Effectiveness of a Hospital-Based Intervention to Reduce the Quantity of Medicine in Polymedicated patients with Renal Impairment - Using Changes in Blood Biochemical index as Indicators

• Main Authors: Dun Huai Yung, 楊敦懷
• Other Authors: H. M. Tseng
• Format: Others
• Language: zh-TW
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/r4sr4x

碩士 === 長庚大學 === 醫務管理學系 === 104 === Background The prevalence of polypharmacy is increasing worldwide, and is becoming challenges for Taiwan because of aging population. In response, Taiwan’s medical institutions have recently undertaken intervention measures to alleviate polypharmacy. However, few studies have been conducted to examine the effectiveness of intervention using biochemical indicators, which may help to determine the influence of such intervention on patient health. Objectives Using the biochemical measurement values of hematology tests, this study aimed to determine the actual influence of system-wide intervention for polypharamcy on biochemical indicators of polymedicated patient. Materials and Methods A project to increase the appropriateness of medication prescription was initiated in a medical center in Northern Taiwan in 2012. An information system was setup to list those who have been prescribed more than 800 pills per month. Data from patients with renal disorders with hematology test results in each phase were retrieved form medical records. After the system-wide intervention, patients whose original dosage reduced more than 20% were categorized as the dosage reduction group and a matched group were established using criteria including age, gender, and disease status. Results Both groups showed a decline in the number of pills taken throughout the observation periods; from 721.8 to 501.5 for the dosage reduction group (31% reduction) and from 757.9 to 683.2 for the control group (9% reduction). Regarding the types of medication, the greatest dosage reduction was observed in the use of stool softeners, and analgesic drugs. Concerning the results of biochemical indicators, two test items (i.e. creatinine and Modification of Diet in Renal Disease) showed significant interaction effect of time and group (F=8.704**). Significant difference in potassium ions was observed among the various time points (F=6.914**). Between the two groups, the difference in sodium ions (F=9.2**), fasting plasma glucose (F=4.892^*) and white blood cell count (F=〖6.901〗^(**)) were significant. Conclusion Intervention plans for rational use of drugs effectively alleviated polypharmacy among patients, reducing drug dosage intake without negatively affecting their physiological values.