노인의료센터 입원환자의 약물유해반응 현황 및 위험인자 분석

Abstract

Adverse drug reaction(ADR) is an expression that describes the unwanted, negative consequences associated with the use of given medications. Several circumstance contribute to the greater propensity for ADRs in the elderly, including use of multiple drugs, pharmacokinetic and pharmacodynamic alterations intrinsic to aging and loss of functional reserve in the body. In other countries, it has been estimated that ADRs in the elderly, but, such study is insufficient in our country. This study assesses the prevalence of ADRs among an acute elderly care unit, determines the drugs more frequently associated with ADRs and characterises the risk factors implicated in these reactions. We studied 252 patients who admitted the Geriatric Center(GC) in Seoul National University Bundang Hospital from March 1 2006 to August 31 2007. The adverse drug reactions were collected by pharmacist using daily patient medication profiles and computerized Adverse Drug Event Surveillance System method to report ADRs. The degree of probability for each adverse drug reaction was determined using the Naranjo algorithm. Medication-related information was obtained from medication assessment of Comprehensive Geriatric Assessment (CGA) by pharmacist and baseline information was obtained from Electronic Medication Record(EMR). Up to 51 patients(20.2%) of the study population presented at least one ADR. Total of 80 ADRs were found, and type A reactions were more common(72 ADRs; 90%) than type B reactions(8 ADRs; 10%). The 54 prescribed drugs led to ADRs. The variables that were associated with ADRs were use of inappropriate drugs before admission into a hospital(p<0.001), number of diagnoses(p<0.001), prescribed drugs during hospitalization(p=0.003), and abnormal liver function test(p=0.048). In addition, length of hospitalization was significantly greater among elderly patients who experienced ADRs(p=0.005). By means of a multiple logistic regression model, the following were considered to be significant risk factors for the appearance of ADRs: number of diagnosis(p=0.003). In conclusion, we need to be extremely careful that use of inappropriate drugs before admission into a hospital, multiple organ diseases, and an abnormal liver function test in the elderly to prevent ADRs. Thus, the prevalence of ADRs in the study population, is lower than result of prospective study in developing country(46.2%). It is likely that the main reason for this relates to the active pharmacist intervention through the medication assessment helps to reduce the potentially inappropriate medication uses in the elderly patients and it can aid the safe and effective medication uses in elderly. Therefore, the medication assessment of pharmacist may be crucial in the realization of improving quality of life in elderly by preventing ADRs and declining hospitalization.