Earticle

Background: Elderly patients with multimorbidity have a high prevalence of polypharmacy. Although negative consequences of polypharmacy have been reported, the definition of polypharmacy and inappropriate polypharmacy have not been established. The purpose of this study was to review the definition of polypharmacy and foreign countries’ interventions aimed at improving the appropriate use of polypharmacy in older people. We searched for relevant studies up to December 2024 using MEDLINE, Cochrane Library, and reports using Google. We also conducted web searches and literature reviews in Australia, the United Kingdom, and global organizations such as the World Health Organization (WHO). We found out that polypharmacy can refer to the prescribing of many drugs (appropriately) or too many drugs (inappropriately). Problematic polypharmacy was defined as ‘the prescribing of multiple [medicines] inappropriately, or where the intended benefit of the [medicines] is not realized’. Also, it is necessary to develop guidance on inappropriate polypharmacy and intervention to improve drug-related problems due to polypharmacy among the elderly.

Background: The World Health Organization (WHO) and the International Pharmaceutical Federation (FIP) released Good Pharmacy Practice (GPP) guidelines in 2011, which have since been adopted in many countries. Korea, in response to changes such as the adoption of a six-year pharmacy education system, developed a draft version of Korea’s Good Pharmacy Practice (KGPP) in 2014. However, this draft has not yet been officially implemented. Accordingly, this review examines the content and direction of the KGPP by referencing best practices from leading jurisdictions such as Canada. Official documents from WHO, FIP, national pharmacy associations, and relevant legislation were analyzed, along with literature on pharmacist-led services such as Medication Therapy Management (MTM). Based on this review, the KGPP presents fewer and less detailed domains, standards, and indicators than are needed to clearly delineate pharmacists’ roles as outlined by WHO. Many provisions are enumerated as discrete activities rather than embedded within an integrated framework, leading to potential ambiguity in interpretation. The draft focuses mainly on traditional dispensing functions, offering limited guidance on clinical or cognitive services like MTM. Additionally, while "pharmaceutical care" is mentioned, it is not clearly defined in the draft or related legislation, creating legal and practical uncertainty that may hinder effective implementation of the KGPP. Lessons from other countries indicate that establishing a nationally endorsed GPP framework with clearly defined roles and outcomes is essential. To meet the changing needs of healthcare and pharmacy practice in Korea, prompt revision, formal adoption, and integration of a Korea-specific GPP model are strongly recommended.

Beginning in March 2026, South Korea will implement the Community Care Integration Act to establish a nationwide system linking healthcare, long-term care, and social services—particularly for the elderly, who face high risks from chronic diseases and polypharmacy. Although the Act formally acknowledges pharmacists’ roles in integrated care (Article 15, Clause 7), their participation remains limited and their clinical expertise underutilized. This study investigates strategies to enhance the integration of pharmacists into South Korea’s community care system by analyzing pharmacist-led medication management services in Australia. Australia has developed a robust healthcare and medication safety framework through national and state-level agencies (e.g., Home Medicines Review (HMR), and Residential Medication Management Review (RMMR)). These services improve medication safety and adherence through structured medication reviews and interdisciplinary collaboration. In contrast, pharmacist-led services in Korea remain fragmented and are not yet systematically embedded within the integrated care infrastructure, despite a series of pilot initiatives since 2018 aimed at managing polypharmacy in both hospital and community settings. These pilots, however, offer a foundational platform for national-scale adoption. Based on the Australia’s experience, this paper recommends establishment standardized medication review protocols, expanding pharmacist roles services within interdisciplinary teams, and provision of financial and institutional support to ensure sustainable implementation. Deploying clinically trained pharmacists in community settings will be critical to safeguarding medication use and advancing person-centered care for Korea’s aging population.

