpatient Comprehensive Geriatric Assessment on Medication Utilization and Cost Savings
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Background : Seoul National University Bundang Hospital (SNUBH)’s Geriatric Center has established a multidisciplinary approach to enhance care for older adults, integrating pharmacists into Comprehensive Geriatric Assessments (CGA) for medication reconciliation and counseling. This study aimed to evaluate the impact of CGA, including pharmacist-involved interventions, on medication utilization and cost-savings in outpatient setting. Methods : We conducted a retrospective analysis of 280 outpatient medical records, focusing on those who underwent CGA at the Geriatric Center from July 1, 2022, to June 30, 2023. We evaluated the number of medications, and the potentially inappropriate medications (PIM) as per the 2019 Beers Criteria®, Korean Anticholinergic Burden Scale (KABS), and drug duplications before and after CGA. Polypharmacy was defined as the use of more than 10 medications, and those with a KABS score of 3 were considered as strong anticholinergics. Cost savings analysis considered a 365-day duration for chronic medications, and actual supply days for other medications. Results : The mean age of the patients was 79.9 years. There was a significant reduction in the mean number of medications per patient, from (8.9 ± 5.4) to (5.0 ± 4.3) post-CGA. Polypharmacy prevalence decreased from (39.3 to 12.5) % (both p<0.001), PIM use dropped from (49.6 to 27.5) %, and the use of strong anticholinergic drugs declined from (12.9 to 5.0) %. Drug duplications also significantly reduced, from (9.3 to 1.1) % (all p<0.001). The CGA process yielded a total cost saving of approximately 76,246,980 won, averaging 272,311 won per patient. Conclusion : This study demonstrated the effectiveness of a multidisciplinary team, particularly the role of pharmacists in medication reconciliation, in reducing inappropriate polypharmacy and medications costs in older patients. These findings underscore the value of the involvement of pharmacists in enhancing patient safety and reducing healthcare costs in geriatric care settings.
Abstract
Background : Seoul National University Bundang Hospital (SNUBH)’s Geriatric Center has established a multidisciplinary approach to enhance care for older adults, integrating pharmacists into Comprehensive Geriatric Assessments (CGA) for medication reconciliation and counseling. This study aimed to evaluate the impact of CGA, including pharmacist-involved interventions, on medication utilization and cost-savings in outpatient setting. Methods : We conducted a retrospective analysis of 280 outpatient medical records, focusing on those who underwent CGA at the Geriatric Center from July 1, 2022, to June 30, 2023. We evaluated the number of medications, and the potentially inappropriate medications (PIM) as per the 2019 Beers Criteria®, Korean Anticholinergic Burden Scale (KABS), and drug duplications before and after CGA. Polypharmacy was defined as the use of more than 10 medications, and those with a KABS score of 3 were considered as strong anticholinergics. Cost savings analysis considered a 365-day duration for chronic medications, and actual supply days for other medications. Results : The mean age of the patients was 79.9 years. There was a significant reduction in the mean number of medications per patient, from (8.9 ± 5.4) to (5.0 ± 4.3) post-CGA. Polypharmacy prevalence decreased from (39.3 to 12.5) % (both p<0.001), PIM use dropped from (49.6 to 27.5) %, and the use of strong anticholinergic drugs declined from (12.9 to 5.0) %. Drug duplications also significantly reduced, from (9.3 to 1.1) % (all p<0.001). The CGA process yielded a total cost saving of approximately 76,246,980 won, averaging 272,311 won per patient. Conclusion : This study demonstrated the effectiveness of a multidisciplinary team, particularly the role of pharmacists in medication reconciliation, in reducing inappropriate polypharmacy and medications costs in older patients. These findings underscore the value of the involvement of pharmacists in enhancing patient safety and reducing healthcare costs in geriatric care settings.
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