고령 환자의 polypharmacy 현황 분석

Abstract

In general, individuals with advanced age are often associated with a number of chronic illnesses and, thus, polypharmacy becomes therapeutic necessity for these patients. In these cases, the inappropriate prescription, a problem associated with the polypharmacy, may lead to the complication in the pharmacotherapy, the increase in the unnecessary financial burden and the increase in the number of incidence of toxic/adverse reactions. The objectives of the study are to evaluate the status of polypharmacy in patients over 65 years of age in Seoul National University Bundang Hospital, and to formulate way(s) to alleviate the problem. Using the Electronic Medical Record (EMR) system of the hospital, various demographical and therapeutic variables (i.e., the gender, age, medical department, number of medicine, frequency of prescription for a given therapeutic class and frequency of inappropriate prescription) were complied during the 6 month period (viz, January 1st 2004~June 30th 2004) for patients over 65 years of age having 4 or more medicines per each treatment. In addition, the frequency of the duplication of therapeutics in prescriptions was determined in the departments of cardiology and neurology. The number of patients in the category was 4,378, accounting for 24.2% of patients over 65 years of age. The average age was 72.4 years (range of 65 to 96 years) while 57.6% (i.e., 2,521 patients) of the group was female patients. Based on the Beers Criteria, 0.94 % of the patient group was found to receive the medications always be avoided by elderly patients. For 3,399 patients who attended both departments, 13 patients were prescribed with the therapeutic duplication. Considering the fact the elderly patients are likely to be associated with the deterioration in the physiological and psychological functions, the outcome of the toxic/adverse reaction may become significantly amplified. Therefore, these observations indicate that an early warning system has to be implemented to alleviate the incidence of inappropriate prescription such as therapeutic duplication, overdose and/or potential drug-drug interaction.