Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
권호 표지
DOI QR코드

DOI QR Code

Development of Eligibility Criteria for Comprehensive Medication Management Programs in Long-term Care Facilities Using RAND/UCLA Appropriateness Method

RAND/UCLA Appropriateness Method를 이용한 요양시설의 포괄적 약물관리 프로그램의 대상자 기준 개발

  • Jang, Suhyun (College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University) ;
  • Kang, Cinoo (Graduate School of Public Health, Seoul National University) ;
  • Ah, Youngmi (College of Pharmacy, Yeungnam University) ;
  • Lee, Ju-Yeun (College of Pharmacy, Seoul National University) ;
  • Kim, Jung-Ha (College of Medicine, Chung-Ang University) ;
  • Jang, Sunmee (College of Pharmacy and Gachon Institute of Pharmaceutical Sciences, Gachon University)
  • 장수현 (가천대학교 약학대학 가천약학연구소) ;
  • 강신우 (서울대학교 보건대학원) ;
  • 아영미 (영남대학교 약학대학) ;
  • 이주연 (서울대학교 약학대학) ;
  • 김정하 (중앙대학교 의과대학) ;
  • 장선미 (가천대학교 약학대학 가천약학연구소)
  • Received : 2022.08.25
  • Accepted : 2022.09.20
  • Published : 2022.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Comprehensive medication management is essential to achieve safe and optimal drug use for the elderly in long-term care facilities (LTCF). This study aimed to develop eligibility criteria for "Comprehensive medication management program in LTCF" using the RAND/UCLA Appropriateness Method (RAM). Furthermore, we attempted to estimate the number of beneficiaries who met the criteria by analyzing the National Health Insurance claims data. Methods: Twelve criteria were selected initially. We composed a panel of 14 experts with expertise in long-term care. We conducted two survey rounds to reach a consensus. Rating for appropriateness and decision regarding agreement were applied per RAM. We analyzed the National Health Insurance data to estimate the number of LTCF residents who met each eligibility criterion. Results: Of the 11 items agreed upon, ten items were determined to be appropriate. In 2018, 83.6% of 165,994 residents of LTCF met one or more eligibility criteria. The largest number of subjects met the "New residents of LTCF" criterion, followed by "Take high-alert drugs" and "Chronic excessive polypharmacy." Since the items evaluated as most appropriate by the expert panel and those with a large number of subjects were similar, we confirmed the external validity of our criteria. Conclusion: It is worth noting that this is the first attempt to establish the eligibility criteria for medication management in LTCF. Further preliminary research is needed to identify the selected subjects' drug-related problems and revise the criteria according to the results.

Keywords

Acknowledgement

본 연구는 보건복지부 환자중심 의료기술 최적화 연구사업지원에 의하여 이루어진 것입니다 (과제번호: HC21C0069).

