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노인의료센터 입원 환자 중 약물관련문제로 인한 입원의 유병률 및 위험인자 분석

Prevalence of Drug-related Admissions and Associated Factors among Geriatric Center Patients

김은경|최정연|이주연|김광일|노주현|김다혜|박소연|김윤희|남궁형욱|이정화|김서영
한국병원약사회 (The Korean Society of Health-System Pharmacists)|2023.11|병원약사회지 (Journal of Korean Society of Health-System Pharmacists)|제40권 제4호|pp. 409-422

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참고문헌

키워드

ElderlyAdherenceDrug-related AdmissionPotentially inappropriate medications

초록

Background : Older adults are at a higher risk of drug-related admissions (DRA) compared with younger adults. This study aimed to evaluate the prevalence of DRA and identify the associated factors among the geriatric center elderly patients. Methods : This retrospective cross-sectional study included older patients admitted at the geriatric center at Seoul National University Bundang Hospital from August 1, 2020 to June 30, 2022. Two pharmacists independently assessed DRA cases following the DRA adjudication guide and assessed their causality and preventability using the Schumock and Thornton criteria. We analyzed the type of DRA, medications involved, preventive measures, and the associated factors. Results : Among the 403 patients included in the study, 26.3% (106 patients) experienced 125 drug-related problems causing admission, of which 55.2% were preventable. The most common DRAs were gastrointestinal hemorrhage (21 cases, 16.8%), followed by acute kidney injury (16 cases, 12.8%). A total of 179 medications were implicated in these cases, with the most prevalent classes being anticoagulants (23 cases, 12.8%) and nonsteroidal anti-inflammatory drugs (21 cases, 11.7%). Factors associated with DRAs included poor adherence (aOR=3.69, 95% CI 1.40-9.73), use of 10 or more drugs (aOR=2.12, 95% CI 1.30-3.45), and a higher number of potentially inappropriate medications for the elderly (aOR=1.60, 95% CI 1.10-2.33). Conclusion : Approximately one-fourth of admissions to the geriatric center were related to drug-related problems. Alarmingly, over half of these incidents were preventable, highlighting a critical need for improved medication management strategies among elderly patients.

Abstract

Background : Older adults are at a higher risk of drug-related admissions (DRA) compared with younger adults. This study aimed to evaluate the prevalence of DRA and identify the associated factors among the geriatric center elderly patients. Methods : This retrospective cross-sectional study included older patients admitted at the geriatric center at Seoul National University Bundang Hospital from August 1, 2020 to June 30, 2022. Two pharmacists independently assessed DRA cases following the DRA adjudication guide and assessed their causality and preventability using the Schumock and Thornton criteria. We analyzed the type of DRA, medications involved, preventive measures, and the associated factors. Results : Among the 403 patients included in the study, 26.3% (106 patients) experienced 125 drug-related problems causing admission, of which 55.2% were preventable. The most common DRAs were gastrointestinal hemorrhage (21 cases, 16.8%), followed by acute kidney injury (16 cases, 12.8%). A total of 179 medications were implicated in these cases, with the most prevalent classes being anticoagulants (23 cases, 12.8%) and nonsteroidal anti-inflammatory drugs (21 cases, 11.7%). Factors associated with DRAs included poor adherence (aOR=3.69, 95% CI 1.40-9.73), use of 10 or more drugs (aOR=2.12, 95% CI 1.30-3.45), and a higher number of potentially inappropriate medications for the elderly (aOR=1.60, 95% CI 1.10-2.33). Conclusion : Approximately one-fourth of admissions to the geriatric center were related to drug-related problems. Alarmingly, over half of these incidents were preventable, highlighting a critical need for improved medication management strategies among elderly patients.

참고문헌 (20)

  1. Salvi F, "Is polypharmacy an independent risk factor for adverse outcomes after an emergency department visit?", Internal and Emergency Medicine, 12(2), pp.213~220 (2017)
  2. Davies LE, "Adverse Outcomes of Polypharmacy in Older People : Systematic Review of Reviews", Journal of the American Medical Directors Association, 21(2), pp.181~187 (2020)
  3. PA Atkin, "The epidemiology of serious adverse drug reactions among the elderly", Drugs & aging, 14(2), pp.141~152 (1999)
  4. AJ Leendertse, "Frequency of and risk factors for preventable medication-related hospital admissions in the Netherlands", Arch Intern Med, 168(17), pp.1890~1896 (2008)
  5. CK Mannesse, "Adverse drug reactions in elderly patients as contributing factor for hospital admission cross sectional study", BMJ, 315, pp.1057~1058 (1997)
  6. Lazarou J, "Incidence of adverse drug reactions in hospitalized patients : a meta-analysis of prospective studies", JAMA, 279(15), pp.1200~1205 (1998)
  7. Ernst Fr, "Drug-related morbidity and mortality : updating the costof-illness model", J Am Pharm Assoc(Wash), 41(2), pp.192~199 (2001)
  8. "Classification for drug-related problems V9.1" (2023)[URL]
  9. S Thevelin, "Development of a standardized chart review method to identify drug-related hospital admissions in older people", Br J ClinPharmacol, 84(11), pp.2600~2614 (2018)
  10. 최남경, "우리나라 약물유해반응 감시체계", 예방의학회지, 40(4), pp.278~284 (2007), 대한예방의학회
  11. Davies EA, "Adverse drug reactions in special populations – the elderly", Br J ClinPharmacol, 80(4), pp.796~807 (2015)
  12. Ayalew MB, "Drug Related Hospital Admissions; A Systematic Review of the Recent Literatures", Bull Emerg Trauma, 7(4), pp.339~346 (2019)
  13. 임경환, "자발적 보고자료를 이용한 노인의 약물유해반응 특성", 대한내과학회지, 92(3), pp.277~285 (2017), 대한내과학회[DOI]
  14. 김정미, "국내 한 상급종합병원의 입원환자 대상 약물이 상반응현황 분석", 병원약사회지, 32(4), pp.318~334 (2015), 한국병원약사회[DOI]
  15. Park S, "Prevalence and predictors of medication-related emergency department visit in older adults: A multicenter study linking national claim database and hospital medical records", Front. Pharmacol, 13, pp.1009485~ (2022)
  16. Kim WY, "Medication-Related Acute Care Admission and Inappropriate Polypharmacy of Nursing Home Residents", J Am Med Dir Assoc, 24(2), pp.242~249 (2023)
  17. Edwards IR, "Adverse drug reactions : definitions, diagnosis, and management", Lancet, 356, pp.1255~1259 (2000)
  18. Schumock GT, "Focusing on the preventability of adverse drug reactions", Hosp. Pharm, 27(6), pp.538~ (1992)
  19. 2019 American Geriatrics Society Beers Criteria® Update Expert Panel, "geriatrics society 2019 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults", J. Am. Geriatr. Soc, 67(4), pp.674~694 (2019)
  20. Jun K, "Development of an anticholinergic burden Scale specific for Korean older adults", Geriatr. Gerontol. Int, 19(7), pp.628~634 (2019)

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