A Population-based Study on the Association between Acute Renal Failure(ARF), Duration of Polypharmacy and Inappropriate Medication

• Main Authors: Wen-Jing, Chang, 張文菁
• Other Authors: Ching-Wen, Chien
• Format: Others
• Language: zh-TW
• Published: 2013
• Online Access: http://ndltd.ncl.edu.tw/handle/71349697714986507159

碩士 === 國立陽明大學 === 醫務管理研究所 === 101 === Background: Polypharmacy and inappropriate medications have become an emerging public health issue in recent years. And because of the rapid growth in elderly population, the situation of polyparmacy and inappropriate medications became more complex and seriouse. The Acute Renal Failure (ARF) is one adverse drug reaction by the wrong way of drug utilization. In fact, not only the polypharmacy and inappropriate medication but also the drug-induced ARF all cause the social problems of the waste of medical resource and rise the medical expenditure. But there are short of the studies about the association between ARF, the duration of polypharmacy and inappropriate medication. The study will to assessed and discuss the association and to provide the suggestions about the solution in the future. Methods: Data were collected from the Taiwan National Health Insurance Research Database (NHIRD) from 2003 through 2006. The study is case-control study. The case group included patients hospitalized for ARF during 2006, and not admitted for ARF from 2003 to 2006. The control group included patients hospitalized without ARF. The definition of polypharmacy is the concomitant use of five or more drugs. The cumulative number of drugs of polypharmacy defined as more than 5 prescriptions per day for 1year prior to admission was determined, with patients further subdivided into five categories:” non-polypharmacy”,” less than 30 days”,” 31~90 days”,” 91~180 days” and “over 181 days.” And the other side, we use “Beers Criteria-2012” and group with ATC-Code in order to analyze the situation of inappropriate medications in sample and the risk of suffering from ARF. The dependent variable was ARF; Independent variable were polypharmacy, inappropriate medication; and the control variables were age, gender and Resource Utilization Bands (RUBs). Results: There were 25,490 sample size in each groups. More than 65% were older than 65 years. And 60% were male. The tendency of RUB centralized to media and high. We found that except the number of “non-polypharmacy group”, the case group (10.52%) was less than control group(12.86%). In other groups of the duration of polypharmacy, the number was case group higher than control group. A statistical model indicated that, relative to penitent who received polypharmacy for “non-polypharmacy”, those who received polypharmacy for ” less than 30 days”,” 31~90 days”,” 91~180 days” and “over 181 days.” Had Odds ratios of developing ARF of 0.94(p=0.0602), 0.958(p=0.2278), 1.038(p=0.2946), 1.207(p<0.0001), respectively. Only the group of “over 180 days” have statistical significant. Conclusions: Polypharmacy is a widespread problem. The trend of polypharmacy, inappropriate medications rise year by year. We observed the trend was much more higher in elderly populations than other cohort. And the rate of population ageing in Taiwan is much faster than other countries. So the government and experts should focus on the issue of drug-induced problem, and educate people the correct concepts. Keywords: Polypharmacy、Inappropriate medications、Adverse drug reaction、Acute renal failure(ARF)