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KMID : 0869620140310050983
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Journal of Korean Society of Hospital Pharmacists
2014 Volume.31 No. 5 p.983 ~ p.991
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Drug Use Review, Analysis, and Adequacy Assessment of Elderly Outpatients
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Woo Hee-Kyung
Shin Eun-Jeong
Lim Jung-Mi
Lee Hye-Sook
Kim Hyang-Suk
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Abstract
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Elderly patients with chronic disease and long-term complications take many types of drugs that may cause drug interactions and side effects. The aging body makes the vital functions slow, and pharmacokinetic changes make a unsafe drug therapy may be inappropriate for the elderly. However, elderly patients guidelines for drug use in Korea are not clear. Thus, in Seoul National University Hospital, by using the elderly standard guidelines Beer’s criteria of adequacy assessment, appropriate drug use of the elderly patients can be seen at our hospital outpatient care for substance evaluation. June-August 2011 at Seoul National University Hospital, 39,763 elderly patients over 65 years of hospital outpatient care received more than one prescription drug, and the personal history of patients and prescription drug information were collected retrospectively. The adequacy and improper prescribing practices were analyzed and assessed by using Beer’s criteria. The elderly patients received an average 5.23 different drugs prescribed and as increased with age, the number of prescription medications also increased. The usage of cardiovascular medications (30.7%), digestive and metabolic medications (22.6%), and neurological medications (16.0%) were prescribed, and the orders were analyzed by Anatomical Therapeutic Chemical Classification criteria. Inappropriate drugs were prescribed to 6,387 people (17%) of the entire elderly patients population, and more than one of the inappropriate drugs were prescribed. An average number of inappropriate prescription medications is 1.3, and the adequacy was investigated by Beer’s criteria. Amitriptyline (20.9%), diazepam (18.9%), and digoxin (17.6%) were prescribed mainly by neurologists followed by cardiologists having prescribed them at a high rate. Inadequate prescriptions were most common in 25 cases of depression using benzodiazepines according to the drug prescription system considering diseases. Elderly patients with long-term various types of drugs are more likely to be at risk from side effects of the drugs. Thus, the government should develop a specific medication guide to reduce adverse drug reactions for the geriatric patients in collaboration with the experts, and hastily prepared guidelines for the safe use of medication and standards for the prescription review should consider the characteristics of the geriatric patients.
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KEYWORD
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Elderly Patients, Adequacy Assessment, Beer’s Criteria
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