부산대학교 도서관

Objectives: This study firstly aimed to identify the percentage of nursing home patients who were prescribed more than nine drugs (polypharmacy) and compared prescribing patterns of this patient group to patients who were prescribed fewer drugs. Secondly, teams of hospital pharmacists and nursing home physicians aimed to identify the drug related problems of the polypharmacy patients and the extent to which it was feasible to optimise their medication profiles. Methods: Characteristics of the polypharmacy population were illustrated by retrospective point measurements in five Dutch nursing homes (total of 742 beds) over the years 2004, 2005 and 2006. Additionally, 91 polypharmacy patients in those nursing homes were included for a medication review by a hospital pharmacist and a nursing home physician. The appropiateness of each drug was discussed adressing indication, effectiveness and safety, as well as possible undertreatment. Drug related problems were accordingly (sub)categorised. The pharmacist and physician prioritised the problems and jointly preparared a plan who to optimise the medication profile. Six weeks later, the same pharmacist and physician met again and discussed for each patient the list of problems and the alterations in the medication profile. Results: We found an increase in the percentage polypharmacy patients over the years (14.6%, 2004; 17.5%, 2005; 19.8%, 2006). Drugs from the ATC-groups ‘alimentary tract and metabolism’, ‘cardiovascular system’ and ‘nervous system’ were prescribed most frequently in the polypharmacy population. The 91 reviewed polypharmacy patients used 1226 drugs. We registered 323 drug related problems (mean of 3.5 problems per patient). A decreased renal function (creatinin clearance < 40 ml/min) was observed in a high number of polypharmacy patients (at least 40%). The majority of drug related problems were in the category ‘indication’. In total, 62% of all drug related problems were subcategorised as ‘unclear or not confirmed indication’. These problems were observed in 87% of the polypharmacy patients. A mean of 1.7 (n=159) problems per patient were solved during the subsequent intervention period and the number of drugs per patients decreased statistically significantly from 13.5 to 12.7 (p < 0.0001). Conclusion: The percentage of nursing home patients meeting the polypharmacy definition ranged from 14,6% to 19,8% over 2004–2006. The majority of polypharmacy patients had at least one drug prescribed for which the indication was unknown. The intervention was accompanied with a significant decrease in the number of drugs per patient, but half of the drug related problems remained unsolved. [ABSTRACT FROM AUTHOR]