노인환자의 복약순응도 현황 및 영향인자 분석 = Predictive Factors for Medication Adherence in a Geriatric Assessment Program in Korea

다국어 초록 (Multilingual Abstract)

Background : To improve medication adherence in elderly patients, the role of pharmacists in teambased services has been highlighted in the literature. However, not much is known about the role and the service elements involved in comprehensive geriatric programs in South Korea. This study was designed to describe the current status of medication adherence in geriatric patients based on the comprehensive geriatric assessment program and analyze the predictive factors for medication adherence in a tertiary teaching hospital.
Methods : A retrospective cohort study was performed using electronic medical records of 247 patients from March 1st, 2015 to August 31st, 2015. Medication adherence and the types of non-adherence were also collected. Predictive factors for adherence were evaluated by including factors related to demographics, medications, illness, and patterns of medical usage.
Results : The mean age of the study population was 81.2 years (range 65~98 years) and they were taking 9.7 drugs on an average (SD 5.0 drugs). The overall rate of non-adherence was 34%. About 48% of the patients had any forms of assistance in the medication administration. The most common type of non-adherence was“ self-adjustment”. The multivariate analyses revealed that age (adjusted odds ratio, 0.87 [95% CI, 0.80-0.96]; p 0.05) and the number of inappropriate medications (adjusted odds ratio, 0.59 [95% CI, 0.40-0.89]; p 0.05) were strong predictors for non-adherence.
Conclusions : These results indicate that strategic considerations of the predictors of non-adherence should be improved in medication counseling services targeting elderly patients.

참고문헌 (Reference)

1 김성옥, "한국의료패널을 활용한 고혈압환자의 복약순응도가 의료이용 및의료비 지출에 미치는 영향 분석" 대한약학회 57 (57): 369-375, 2013

2 박찬미, "치료지속성에 따른 의료비용 및 건강결과 분석: 고혈압, 당뇨를 중심으로" 건강보험심사평가원 2010

3 김경선, "제2형 당뇨병 환자의 치료에서 복약순응도가 혈당 조절에 미치는 영향" 한국병원약사회 26 (26): 148-153, 2009

4 통계청, "장래인구추계: 2015~2065년"

5 이서영, "자가보고 설문을 이용한 복약순응도 측정 연구분석" 이화여자대학교 임상보건과학대학원

6 이준석, "일개 노인복지관 방문 노인환자들의 다약제복용과 부적절한 약물처방 실태" 대한가정의학회 29 (29): 925-931, 2008

7 이의경, "의료기관 외래 이용자의 복약순응관련 요인 분석" 9 (9): 164-175, 2002

8 허재헌, "복약지도 만족도가 복약순응도에 미치는 영향 : 외래환자를 대상으로" 한국임상약학회 19 (19): 110-119, 2009

9 이혜리, "노인환자의 복약순응도에 미치는 요인" 20 (20): 1216-1223, 1999

10 이의경, "노인 당뇨환자의 복약 및 다제병용실태 분석" 17 (17): 81-93, 2000

11 김성옥, "고혈압과 당뇨병 노인의 복약순응도와 이에 영향을 미치는 요인" 한국임상약학회 21 (21): 81-89, 2011

12 백안나, "개정된 원내 노인부적절약물 목록을 활용한 외래환자의 약물사용평가 및 약제비 절감효과 분석" 한국병원약사회 31 (31): 785-794, 2014

13 김영희, "가정간호 노인대상자의 처방약물복용 실태 및 복용 이행도 영향요인" 한국지역사회간호학회 22 (22): 290-301, 2011

14 Col N, "The role of medication noncompliance and adverse drug reactions in hospitalizations in the elderly" 150 (150): 841-845, 1990

15 Chumney EC, "The effects of pharmacist interventions on patients with polypharmacy" 4 (4): 103-109, 2006

16 Hong JS, "Relationship between oral antihyperglycemic medication adherence and hospitalization, mortality, and healthcare costs in adult ambulatory care patients with type 2 diabetes in South Korea" 49 (49): 378-384, 2011

17 Russell C, "Older adult medication compliance: Integrated review of randomized controlled trials" 30 (30): 636-650, 2006

18 The Task Force For Compliance, "Noncompliance with Medications: And Economic Tragedy with Important Implications for Health Care Reform"

19 Kim SW, "Multidimensional Frailty Score for the prediction of postoperative mortality risk" 149 (149): 633-640, 2014

20 National Community Pharmacists Association, "Medication Adherence in America: a national report 2013" 2013

21 Barat I, "Drug therapy in the elderly: what doctors believe and patients actually do" 51 (51): 615-622, 2001

22 Barat I, "Drug therapy in the elderly: what doctors believe and patients actually do" 51 (51): 615-622, 2001

23 Galt KA, "Cost avoidance, acceptance, and outcomes associated with a pharmacotherapy consult clinic in a veterans affairs medical center" 18 (18): 1103-1111, 1998

24 Vik SA, "Assessing medication adherence among older persons in community settings" 12 (12): 152-164, 2005

25 Osterberg L, "Adherence to Medication" 353 (353): 487-497, 2005

26 Gellad WF, "A review of Barriers to medication adherence: a framework for driving policy options" Rand health 4-6, 2009

27 Gillespie U, "A comprehensive pharmacist intervention to reduce morbiity in patients 80 years or older" 169 (169): 894-900, 2009