외래 천식 환자의 polypharmacy 현황 분석을 통한 약물 사용의 적정성 평가

Abstract

Since 2001, the Health Insurance Review & Assessment Service(HIRA) analyzed the ratio of prescriptions more than 6 medications and assessed overprescribing of medications, however, there has been some controversies on its validity as the contents of the assessment was based on the total amount. Therefore, the objective of this study is to analyze polypharmacy status and evaluate appropriateness of prescriptions in asthma patients, one of chronic diseases with the highest ratio of prescriptions more than 6 medications, and to suggest some recommendations to improve current evaluation criteria. Based on the prescriptions for asthma outpatients from department of pulmonology since April 1, 2009 to June 30, we’ve classify the data into prescriptions more than 6 medications and those less than 6 medications and compared appropriateness by ratio of reliever prescription, which are advised for all patients according to GINA guideline, ratio of inappropriate prescription of controller, and ratio of therapeutic duplications. A total number of prescription was 371 and the average number of medications per prescription was 4.9 and 35.6% had more than 6 medications. The reliever prescribed ratio was 56.8% in prescription more than 6 items and 49.0% with less than 6 items(p=0.1467), accordingly, and the ratio of inappropriately prescribed controller is 13.6% and 8.8%(p=0.1448), so there is no any significant differences between these two groups. The ratio of therapeutic duplications for prescriptions with more than 6 items are 40.2% and for those less than 6 items are 9.6%(p<0.0001), mostly expectorants, antihistamines, and cough remedy. In addition, asthma medications, respiratory symptomatic medications, digestive medicines, and other disease medications appeared higher for prescriptions more than 6 medications(p<0.0001), so all items appeared as a reason for increased number of medications. In conclusion, the appropriateness of asthma prescriptions more than 6 medications is not different from that with less than 6 medications, except therapeutic duplication. Therefore, they’re suggested to develop criteria which based on not only the quantity of medications, but also the quality of pharmacotherapy. And they should consider the severity of the disease and co-morbidity of other disease when evaluating medications for asthma patient and must improve a way to avoid those duplicated prescription such as expectorants, antihistamines, and cough remedy.