신이식 환자의 처방 현황 분석을 통한 Polypharmacy 적정성 평가

Abstract

The polypharmacy refers to the use of more medications than clinically indicated. The Health Insurance Review & Assessment Service (HIRA) has evaluated polypharmacy with more than 6 medicines per prescription in each hospital every quarter. The objective of this study was to analyze polypharmacy status and to evaluate the appropriateness of a current standard of HIRA regarding polypharmacy in kidney transplantation (KT) patients. We searched the pharmacy data and analyzed the prescription medicines by immunosuppression and complications for KT outpatients from January to March of 2008. Prescriptions(Rxs) were analyzed for factors affecting number of medicines, unnecessary drug use and duplication. Total Rxs were 650 in 380 patients. The average numbers of medications on each prescription was 8.0 drugs(±3.0), immunosuppressive agents were 2.5 drugs(±0.6), and non-immunosuppressive agents were 5.5 drugs(±3.0). The Rxs with more than 6 drugs were 80.6%. The Rxs for patients more than 2complications were 81.7%. The highest ranked class of drugs other than immunosuppression was cardiovascular drugs (78.0%) followed by hyperlipidemia drugs (45.3%), gastrointestinal drugs (43.8%) and osteoporosis drugs (42.0%). The duplication rate was 4.5% based on the same ATC classification. However, they did not significantly influence on the situation of the polypharmacy. In conclusion, the current policy regarding polypharmacy is not appropriate for KT patients with many drugs and complications.