臺灣老年門診病患多重用藥的整合性及持續性照護

Continuous and Integrated Care of Elderly Outpatients with Polypharmacy in Taiwan

陳明正(Ming-Chen Chen) ； 余文瑞(Wen-Ruey Yu) ； 翁林仲(Lin-Chung Woung) ； 何清幼(Chin-Yu Ho)

《北市醫學雜誌》 9卷1期 (2012/03) Pp. 21-29

https://doi.org/10.6200/TCMJ.2012.9.1.03

摘要

Objective: Polypharmacy (concurrent use of more than five different medications or unnecessary drugs) is highly prevalent in the elderly due to their increased number of co-morbid diseases. Polypharmacy not only increases the risk of ADRs (adverse drug reactions) but also lowers adherence to drug regimens. Both ADRs and low adherence to drug regimens are related to morbidity and mortality. The aim of this study was to identify the prevalence of polypharmacy and to assess the effectiveness of reducing inappropriate medication via attendance at an Integrated Geriatric Clinic (IGC). Methods: IGCs are an emerging new approach when treating patients with multiple medical needs. The clinic started in May 2009 in Taipei City Hospital, Yangming Branch. Elderly outpatients with polypharmacy consulted with an interdisciplinary team of professionals that included a geriatric specialist, a neurologist, physiatrist and pharmacist over 20 months. Results: A total of 99 patients (males: 47, females: 52) were enrolled at the IGC. The average age was 77.6±9.9 years. About half of the elderly had a normal BMI (Body Mass Index, normal range 18.5~23.9 Kg/m2) and 39 (40%) were overweight. More than half had renal function impairment [average CLcr (creatinine clearance): 48.3±21.4 ml/min]. Seventy-three patients (73.7%) took complementary medications, and 14.1% of them took Chinese herbal products. The prevalence of polypharmacy was 72.7% at the first clinic survey and this had significantly dropped to 58.6% at the final survey. The mean number of medications was 7.3±4.1 at initial visit compared with 6.3±3.0 at final visit. A statistically significant reduction in the total number of medications taken was observed. Conclusions: The prevalence of polypharmacy is extremely high among the Taiwanese elderly. We found a significant reduction in the number of medications being taken by the elderly could be brought about through continuous IGC intervention. To improve drug safety among this high-risk population, the goal of the IGC is to promote appropriate medication usage, and to reduce the incidence of polypharmacy. Comments: Health care professionals should be aware of ADR among the elderly. A reduction in the number of medications taken and in unnecessary drug use at each patient visit is an important issue that is closely related to drug safety.

關鍵字

多重用藥 ； 藥物不良反應 ； 老年整合性門診

並列摘要

Objective: Polypharmacy (concurrent use of more than five different medications or unnecessary drugs) is highly prevalent in the elderly due to their increased number of co-morbid diseases. Polypharmacy not only increases the risk of ADRs (adverse drug reactions) but also lowers adherence to drug regimens. Both ADRs and low adherence to drug regimens are related to morbidity and mortality. The aim of this study was to identify the prevalence of polypharmacy and to assess the effectiveness of reducing inappropriate medication via attendance at an Integrated Geriatric Clinic (IGC). Methods: IGCs are an emerging new approach when treating patients with multiple medical needs. The clinic started in May 2009 in Taipei City Hospital, Yangming Branch. Elderly outpatients with polypharmacy consulted with an interdisciplinary team of professionals that included a geriatric specialist, a neurologist, physiatrist and pharmacist over 20 months. Results: A total of 99 patients (males: 47, females: 52) were enrolled at the IGC. The average age was 77.6±9.9 years. About half of the elderly had a normal BMI (Body Mass Index, normal range 18.5~23.9 Kg/m2) and 39 (40%) were overweight. More than half had renal function impairment [average CLcr (creatinine clearance): 48.3±21.4 ml/min]. Seventy-three patients (73.7%) took complementary medications, and 14.1% of them took Chinese herbal products. The prevalence of polypharmacy was 72.7% at the first clinic survey and this had significantly dropped to 58.6% at the final survey. The mean number of medications was 7.3±4.1 at initial visit compared with 6.3±3.0 at final visit. A statistically significant reduction in the total number of medications taken was observed. Conclusions: The prevalence of polypharmacy is extremely high among the Taiwanese elderly. We found a significant reduction in the number of medications being taken by the elderly could be brought about through continuous IGC intervention. To improve drug safety among this high-risk population, the goal of the IGC is to promote appropriate medication usage, and to reduce the incidence of polypharmacy. Comments: Health care professionals should be aware of ADR among the elderly. A reduction in the number of medications taken and in unnecessary drug use at each patient visit is an important issue that is closely related to drug safety.

並列關鍵字

Polypharmacy ； adverse drug reaction ； Integrated Geriatric Clinic