Background: This study aims to analyze the experiences of self-medication for minor symptoms, examine over-the-counter (OTC) drug usage patterns, and evaluate consumer satisfaction with pharmacy services to explore future improvements in self-medication practices. Methods: A 27-item questionnaire was used in this cross-sectional survey to examine self-medication experiences for minor ailments among adults living in Korea during March to April 2019 through an online channel. Results: Of the 354 respondents, 98.9% experienced minor symptoms such as cough, cold, headache, muscle pain, indigestion, lower back pain, sore throat, diarrhea, body aches, heartburn, constipation, and fever for the past year. 31.9% purchased OTC medication from pharmacies, 37.6% visited healthcare providers such as clinics, and 30.5% rested at home, to cope with them. The main advantage of self-medication was identified as being easier and more convenient than physician visits, while the primary concern was uncertainty about the accuracy of self-diagnosis. 91.8% purchased OTC drugs from a pharmacy in the past year, 53.8% trusted pharmacists’ product choices, and 72.6% were satisfied with pharmacists’ medication guidance. In cases of chronic illness, the rate of visits to hospitals, clinics, or pharmacies was higher, while the proportion of those who “endure and bear with it” was lower (p = 0.012). Conclusion: This study highlights the crucial role of pharmacists in improving the quality of self-medication and provides foundational data for enhancing pharmacy services.

Background: The use of immune checkpoint inhibitors (ICIs) for advanced cancer is increasing, particularly in combination with chemotherapy. However, previous studies have focused on immune-related adverse events (irAEs) in specific organs, with limited research on combination therapy. Objective: We aimed to detect signals of adverse drug reaction (ADR) in both ICIs plus chemotherapy and ICIs alone compared to chemotherapy. Methods: We investigated individual case safety reports (ICSRs) between 2014 and 2022 using Korea Institute of Drug Safety and Risk Management Korean Adverse Event Reporting System database (KIDS KAERS DB (2304A0076)). We defined adverse events (AEs) and drugs using MedDRA and the national drug code directory provided by the Ministry of Food and Drug Safety. To detect signals, we performed disproportionality analysis using indices of reporting odds ratio (ROR) and information component (IC). Results: We identified 206,959 ICSRs in the KIDS KAERS DB, of which 5,154 contained ICIs and 201,805 were for chemotherapy. Compared to chemotherapy, radiation pneumonitis (ROR, 2313.6; IC, 5.4), hyperthyroidism (ROR, 53.4; IC, 4.2), and eczema (ROR,18.3; IC, 3.4) were detected as signals for ICIs. For ICIs with chemotherapy, additional signals including heart failure (ROR 9.65; IC 2.45), proteinuria (ROR 28.67; IC 4.16), and urinary tract infections (ROR 3.46; IC 1.03) were detected. Conclusion: The study highlights an essential signal of ADRs associated with ICIs, both alone and in combination therapy, with conditions such as hyperthyroidism, hypothyroidism, and pneumonitis. These AEs should be monitored in clinical settings.

Background: Rifampin exhibits highly variable exposure in tuberculosis patients, leading to adverse effects or treatment failure. This study aimed to develop therapeutic drug monitoring (TDM) strategy for rifampin using a single concentration-time point to estimate the area under the concentration-time curve (AUC), with the potential to reduce the number of blood draws. Methods: Plasma concentration(Cp)-time data were obtained from tuberculosis patients by collecting serial venous blood samples after rifampin administration. The Cp timepoint (Ct) that predicts AUC best was explored using linear regression (Exploration). The accuracy and precision were evaluated using Bland-Altman plot. Physiologically based pharmacokinetic modeling approach was used to evaluate whether the single Ct point identified in Exploration provides the best prediction of the AUC (Complement). Results: Cp-time data obtained from 26 participants were evaluable for the determination of AUC by Ct. In Exploration, C4 best predicted the AUC (r2=0.91, p<0.0001), followed by C2 (r2=0.84, p<0.0001). In AUC prediction by C4, the datapoints for predicted and observed AUC pairs were randomly scattered in Bland-Altman plot with the mean bias of −0.029 μg · h/mL, and the 95% limit of agreement of −21.1 to 21.1 μg · h/mL. In Complement, C4,sim best predicted the AUC (r2=0.86, p<0.0001), which supports that C4 reliably predicted AUC. Conclusions: For improving treatment outcomes in the treatment of tuberculosis, a single concentration monitoring is applicable to rifampin TDM instead of AUC, potentially making the process less invasive, painful and cumbersome for patients, clinicians and healthcare providers.