Risk Factors of Potentially Inappropriate Medications and Cost by Polypharmacy among Elderly Patients of a Community Pharmacy near a Top Tier General Hospital

상급종합병원 근처의 한 지역약국 처방전 분석에 의한 노인 환자의 다약제복용과 약제비용 및 잠재적으로 부적절한 약물사용 관련 위험인자

  • Kim, Aram (Graduate School of Clinical Health Sciences, Ewha Womans University) ;
  • Kim, Hong Ah (Korea Institute of Drug Safety and Risk Management) ;
  • Rhie, Sandy Jeong (College of Pharmacy and Graduate School of Clinical Health Sciences, Ewha Womans University)
  • 김아람 (이화여자대학교 임상보건과학대학원) ;
  • 김홍아 (한국의약품안전관리원) ;
  • 이정연 (이화여자대학교 임상보건과학대학원)
  • Received : 2015.07.17
  • Accepted : 2015.08.18
  • Published : 2015.09.30

Abstract

Objective: Polypharmacy is one of the main causes of inappropriate medication use, adverse drug-related events and cost. It aimed to investigate the status of polypharmacy and potentially inappropriate medication (PIM), the factors affecting polypharmacy and cost in elderly outpatients. Method: A pharmacy claim data were retrospectively analyzed with elderly patients prescriptions at a pharmacy located near a top tier general hospital. The numbers of medications per person, prevalence of polypharmacy and PIM according to the 2012 Beers criteria and Korea PIM list, medication cost and the factors affecting polypharmacy were investigated. Results: Forty-six percentages of the elderly outpatients received polypharmacy and over 21% of them had medications listed in Beers or Korean PIM. In multiregressional analysis, we found that age, gender and insurance types were affective factors of polypharmacy. (p < 0.001, 0.047, 0.009, respectively). The cost of polypharmacy with PIM in elderly outpatients was increased with age. Various approaches of interventions would be further required.

Keywords

References

  1. Statistics Korea. Elderly statistics 2012. Available at http://kostat.go.kr. (Accessed on Dec 18, 2014).
  2. Edwards IR, Aronson JK. Adverse drug reactions: definitions, diagnosis, and management. Lancet 2000;356(9237):1255-9. https://doi.org/10.1016/S0140-6736(00)02799-9
  3. Goldberg RM, Mabee J, Chan L, et al. Drug-drug and drug-disease interactions in the emergency department: analysis of a high-risk population. Am J Emerg Med 1996;14(5):447-50. https://doi.org/10.1016/S0735-6757(96)90147-3
  4. Ruggiero C, Dell'Aquilla G, Gasperini B, et al. Potentially inappropriate drug prescriptions and risk of hospitalization among older, Italian, nursing home residents: the ULISSE project. Drugs Aging 2010;27(9):747-58. https://doi.org/10.2165/11538240-000000000-00000
  5. American Geriatrics Society 2012 Beers Criteria Update Expert Panel, American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 2012;60(4):616-31. https://doi.org/10.1111/j.1532-5415.2012.03923.x
  6. Zhan C, Sangl J, Bierman AS, et al. Potentially inappropriate medication use in the community-dwelling elderly: findings from the 1996 Medical Expenditure Panel Survey. JAMA 2001;286(22):2823-9. https://doi.org/10.1001/jama.286.22.2823
  7. McLeod PJ, Huang AR, Tamblyn RM, et al. Defining inappropriate practices in prescribing for elderly people: a national consensus panel. CMAJ 1997;156(3):385-91.
  8. Gallagher P, Ryan C, Byrne S, et al. STOPP (Screening Tool of Older Person's Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment). Consensus validation. Int J Clin Pharmacol Ther 2008;46(2):72-83. https://doi.org/10.5414/CPP46072
  9. Holt S, Schmiedl S, Thurmann PA. Potentially inappropriate medications in the elderly: The PRISCUS list. Dtsch Arztebl Int 2010;107(31-32):543-51.
  10. Winit-Watiana W, Sakulrat P, Kespichayawattane J. Criteria for high-risk medication use in Thai older patients. Arch Gerontol Geriatr 2008;47(1):35-51. https://doi.org/10.1016/j.archger.2007.06.006
  11. Akazawa M, Imai H, Igarashi A, et al. Potentially inappropriate medication use in elderly Japanese patients: Am J Geriatr Pharmacother 2010;8(2):146-60. https://doi.org/10.1016/j.amjopharm.2010.03.005
  12. Chang CB, Chen JH, Wen CJ, et al. Potentially inappropriate medications in geriatric outpatients with polypharmacy: application of six sets of published explicit criteria. Br J Clin Pharmacol 2011;72(3):482-9. https://doi.org/10.1111/j.1365-2125.2011.04010.x
  13. Albert SM, Colombi A, Hanlon J. Potentially inappropriate medicaions and risk of hospitalization in retirees: analysis of a US retiree health claims database. Drugs Aging 2010;27(5):407-15. https://doi.org/10.2165/11315990-000000000-00000
  14. O'Sullivan DP, O'Mahoney D, Parsons C, et al. A prevalence study of potentially inappropriate prescribing in Irish longterm care residents. Drugs Aging 2013;30(1):39-49. https://doi.org/10.1007/s40266-012-0039-7
  15. Kim DS, Heo SI, Lee SH. Development of a list of potentially inappropriate drugs for the Korean elderly using the delphi method. Healthc Inform Res 2010;16(4):231-52. https://doi.org/10.4258/hir.2010.16.4.231
  16. Blozik E, Rapold R, van Overberk J, et al. Polypharmacy and potentially inappropriate medication in the adult, community-dwelling population in Switzerland. Drugs Aging 2013;30(7):561-8. https://doi.org/10.1007/s40266-013-0073-0
  17. Haider SI, Johnell K, Thorslund M, et al. Trends in polypharmacy and potential drug-drug interactions across educational groups in elderly patients in Sweden for the period 1992-2002. Int J Clin Pharmacol Ther 2007;45(12):643-53. https://doi.org/10.5414/CPP45643
  18. Amann U, Schmedt N, Garbe E. Prescribing of potentially inappropriate medications for the elderly: an analysis based on the PRISCUS list. Dtsch Arztebl Int 2012;109(5):69-75.