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INTRODUCTION
South Korea is experiencing a rapid demographic transition into an aging society, driven by an increase in life expectancy and a simultaneous decrease in birth rates.1 Consequently, both the absolute number and the proportion of older adults in the overall population have risen sharply. As age increases, the number of chronic diseases accumulates, and the combination of existing diseases can cause new illnesses, resulting in a higher likelihood of multimorbidity among older adults.2 This poses a serious challenge to the healthcare system in an aging society. The total healthcare expenditure in South Korea, covered by the National Health Insurance, has been increasing at an average annual rate of 7% in recent years, reaching 110.8 trillion won in 2023 (approximately 76.8 billion USD).3 Among this, the medical expenses for adults aged 65 and above amounted to 48.9 trillion won (≤ 33.9 billion USD), a 36.6% increase from 35.8 trillion won (≤ 24.8 billion USD) in 2019, four years prior. The proportion of medical expenses for older adults in the total healthcare expenditure has also increased from 41.6% to 44.1%.
Older adults often require multiple medications to manage and treat various conditions, and due to the high prevalence of multimorbidity among this population, the number of medications they take tends to increase. According to a survey, 38.1% of older adults take five or more medications for more than six months a year, and 9.4% take ten or more medications, with these proportions gradually increasing.4 However, due to physiological changes that occur with aging, older adults experience pharmacokinetic and pharmacodynamic differences compared to younger individuals, such as changes in drug absorption, distribution, metabolism, and excretion.5 This leads to a higher likelihood of experiencing adverse drug reactions in older adults compared to those in younger adults. Moreover, the presence of multimorbidity increases the risk of drug-disease interactions and drug-drug interactions. Even if the same adverse reactions occur, older adults are more likely to suffer from them or develop disabilities due to frailty associated with aging. Therefore, greater caution is necessary when using medications in older adults.6
Accordingly, the American Geriatrics Society and the European Geriatric Medicine Society have identified and published a list of potentially inappropriate medications (PIMs) that are likely to cause more harm than benefit when used in older adults.78 They not only educate healthcare professionals about these medications but also promote a "Deprescribing" campaign, which involves systematically reviewing the medications currently in use and comprehensively considering the benefits and risks of each medication to reduce the dosage or discontinue its use.9 Numerous studies have reported that deprescribing, which involves reviewing the medications used by older adults and discontinuing those with low benefit-to-risk ratios, can reduce medication burden and maintain or improve quality of life. Optimizing pharmacotherapy through personalized prescribing that considers the comorbidities and frailty of older patients is crucial for managing chronic diseases, preventing adverse effects, and improving treatment outcomes.10
To effectively carry out the deprescribing process and maintain efficient medication use patterns in the long term, not only the healthcare professionals who prescribe the medications actively participate, but also the patients themselves must be engaged with a shared sense of purpose. If patients feel anxious when choosing non-pharmacological treatments over medications or when discontinuing medications whose risks outweigh the benefits, they may seek new prescriptions or revert to their original prescribing habits due to inertia. This can hinder the maintenance of efficient medication use behaviors over an extended period. To establish and sustain healthy medication use practices, rather than being satisfied with short-term deprescribing results, both patients and healthcare professionals must recognize the risks of polypharmacy and PIMs.11 They should build therapeutic alliances and create a structure for voluntary participation.
In this study, the authors conducted a deprescribing intervention targeting patients with polypharmacy and PIMs among those visiting the geriatric outpatient clinic or receiving inpatient care at the hospitalist center of tertiary hospitals in South Korea. They assessed the persistence of the intervention effects three months later. Through individual interviews with participants, the authors inquired about changes in perceptions or attitudes towards polypharmacy and PIMs before and after participating in the intervention. They also listened to the participants’ intervention experiences and gathered information on the inconveniences felt by patients and areas for improvement during the process. Furthermore, the authors collected data on the difficulties and future improvements of the intervention activities through focus group interviews with geriatric medical professionals who had experience in conducting deprescribing interventions. By comprehensively analyzing these data and promoting the motivation of patients and healthcare professionals, the authors aimed to explore voluntary and sustainable methods for healthy medication intervention activities.
