개정된 원내 노인부적절약물 목록을 활용한 외래환자의 약물사용평가 및 약제비 절감효과 분석
Drug Use Evaluation and Cost Saving Analysis by Comprehensive Geriatric Assessment for Outpatients based on 2012 SNUBH Inappropriate Medication for Elderly Criteria
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초록
The 2008 STOPP (Screening Tool of Older Persons’potentially inappropriatePrescriptions) criteria proved its clinical effectiveness, and the Beers criteria was revised in 2012. The Geriatric Center of Seoul National University Bundang Hospital (SNUBH) initially used the2005 SNUBH criteria to screen inappropriate medication for elderly patients, and the list of inappropriatemedication was recently revised based on the 2008 STOPP criteria and the 2012 Beerscriteria. The objective of this study was to confirm the effectiveness of the 2012 SNUBH criteriaon screening inappropriate medication for elderly by comparing with the 2005 SNUBH criteria. Also, this study aimed to analyze prescription alterations and cost reductions for outpatients after comprehensive geriatric assessment (CGA) based on the 2012 SNUBH criteria. A total of 71 geriatric patients, who went through CGA at SNUBH from March 1st to August 31stof 2013, were involved in this study. To obtain the medication information prior to CGA, weinterviewed the patients and called local hospitals and pharmacies to confirm previous prescriptions. The cost of drugs at the time of use was calculated by applying upper limit of the insurancefees. The 2012 SNUBH criteria screened more inappropriate medication than the 2005 SNUBH criteriadid. Before CGA, the percentages of patients with inappropriate medication were 56.3% and22.5% based on the 2012 SNUBH criteria and the 2005 SNUBH criteria, respectively (p<0.001). With the implementation of the CGA based on the 2012 SNUBH criteria, the median number ofmedicine per patients decreased from 6.7(±3.3) to 4.6(±2.6) (p<0.001). In addition, the ratio ofhaving 10 or more medications and the patients being prescribed with inappropriate medicationssignificantly declined (p<0.001). The overall cost of saving through CGA was 10,966,206 won. This was the first study of drug use evaluation and cost saving analysis for outpatients basedon the 2012 SNUBH criteria. Our results demonstrate that medication assessment by pharmacistsleds to safer and more appropriate pharmacotherapy for elderly patients.
Abstract
The 2008 STOPP (Screening Tool of Older Persons’potentially inappropriatePrescriptions) criteria proved its clinical effectiveness, and the Beers criteria was revised in 2012. The Geriatric Center of Seoul National University Bundang Hospital (SNUBH) initially used the2005 SNUBH criteria to screen inappropriate medication for elderly patients, and the list of inappropriatemedication was recently revised based on the 2008 STOPP criteria and the 2012 Beerscriteria. The objective of this study was to confirm the effectiveness of the 2012 SNUBH criteriaon screening inappropriate medication for elderly by comparing with the 2005 SNUBH criteria. Also, this study aimed to analyze prescription alterations and cost reductions for outpatients after comprehensive geriatric assessment (CGA) based on the 2012 SNUBH criteria. A total of 71 geriatric patients, who went through CGA at SNUBH from March 1st to August 31stof 2013, were involved in this study. To obtain the medication information prior to CGA, weinterviewed the patients and called local hospitals and pharmacies to confirm previous prescriptions. The cost of drugs at the time of use was calculated by applying upper limit of the insurancefees. The 2012 SNUBH criteria screened more inappropriate medication than the 2005 SNUBH criteriadid. Before CGA, the percentages of patients with inappropriate medication were 56.3% and22.5% based on the 2012 SNUBH criteria and the 2005 SNUBH criteria, respectively (p<0.001). With the implementation of the CGA based on the 2012 SNUBH criteria, the median number ofmedicine per patients decreased from 6.7(±3.3) to 4.6(±2.6) (p<0.001). In addition, the ratio ofhaving 10 or more medications and the patients being prescribed with inappropriate medicationssignificantly declined (p<0.001). The overall cost of saving through CGA was 10,966,206 won. This was the first study of drug use evaluation and cost saving analysis for outpatients basedon the 2012 SNUBH criteria. Our results demonstrate that medication assessment by pharmacistsleds to safer and more appropriate pharmacotherapy for elderly patients.
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