노인포괄평가 시행 전후의 약물 복용 현황 및 처방 변화

Abstract

One of the primary mission for Seoul National University Bundang Hospital is the management Geriatric Center(GC). Therefore, geriatrician, pharmacist, nurse, dietician and social worker was consolidated to provide a better care to geriatric patients in the GC. The role of pharmacist in the team is to identify medicines that are inappropriate, unnecessary and potentially therapeutically problematic(e.g., drug-drug interaction, drug-disease interaction, inappropriate dosage and therapeutic duplication) in geriatric patients. In a previous study, we reported the successful implementation of the Comprehensive Geriatric Assessment(CGA) protocol in the hospital; In particular, we found the assessment score was quite useful in improving the medication assessment. The objective of the current study was to determine further the usefulness of the CGA in the extension of the role of pharmacist in the alteration of prescription. One hundred and fifty geriatric patients, who visited the GC in Seoul National University Bundang Hospital during the period of the 1st of January to the 31st of August of 2006, were involved in this study. Prescription status of the patients indicated that there was a significant incidence of polypharmacy [i.e., more than 4 medications; 114 patients(76%)] and therapeutic duplication [i.e., 28 patients(18.7%)]. In addition, a significant number [i.e., 98(65.3%)] of patients had a reduced renal function(i.e., creatinine clearance below 50 mL/min), suggesting a dose adjustment should have been necessary for the patients, while 48 patients(32%) had inappropriate medication. As for the medication-related characteristics based on ATC codes, the patients were prescribed with drugs for cardiovascular system(82.7%), alimentary tract and metabolism(66%). Particularly, the ratio of patients with inappropriate medication was 1.9-folds higher for patients visiting more than two hospitals, 1.8-folds higher for patients visiting more than two clinics. With the implementation of the CGA, the average number of medicine per patient decreased from 6.9(±4.4) to 3.7(±3.1). In addition, the ratio of polypharmacy(76%->48%) and patients prescribed inappropriate medication(32%->1.3%) were declined. The pharmacist documented 224 recommendations, of which 129(57.6%) were accepted by the physician. The physicians tend to accept the recommendation by the pharmacist for the problems associated with drug-drug interaction(83.3%), inappropriate medication(75.4%) and drug duplication(69.2%). Taken together, these observations indicate that the implementation of CGA is indeed useful in reducing incidences that are related to the pharmacotherapy and the extension of the role of pharmacist for the prescription process. Therefore, the medication assessment of pharmacist may be crucial in the realization of a safer and more appropriate pharmacotherapy.