외래 노인환자의 약물사용현황 분석 및 적절성 평가
Drug Use Review, Analysis, and Adequacy Assessment of Elderly Outpatients
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Elderly patients with chronic disease and long-term complications take many typesof drugs that may cause drug interactions and side effects. The aging body makes the vital functionsslow, and pharmacokinetic changes make a unsafe drug therapy may be inappropriate forthe elderly. However, elderly patients guidelines for drug use in Korea are not clear. Thus, inSeoul National University Hospital, by using the elderly standard guidelines Beer’s criteria ofadequacy assessment, appropriate drug use of the elderly patients can be seen at our hospitaloutpatient care for substance evaluation. June-August 2011 at Seoul National University Hospital, 39,763 elderly patients over 65 yearsof hospital outpatient care received more than one prescription drug, and the personal history ofpatients and prescription drug information were collected retrospectively. The adequacy and improper prescribing practices were analyzed and assessed by using Beer’s criteria. The elderly patients received an average 5.23 different drugs prescribed and as increased withage, the number of prescription medications also increased. The usage of cardiovascular medications(30.7%), digestive and metabolic medications (22.6%), and neurological medications (16.0%)were prescribed, and the orders were analyzed by Anatomical Therapeutic Chemical Classificationcriteria. Inappropriate drugs were prescribed to 6,387 people (17%) of the entire elderly patients population,and more than one of the inappropriate drugs were prescribed. An average number of inappropriateprescription medications is 1.3, and the adequacy was investigated by Beer’s criteria. Amitriptyline (20.9%), diazepam (18.9%), and digoxin (17.6%) were prescribed mainly by neurologistsfollowed by cardiologists having prescribed them at a high rate. Inadequate prescriptionswere most common in 25 cases of depression using benzodiazepines according to the drug prescriptionsystem considering diseases. Elderly patients with long-term various types of drugs are more likely to be at risk from sideeffects of the drugs. Thus, the government should develop a specific medication guide to reduceadverse drug reactions for the geriatric patients in collaboration with the experts, and hastilyprepared guidelines for the safe use of medication and standards for the prescription reviewshould consider the characteristics of the geriatric patients.
Abstract
Elderly patients with chronic disease and long-term complications take many typesof drugs that may cause drug interactions and side effects. The aging body makes the vital functionsslow, and pharmacokinetic changes make a unsafe drug therapy may be inappropriate forthe elderly. However, elderly patients guidelines for drug use in Korea are not clear. Thus, inSeoul National University Hospital, by using the elderly standard guidelines Beer’s criteria ofadequacy assessment, appropriate drug use of the elderly patients can be seen at our hospitaloutpatient care for substance evaluation. June-August 2011 at Seoul National University Hospital, 39,763 elderly patients over 65 yearsof hospital outpatient care received more than one prescription drug, and the personal history ofpatients and prescription drug information were collected retrospectively. The adequacy and improper prescribing practices were analyzed and assessed by using Beer’s criteria. The elderly patients received an average 5.23 different drugs prescribed and as increased withage, the number of prescription medications also increased. The usage of cardiovascular medications(30.7%), digestive and metabolic medications (22.6%), and neurological medications (16.0%)were prescribed, and the orders were analyzed by Anatomical Therapeutic Chemical Classificationcriteria. Inappropriate drugs were prescribed to 6,387 people (17%) of the entire elderly patients population,and more than one of the inappropriate drugs were prescribed. An average number of inappropriateprescription medications is 1.3, and the adequacy was investigated by Beer’s criteria. Amitriptyline (20.9%), diazepam (18.9%), and digoxin (17.6%) were prescribed mainly by neurologistsfollowed by cardiologists having prescribed them at a high rate. Inadequate prescriptionswere most common in 25 cases of depression using benzodiazepines according to the drug prescriptionsystem considering diseases. Elderly patients with long-term various types of drugs are more likely to be at risk from sideeffects of the drugs. Thus, the government should develop a specific medication guide to reduceadverse drug reactions for the geriatric patients in collaboration with the experts, and hastilyprepared guidelines for the safe use of medication and standards for the prescription reviewshould consider the characteristics of the geriatric patients.
참고문헌 (6)
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- 이혜숙, "노인약학", 병원약사회지, 17(295-311) (2000)
- Gallagher P.F, "Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beers'Criteria", Age and ageing, 37(1), pp.96~101 (2008)
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- Beers M.H., "Explicit criteria for determining potentially inappropriate medication use by the elderly", Arch Intern Med, 157(14), pp.1531~1536 (1997)
- Van Der Hooft, C. S., "Ina-ppropriate drug prescribing in older adults:the updated 2002 Beers criteria - a population-based cohort study", Br J Clin-Pharmacol, 60(2), pp.137~144 (2005)