References

  1. Statistics Korea. Population Projections for Korea (2020-2070). Statistics Korea; 2021. Available from http://kostat.go.kr/portal/eng/pressReleases/8/8/index.board?bmode=read&bSeq=&aSeq=416209&pageNo=1&rowNum=10&navCount=10&currPg=&searchInfo=&sTarget=title&sTxt=. Accessed September 12, 2022.
  2. National Health Insurance Service. 2020 Long Term Care Insurance Statistical Yearbook. Korea: National Health Insurance Service; 2021. Available from https://www.nhis.or.kr/nhis/together/wbhaec07200m01.do?mode=view&articleNo=10810012&article.offset=0&articleLimit=10. Accessed September 12, 2022.
  3. Jang IY, Lee HY, Lee E; 50th Anniversary Committee of Korean Geriatrics Society. Geriatrics fact sheet in Korea 2018 from national statistics. Ann Geriatr Med Res 2019;23(2):50-3. https://doi.org/10.4235/agmr.19.0013
  4. Chung K. 2017 National survey of older Koreans: Findings and implications. Korea Institute for Health and Social Affairs 2018. Available from https://www.kihasa.re.kr/publish/report/view?type=others&seq=29648. Accessed September 12, 2022.
  5. Kang E, Lee Y, Lim J, Joo B, Bae H. Long-term care status survey. Health policy report Sejong: Ministry of Health & Welfare, Korea Institute for Health and Social Affairs. 2019:2019-32. Available from http://www.mohw.go.kr/react/jb/sjb030301vw.jsp?PAR_MENU_ID=03&MENU_ID=032901&CONT_SEQ=354919. Accessed September 12, 2022.
  6. Kim J-S, Kang S. Status of polypharmacy and inappropriate medication use of the elderly in nursing homes. The Korean Journal of Health Service Management 2013;7(3):237-49. https://doi.org/10.12811/kshsm.2013.7.3.237
  7. Moon A, Cho H, Jang S, Kang E, Jang S. Pharmacy-led medication management services in long-term care facilities: Lessons from other countries for Korea. Yakhak Hoeji 2020;64(2):166-72. https://doi.org/10.17480/psk.2020.64.2.166
  8. Choi B. Decision-making method using RAND/UCLA Appropriateness Method RAM. 2010, HIRA Policy trends. Available from https://repository.hira.or.kr/handle/2019.oak/1723. Accessed September 12, 2022.
  9. Ji S-M, Kim S-Y, Sheen S-S, Heo D-S, Kim N-S. Consensus on definition and quality standard of clinical practice guideline using RAND method. Health Policy and Mangemnet 2010;20(2):1-16.
  10. de Meyrick J. The Delphi method and health research. Health Educ 2003;103(1):7-16 https://doi.org/10.1108/09654280310459112
  11. Fitch K, Bernstein SJ, Aguilar MD, Burnand B, LaCalle JR. The RAND/UCLA appropriateness method user's manual. 2001. Available from https://www.rand.org/pubs/monograph_reports/MR1269.html. Accessed September 12, 2022.
  12. Institute for Safe Medication Practices (ISMP). ISMP List of HighAlert Medications in Community/Ambulatory Care Settings. ISMP; 2021. Available from https://www.ismp.org/sites/default/files/attachments/2017-11/highAlert-community.pdf. Accessed September 12, 2022.
  13. Institute for Safe Medication Practices (ISMP). ISMP List of HighAlert Medications in Long-Term Care (LTC) Settings. ISMP; 2021. Available from https://www.ismp.org/sites/default/files/attachments/2017-11/LTC-High-Alert-List.pdf. Accessed September 12, 2022.
  14. Scott MG, Scullin C, Hogg A, Fleming GF, McElnay JC. Integrated medicines management to medicines optimisation in Northern Ireland (2000-2014): a review. Eur J Hosp Pharm 2015;22(4):222-8. https://doi.org/10.1136/ejhpharm-2014-000512
  15. Japan Pharmaceutical Associaltion. Practice Guidelines for Pharmaceutical Management of High-Risk Drugs in Pharmacies. Japan Pharmaceutical Associaltion 2012. Available from https://www.nichiyaku.or.jp/pharmacy-info/other/guideline01.html. Accessed September 12, 2022.
  16. High-risk drugs list. London: National Patient Safety Agency; 2011. Available from https://www.mpft.nhs.uk/application/files/5915/5159/0841/High-Risk-Drugs-List.pdf. Accessed September 12, 2022.
  17. Polit DF, Beck CT. The content validity index: are you sure you know what's being reported? Critique and recommendations. Res Nurs Health 2006;29(5):489-97. https://doi.org/10.1002/nur.20147
  18. Yusoff MSB. ABC of content validation and content validity index calculation. Education in Medicine Journal 2019;11(2):49-54. https://doi.org/10.21315/eimj2019.11.2.6
