総合診療30巻12号

2020年12月発行

特集 “ヤブ化”を防ぐ！—外来診療 基本の(き) Part 2 【トピックス】

❶ポリファーマシー

著者： 吉田英人¹

所属機関： ¹西伊豆健育会病院 内科

ページ範囲：P.1496 - P.1499

ポリファーマシーの定義
　ポリファーマシーは日常診療のなかでよく出会うプロブレムであるが、明確に定まった定義はない。一般的に、薬の数に注目する「量的」な視点と、薬の内容に注目する「質的」な視点で定義されることが多い。

参考文献

1）Masnoon N, et al : What is polypharmacy? ; a systematic review of definitions. BMC Geriatr 17（1） : 230, 2017. PMID 29017448

2）Gnjidic D, et al : Polypharmacy cutoff and outcomes ; five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol 65（9） : 989-995, 2012. PMID 22742913

3）Scottish Government Polypharmacy Model of Care Group : Polypharmacy Guidance Realistic Prescribing, 3rd ed, 2018.　https://www.therapeutics.scot.nhs.uk/wp-content/uploads/2018/04/Polypharmacy-Guidance-2018.pdf

4）World Health Organization : Medication safety in polypharmacy ; technical report.　https://apps.who.int/iris/bitstream/handle/10665/325454/WHO-UHC-SDS-2019.11-eng.pdf?ua=1

5）Onda M,et al : Identification and prevalence of adverse drug events caused by potentially inappropriate medication in homebound elderly patients ; a retrospective study using a nationwide survey in Japan. BMJ Open 5（8） : e007581, 2015. PMID 26260347

6）Dwyer LL, et al : Polypharmacy in nursing home residents in the United States ; results of the 2004 National Nursing Home Survey. Am J Geriatr Pharmacother 8（1） : 63-72, 2010 PMID 20226393

7）Doan J, et al : Prevalence and risk of potential cytochrome P450-mediated drug-drug interactions in older hospitalized patients with polypharmacy. Ann Pharmacother 47（3） : 324-332, 2013. PMID 23482734

8）Alves-Conceição V, et al : Medication regimen complexity measured by MRCI ; a systematic review to identify health outcomes. Ann Pharmacother 52（11） : 1117-1134, 2018. PMID 29756471

9）Ganz DA, et al : Prevention of falls in community-dwelling older adults. N Engl J Med 382（8） : 734-743, 2020. PMID 32074420

for potentially inappropriate medication use in older adults. J Am Geriatr Soc 67（4） : 674-694, 2019. PMID 30693946

11）O'Mahony D, et al ; STOPP/START criteria for potentially inappropriate prescribing in older people ; version 2. Age Ageing 44（2） : 213-218, 2015. PMID 25324330

12）Hedna K, et al : Potentially inappropriate prescribing and adverse drug reactions in the elderly ; a population-based study. Eur J Clin Pharmacol 71（12） : 1525-1533, 2015. PMID 26407684

13）日本老年医学会，他（編）：高齢者の安全な薬物療法ガイドライン2015．日本老年医学会，2015.

14）Garfinkel D, et al : Feasibility study of a systematic approach for discontinuation of multiple medications in older adults ; addressing polypharmacy. Arch Intern Med 170（18） : 1648-1654, 2010. PMID 20937924

15）Rankin A, et al : Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev 9 : CD008165, 2018. PMID 30175841

16）Verdoorn S, et al : Majority of drug-related problems identified during medication review are not associated with STOPP/START Criteria. Eur J Clin Pharmacol 71（10） : 1255-1262, 2015. PMID 26249851