YAKHAK HOEJI (약학회지)

The Pharmaceutical Society of Korea (대한약학회)
권호 표지

Assessment of Inappropriate Medication Use and Dosage in Elderly Patients

입원 노인환자의 부적절 약물사용현황 및 용량적절성 평가

  • Hong, Yu-Rhee (Graduate School of Clinical Pharmacy, Sookmyung Women's University) ;
  • Lee, Suk-Hyang (Graduate School of Clinical Pharmacy, Sookmyung Women's University)
  • 홍유리 (숙명여자대학교 임상약학대학원) ;
  • 이숙향 (숙명여자대학교 임상약학대학원)
  • Received : 2009.10.27
  • Accepted : 2010.06.10
  • Published : 2010.06.30
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Abstract

This study aimed to evaluate the patterns of inappropriate medication use and inappropriate dosage in elderly patients in Korea. A retrospective study was performed for the elderly 65 years or older admitted from January 2007 to December 2007 in a medical center, Seoul, Korea. Potentially inappropriate medication (PIM) use in the elderly was evaluated using Beers criteria. Eighteen drugs out of Beers criteria were included in the formulary of the institute. Inappropriate dosage was set using Beers criteria, CMS (the Centers for Medicare& Medicaid Services) guideline, Geriatric Dosage Handbook. As results, the patients with PIM were 2,172 during the study period. The commonly used inappropriate medications were drugs for the nervous system (n=1237, 44.78%), the alimentary System (n=663, 24.54%) and the cardiovascular system (n=494, 18.28%). The elderly patients with prescription of inappropriate dosage were 10% out of patients with PIMs. The commonly inappropriate dosage drugs were digoxin (n=75, 27.27%), diazepam (n=70, 22.55%) and ferrous sulfate (n=66, 24.00%). Logistic regression analysis showed the number of PIM, days of hospital stay as predictors related to inappropriate dosage use. In conclusion, CNS drugs were frequently prescribed as PIM and inappropriate dosages were identified. It is needed to develop a means of decreasing adverse drug events in elderly.

Keywords

References

  1. 통계청, 고령자 통계 (2007).
  2. 건강보험심사평가원, 건강보험 통계지표 (2007).
  3. Onder, G., Pedone, C., Landi, F., Cerari, M., Della Vedova, C., Bernabei, R. et al. : Adverse drug reactions as cause of hospital admissions : Results from the italian group of pharmacoepidemiology in the elderly. J. Am. Geriatr. Soc. 50, 1962 (2002). https://doi.org/10.1046/j.1532-5415.2002.50607.x
  4. Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R. and Beers, M. H. : Updating the Beers criteria for potentially inappropriate medication use in older adults. Ach. Intern. Med. 163, 2716 (2003). https://doi.org/10.1001/archinte.163.22.2716
  5. Cutis, L. H., Ostbye, T., Sendersky, V., Hutchison, S., Dans, P. E., Wrigt, A., et al. : Inappropriate prescribing for elderly Americans in a large outpatient population. Arch. Intern. Med. 164, 1621 (2004). https://doi.org/10.1001/archinte.164.15.1621
  6. Zuckerman, L. H., Langenberg, P., Baumgarten, M., Orwig, D., Byrns, P. J., Simoni-Wastila, L., et al. : Inappropriate drug use and risk of transition to nursing homes among communitydwelling older adults. Med. Care. 44, 722 (2006). https://doi.org/10.1097/01.mlr.0000215849.15769.be
  7. 강이경 : 건강보험자료를 이용한 의원의 노인처방경향 및 적절성평가, 숙명여자대학교 임상약학대학원 학위논문 (2006).
  8. 金享美 : 한국의 입원노인환자에서 약물 사용의 경향 및 적절성 평가, 숙명여자대학교 임상약학대학원 학위논문 (2004).
  9. Zhan, C., Sangl, J., Bierman, A. S., Miller, M. R., Friedman, B., Wickizer, S. W. and Meyer, G. S. : Potentially inappropriate medication use in the community-dwelling elderly. JAMA 286, 2823 (2001). https://doi.org/10.1001/jama.286.22.2823
  10. CMS Manual System, Centers for Medicare and Medicaid. (2004). Service Available at: http://www.cms.gov/, Accessed 2008.
  11. 한국표준질병사인분류, 통계청. 2008. Available at http://www.nso.go.kr/std2006/k07c__0000/k07cb_0000/k07cb_0000.html, Accessed 2008
  12. WHO ATC classification. 2008. Available at http://www.whocc.no/atcddd/ Accessed 2008.
  13. Goldstein, L. B., Adams, R., Alberts, M. J., Appel, L. J., Brass, L. M., Bushnell, C. D., et al. : Primary prevention of ischemic stroke. Stroke 37, 1583 (2006). https://doi.org/10.1161/01.STR.0000223048.70103.F1
  14. Unruh, A. M. : Gender variations in clinical pain experience. Pain. 65, 123 (1996). https://doi.org/10.1016/0304-3959(95)00214-6
  15. Fillingim, R. B. and Maixner, W. : Gender differences in the responses to noxious stimuli. Pain Forum. 4, 209 (1995). https://doi.org/10.1016/S1082-3174(11)80022-X
  16. Woodhead, J., Harding, S. A., Simmonds, M., et al. : Premedication for cardiac catheterization and percutaneous coronary intervention: does it increase vascular access site complications? J. Cardiovasc. Nurs 22, 466 (2007). https://doi.org/10.1097/01.JCN.0000297386.14002.f2
  17. Onde, G., Landi, F., Cesari, M., Gambassi, G., Cabonin, P. and Bernabei, R. : Inappropiate medication use among hospitalized oler adults in Italy: results from the italian group of pharmacoepidemiology in the elderly. Eur. J. Clin. Pharmacol. 59, 157 (2003) https://doi.org/10.1007/s00228-003-0600-8
  18. Rothberg, M. B., Pekow, P. S., Liu, F., Korc-Grodzicki, B., Brennan, M. J., Bellantonio, S., et al. : Potentially inappropriate medication use in hospitalized elders. J. Hosp. Med. 3, 91 (2008). https://doi.org/10.1002/jhm.290
  19. Van der Hooft, C. S., Jong, G. W., Dieleman, J. P., Verhamme, K. M., Van der Cammen, T. J., Stricher, B. H. and Sturkenboom, M. C. : Inappropriate drug prescribing in oler adults: the updated 2002 Beers criteria-a population-based cohort study. Br. J. Clin. Pharmacol. 60, 137 (2005). https://doi.org/10.1111/j.1365-2125.2005.02391.x
  20. Wawruch, M., Zikavska, M., Wsolova, L., Jezova, D., Fialova, D., Kunzo, M., et al. : Perception of potentially inappropriate medication in elderly patients by Slovak physicians. Pharmacoepidemiol. Drug Saf. 15, 829 (2006).
  21. Bayard, M., Mcintyre, J., Hill, H. R. and Woodside, J. Jr. : Alcohol withdrawal syndrome. Am. Fam. Physician. 69, 1443 (2004).
  22. Gallagher, P. F., Barry, P. J., Ryan, C., Hartigan, I. and O'Mahony, D. : Inappropriate prescribing in an acutely ill population of elderly patients as determined by Beer's Criteria. Age. Aging 37, 96 (2008). https://doi.org/10.1093/ageing/afm116