65세 이상 외래환자의 NSAIDs 처방현황과 개선방안

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are clinically useful in the treatment of inflammatory diseases such as arthritis, pain, headache, and neuromuscular disorder. A retrospective study was conducted for the status of NSAIDs prescription in geriatric (＞65 years) outpatients who had visited Seoul National University Bundang Hospital using the Electronic Medical Record (EMR) during the period between the 1st of January and the 30th of June, 2005. The primary objective of the study was to analyze the practice of NSAIDs prescription in geriatric patients and the clinical outcome. In the geriatric patients, the prescription frequency of NSAIDs ranged from 6 to 41%, depending on the clinics [i.e., 41% on Joint Disease and Reconstruction Center (JRC), 21% on Neuroscience Center (CNSC) and 6% on Rehabilitation Medicine (RH)].Amongst the NSAIDs used, aceclofenac was most widely prescribed, followed by celecoxib and meloxicam. The average duration of NSAIDs prescription was 42 days (± 47). Based on the records, duplication of NSAIDs prescription was found to be highly prevalent in the patient group; While 51 cases were found to have duplicated NSAIDs prescription on the day prescription, total of 139 duplicated NSAIDs prescription was found during the course of the therapy. For the clinics that prescribed NSAIDs frequently, the duplication was also prevalent [i.e., 63 cases (33%) was on JRC; 53 cases (28%) on CNSC]. The 45% of the patient group was given the NSAIDs concurrently with the remedies of gastrointestinal irritation [i.e., 39% for aceclofenac, 30% for celecoxib, 22% for meloxicam]; It is noteworthy that the remedies for gastric irritation were prescribed even for COX-2 selective NSAIDs which do not cause gastric irritation. Among the geriatric patients with NSAIDs (i.e., 1,581 patients), a significant number of patients developed gastritis [i.e.,approximately 26(1.6%)] or had elevated level of serum creatinine (Scr; i.e., 31%). In particular, at least 16.6% of the patients had the creatinine clearance below 50 mL/min, suggesting the patients may be categorized as renally insufficient, probably need to adjust dose. Taken together with apparently unnecessary prescription and potential health probelem by the medication, the geriatric patients may be prone to additional adverse drug reaction, which, in turn, may lead to the deterioration of the quality of life. Therefore, these analysis indicated that appropriate counseling of pharmacist is necessary for elderly patients who are prescribed with NSAIDs.