Graduate School of Public Health, Teikyo University, Itabashi-ku, Tokyo 173-8605, Japan.
Int J Environ Res Public Health. 2022 Nov 9;19(22):14684. doi: 10.3390/ijerph192214684.
Polypharmacy is a serious health issue for older adults worldwide, including in Japan, which has a rapidly aging society. The "Proper Medication Guideline for Older Adults" was published for healthcare providers in May 2018, and polypharmacy reduction incentives were initiated for medical facilities in April 2016 and April 2018. This study identified the long-term reduction in polypharmacy prescriptions focusing on older adults aged 75 years and above from April 2015 to March 2019. The national health insurance claims database, which covers most reimbursement claims in Japan, was selected as the primary data source. In this study, polypharmacy was defined as the simultaneous prescription of seven or more medications or multi-psychotropic medications. The primary outcome was the polypharmacy reduction ratio, which indicates the decrease in polypharmacy proportion based on the number of medications on an outpatient prescription. A total polypharmacy reduction of 19.3% for the "75-89 years" subgroup and 16.5% for the "90 years and above" subgroup was observed over four years. Based on prefecture analysis, the mean values of polypharmacy proportion showed a statistically significant reduction over four years. This study showed a successful nationwide reduction in polypharmacy prescriptions after implementing the polypharmacy management guidelines for older adults and incentive-based policies.
老年人多病用药在全球范围内都是一个严重的健康问题，包括日本在内，日本社会人口老龄化迅速。2018 年 5 月为医疗保健提供者发布了《老年人适当用药指南》，并于 2016 年 4 月和 2018 年 4 月为医疗机构启动了减少多病用药的激励措施。本研究从 2015 年 4 月至 2019 年 3 月，着眼于 75 岁及以上的老年人，确定了长期减少多病用药处方的情况。选择涵盖日本大部分报销索赔的国家健康保险索赔数据库作为主要数据源。在本研究中，多病用药被定义为同时开具七种或更多种药物或多精神药物的处方。主要结果是多病用药减少率，它表示根据门诊处方的药物数量减少多病用药的比例。在四年内，“75-89 岁”亚组和“90 岁及以上”亚组的总多病用药减少率分别为 19.3%和 16.5%。根据县分析，四年内多病用药比例的平均值显示出统计学上的显著降低。本研究表明，在为老年人实施多病用药管理指南和基于激励的政策后，全国范围内的多病用药处方减少取得了成功。
