RAND/UCLA Appropriateness Method를 이용한 요양시설의 포괄적 약물관리 프로그램의 대상자 기준 개발

Abstract

Background: Comprehensive medication management is essential to achieve safe and optimal drug use for the elderly in long-termcare facilities (LTCF). This study aimed to develop eligibility criteria for ”Comprehensive medication management program inLTCF” using the RAND/UCLA Appropriateness Method (RAM). Furthermore, we attempted to estimate the number ofbeneficiaries who met the criteria by analyzing the National Health Insurance claims data. Methods: Twelve criteria were selectedinitially. We composed a panel of 14 experts with expertise in long-term care. We conducted two survey rounds to reach a consensus. Rating for appropriateness and decision regarding agreement were applied per RAM. We analyzed the National Health Insurancedata to estimate the number of LTCF residents who met each eligibility criterion. Results: Of the 11 items agreed upon, ten itemswere determined to be appropriate. In 2018, 83.6% of 165,994 residents of LTCF met one or more eligibility criteria. The largestnumber of subjects met the “New residents of LTCF” criterion, followed by “Take high-alert drugs” and “Chronic excessivepolypharmacy.” Since the items evaluated as most appropriate by the expert panel and those with a large number of subjects weresimilar, we confirmed the external validity of our criteria. Conclusion: It is worth noting that this is the first attempt to establish theeligibility criteria for medication management in LTCF. Further preliminary research is needed to identify the selected subjects' drugrelatedproblems and revise the criteria according to the results.