다제약제 관리를 위한 시범사업: 현황 분석 및 정책적 함의

Pilot Project for Polypharmacy Management: Empirical Aanalysis and Policy Implications

BACKGROUND The number of patients with polypharmacy has been steadily increasing. Since polypharmacy can lead to various drug-related problems, a systematic review and monitoring led by experts is needed. OBJECTIVE National Health Insurance Service(NHIS) started a pilot project for polypharmacy management in 2018. The purpose of this study is to analyze the characteristics of patients with polypharmacy and identify their drug-related problems. METHODS Pilot project was conducted from July 2018 to December 2018. Participants living in community (n=477) were selected using National Health Insurance Claims Data (NHICD) from July 2017 to December 2017. They had taken more than 10 medicines for over 90 days in six months. All people living in two long-term care facilities (n=207) in Seoul and GyeongGi also participated in this project. The pattern of medical utilization, social-demographic factors and clinical characteristics of all patients were identified using NHICD, National Health Check-up Data and Long Term Care Insurance Data from 2014 to 2018. Drug-related problems reported by pharmacists were reorganized. RESULTS Among the community dwellers, there were more men than women and their average age was 71.7. 19.7% of participants were living alone, and 25.8% of them were disabled. 51.2% of people visited more than six medical institutions for six months, and 40.3% of them have been hospitalized at that time. In long-term care facilities there were more women and the average age was 83. 24.2% of total were one person household and 33.3% of them were disabled. All patients had taken 11 medicines in average. People living in community showed overdose and duplication of analgesic anti-inflammatory drug, digestive medicine, tranquilizer, while duplication of central nervous system medicine among people in long- term care facilities were mainly reported. CONCLUSION To effectively manage polypharmacy, standardized counseling manual focusing on high risk medicine is necessary. Also, a policy is needed to handle drug-related problems in cooperation with doctors and pharmacists.