- 학회명: European Association of Hospital Pharmacists Congress
- 기간: 2026.03.18 - 20
- 장소: Barcelona, Spain
- 발표자: SU-JIN GONG, SEUL-GI HAN, SA-MI YANG, JI-YOUNG CHOI, HYE-WON HAN
Department of Pharmacy, Asan Medical Center, South Korea
Background and Importance
The growing complexity of healthcare underscores the need for patient-centered medication reviews to ensure safe drug use. Pharmacist interventions in older adults (≥65 years) have been shown to significantly reduce hospital readmissions and emergency visits. To deliver effective and timely medication reviews, it is essential to evaluate patient-specific risk factors and establish strategies that prioritize high-risk patients for pharmacist-led interventions.
Aim and Objectives
This study aimed to evaluate associations between patient-specific risk factors and drug-related problems (DRPs), with the goal of developing criteria to identify high-risk patients for targeted pharmacist interventions.
Materials and Methods
This retrospective single-center study included patients aged ≥65 years who were hospitalized at Asan Medical Center in March 2025. Patient-specific risk factors and DRPs were assessed, and their associations were analyzed to identify predictors and selection criteria for high-risk patients.
Results
Among 2,574 patients, 313 (12.2%) had DRPs and 2,261 (87.8%) did not. A total of 578 pharmacist interventions were recorded, most commonly related to potentially inappropriate medications (19.0%), laboratory-based dose adjustments (12.0%), and therapeutic duplication (12.0%). Significant associations were observed between DRPs and most patient-specific risk factors, excluding selected laboratory abnormalities. Independent predictors of DRPs included: Clinical Frailty Scale (CFS ≥5, OR 6.203, 95% CI 4.562–8.436, p<0.001), impaired renal function (eGFR <30;, OR 1.944, 95% CI 1.229–3.075, p=0.005), polypharmacy (≥5 drugs;, OR 2.409, 95% CI 1.500–3.865, p<0.001; ≥10 drugs;, OR 9.162, 95% CI 5.604–14.978, p<0.001), ≥2 opioids (OR 1.853, 95% CI 1.072–3.203, p=0.027), ≥1 TDM drug (OR 1.751, 95% CI 1.061–2.891, p=0.028), and therapeutic duplication (OR 1.641, 95% CI 1.158–2.326, p=0.005).
Conclusion and Relevance
Patient-specific risk factors, including polypharmacy, frailty, impaired renal function, opioid use, TDM drugs, and therapeutic duplication, were significantly associated with increased risk of DRPs. These findings highlight the importance of incorporating risk factor-based criteria into patient selection strategies for pharmacist-led interventions. Further multicenter, prospective studies are warranted to strengthen the evidence base and refine prioritization frameworks.
