Resolving Medication-Related Problems in Older Adults through a Multidisciplinary Approach in Korea’s Hospital-Based Polypharmacy Program

PURPOSE: Polypharmacy in older adults is a significant public health challenge. A hospital-based, multidisciplinary Polypharmacy Management Program (PMP) was initiated nationally. We evaluated this team-based program's initial performance, identifying factors associated with medication-related problems (MRPs) prompting prescription changes. MATERIALS AND METHODS: We retrospectively analyzed 2021 PMP data from 1740 patients (33 hospitals). Medication review records, intervention outcome records, and patient demographics were examined. MRPs were identified, classified, and documented alongside prescription modifications. Multivariable logistic regression was used to determine factors associated with prescription modifications. RESULTS: MRPs were found in 73.5% of patients (average 2.7/patient). Common types were potentially inappropriate medications (PIMs, 58.7%), interactions (46.9%), and adverse drug reactions (ADRs, 26.2%). Pharmacists recommended modifications for 32.4% of MRPs, with 92.2% physician acceptance. Discontinuation (59.2%) was the most common modification, often due to lack of indication or ADRs. Significant predictors for modification included age ≥85 years [adjusted odds ratio (aOR)=2.34], ≥20 medications (aOR=2.46), and use of anticholinergics, multiple oral hypoglycemics, duplicate gastrointestinal agents/proton pump inhibitors or antidementia agents, and certain antidepressants/corticosteroids. CONCLUSION: Hospital-based multidisciplinary teams effectively identify and rectify MRPs in older Korean adults with polypharmacy. Targeting interventions towards high-risk subgroups (very elderly, high medication count, specific drugs) could optimize PMP efficiency. Long-term clinical and economic outcome studies are needed.