노인장기요양시설에서의 미사용 의약품 발생에 영향을 미치는 요인

Abstract

As the number of elderly living in long-term care facilities increases, unused medicines are also increasing. This study investigated the status of unused medicines in long-term care facilities and the factors affecting it. Using National Health Insurance Claims Database(NHICB) and Long-term Care Insurance Claims Database(LTCHCD), 137,309 people who lived only in long-term care facilities and took prescription drugs in 2019 were analyzed in this study. Most of them were prescribed by the clinic (41%), and the days per prescription were 25 days in average. Only 1.8% of prescriptions were from tertiary general hospitals, but the days per prescription reached 85 days, accounting for 67% of prescriptions for more than 60 days. The average age of long-term care facility residents was 84.8 years, and 22.6% of them deceased in 2019. 33.7% of the subjects had unused medicines. The days of unused medicines due to duplication in pharmacologically equivalent groups were 13 days in average. The average days of unused medicine due to death were comparatively longer, which was 75.5 days. Unused medicine costs were about 0.9% of the total pharmaceutical expenditures and 77.8% of the costs was caused by death. Unused medicines increased as the number of outpatient visits increased (Relative Risk (RR): 1.14) or when the days per prescription were long (RR: 1.16). Older adults who died were 15 times more likely to have unused medicines than those who were alive. The amount of unused medicines in long-term care facilities is substantial, so it is necessary to establish appropriate policies to reduce it.