  19. Pharmacy Programs Administrator. Program Rules Residential Medication Management Review. 2021. Available from https://www.ppaonline.com.au/wp-content/uploads/2020/04/RMMRProgram-Rules-COVID-19.pdf. Accessed September 12, 2022.
  20. Pharmacy Programs Administrator. Program Rules Residential Medication Management Review and Quality Use of Medicines. 2019. Available from https://www.ppaonline.com.au/programs/medication-management-programs/residential-medicationmanagement-review-and-quality-use-of-medicines. Accessed September 12, 2022.
  21. Ministry of Health Long-Term Care©Queen's Printer for Ontario. Professional Pharmacy Services Guidebook 3.0: MedsCheck, Pharmaceutical Opinion and Pharmacy Smoking Cessation Program. Queen's Printer for Ontario Toronto, ON, Cananda; 2016. Available from https://www.health.gov.on.ca/en/pro/programs/drugs/medscheck/docs/guidebook.pdf. Accessed September 12, 2022.
  22. NHS England. Structured Medication Reviews and Medicines Optimisation: Guidance. 2020. Available from https://www.england.nhs.uk/wp-content/uploads/2020/09/SMR-Spec-Guidance2020-21-FINAL-.pdf. Accessed September 12, 2022.
  23. The Lewin Group. CMS Review of Current Standards of Practice for Long-Term Care Pharmacy Services Long-Term Care Pharmacy Primer. Centers for Medicare & Medicaid Services; 2004. Available from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Reports/Research-Reports-Items/CMS040427. Accessed September 12, 2022.
  24. Long-Term Care Pharmacy Definition Act of 2020. Available from https://www.congress.gov/bill/116th-congress/senate-bill/4259?s=1&r=64#:~:text=Regulations%from%the%Centers%for,drugs%to%the%facility's%residents. Accessed September 12, 2022.
  25. Centers for Medicare & Medicaid Services. State Operations Manual Appendix PP-Guidance to Surveyors for Long Term Care Facilities F755, F756. 2017. Available from https://www.hhs.gov/guidance/sites/default/files/hhs-guidance-documents/Appendix%PP_Release_Nov%22.pdf. Accessed September 12, 2022.
  26. Griese-Mammen N, Hersberger KE, Messerli M, et al. PCNE definition of medication review: reaching agreement. Int J Clin Pharm 2018;40(5):1199-1208. https://doi.org/10.1007/s11096-018-0696-7
  27. Koria LG, Zaidi TS, Peterson G, Nishtala P, Hannah PJ, Castelino R. Impact of medication reviews on inappropriate prescribing in aged care. Curr Med Res Opin 2018;34(5):833-8. https://doi.org/10.1080/03007995.2018.1424624
  28. Nishtala PS, Hilmer SN, McLachlan AJ, Hannan PJ, Chen TF. Impact of residential medication management reviews on Drug Burden Index in aged-care homes. Drugs Aging 2009;26(8):677-86. https://doi.org/10.2165/11316440-000000000-00000
  29. Leguelinel-Blache G, Castelli C, Rolain J, et al. Impact of pharmacist-led multidisciplinary medication review on the safety and medication cost of the elderly people living in a nursing home: a before-after study. Expert Rev Pharmacoecon Outcomes Res 2020;20(5):481-90. https://doi.org/10.1080/14737167.2020.1707082
  30. Kua C-H, Mak VS, Lee SWH. Health outcomes of deprescribing interventions among older residents in nursing homes: a systematic review and meta-analysis. J Am Med Dir Assoc 2019;20(3):362-72.e11. https://doi.org/10.1016/j.jamda.2018.10.026
  31. Page AT, Clifford RM, Potter K, Schwartz D, Etherton?Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta?analysis. Br J Clin Pharmacol 2016;82(3):583-623. https://doi.org/10.1111/bcp.12975
  32. Kim JH. Development and evaluation of a multidisplinary medication management program in long-term care facility residents (HC21C0069). Korea Health Industry Development Institute.Ministiry of Health and Welfare 2022. Availabe from https://www.htdream.kr/researchInfo/continuePjtList.do. Accessed September 12, 2022.
  33. LaFleur J, McBeth C, Gunning K, Oderda L, Steinvoort C, Oderda GM. Prevalence of drug-related problems and cost-savings opportunities in medicaid high utilizers identified by a pharmacistrun drug regimen review center. J Manag Care Pharm 2006;12(8):677-85.
  34. Chen EY, Wang KN, Sluggett JK, et al. Process, impact and outcomes of medication review in Australian residential aged care facilities: A systematic review. Australas J Ageing 2019;38(Suppl 2):9-25. https://doi.org/10.1111/ajag.12676