METHODS
Study participants
From May to August 2023, patients aged 65 years or older who were admitted to the department of hospitalist medicine at Seoul National University Bundang Hospital or visited the geriatric outpatient clinic at Asan Medical Center were recruited and an equal number of participants were enrolled from each institution. The inclusion criteria were patients taking five or more medications for at least three months, with at least one of them being a PIM. The study participants were consecutively recruited, based on the order of their hospital visits, after receiving an explanation of the purpose of the study, the deprescribing process, and the interview to be conducted three months later.
Additionally, focus group interviews were conducted with geriatric medical professionals, including physicians, nurses, and pharmacists, who were currently treating older adults and had experience in conducting medication intervention activities for patients with polypharmacy or PIMs. The focus group interviews aimed to gather information on the problems of medication use in older adults perceived in clinical settings, the difficulties encountered during the intervention process, and to explore effective and sustainable deprescribing strategies.
Deprescribing intervention
The research institutions had their own customized versions of the PIM list based on the widely used Beers criteria, adapted to their respective hospital situations. The PIM lists from the two institutions were integrated through three round-table meetings among the researchers, and injectable and topical medications were excluded from the scope of this study (Supplementary Table 1).
Before enrolling in the study, the list of medications each patient was taking was compiled by combining the prescription records from the Health Insurance Review and Assessment (HIRA) Service, the actual medications or prescriptions submitted by the patient, and the statements of the patient and their caregivers. Through meetings between physicians and pharmacists, the patient's diseases, symptoms, and medications were reviewed together to identify drugs with unclear purposes, those with a higher likelihood of harm than expected benefit, and those with insufficient evidence for use, such as health supplements or herbal medications. The patients and their caregivers were directly shown the actual medications or their photographs, and the reasons and necessity for discontinuing these drugs were explained. Repeated education was provided to ensure that these medications were not prescribed in the future. Additionally, medications that were deemed necessary but not recommended for use in older adults were replaced with safer alternatives whenever possible.
In depth interviews with patients
Three months after the enrollment date, the participants were contacted through a third-party professional survey agency and underwent focused face-to-face interviews at their preferred schedule and location. Caregivers were allowed to accompany the participants if desired (Supplementary Table 2). To ensure that participants could freely share their experiences and opinions, the interviews were conducted without the participation of the researchers or the medical staff who performed the deprescribing intervention and were instead led by an interviewer holding a master’s degree in sociology with over 20 years of experience in public opinion research. The research team and the interviewer held three meetings in advance to determine the survey methods, question content, and interview guidelines. The duration of each participant's interview was approximately one hour or less. Before the interview, the purpose and objectives were explained, and notification and approval for recording the interview content were obtained.
The specific questions were broadly categorized into three areas: 1) the patient's subjective perception of their health status and pharmacotherapy, 2) experiences of participating in the deprescribing intervention activities and whether they maintained the medication use methods adjusted and recommended during the intervention, and 3) changes in attitudes toward medications and adverse drug reactions, as well as opinions on systemic improvements for rational medication use (Table 1). The researchers verified whether the participants maintained the deprescribing intervention results through the prescription records of the HIRA Service.
Table 1
Participants’ interview question contents
Focus group interviews with geriatrics experts
Focus group interviews were conducted with geriatric medical professionals, including physicians, advanced practice nurses, and pharmacists, who had experience in conducting deprescribing interventions for older adults (Supplementary Table 3). The interviews aimed to gather information on their firsthand experiences with polypharmacy and PIM use in clinical settings, the difficulties encountered during the deprescribing process, and potential improvements. The researchers were excluded from the interview participants, and the question content and guidelines were determined through prior discussion between the research team and the professional survey agency (Table 2).
Table 2
Geriatric experts’ interview question contents
Statistical analysis
Continuous variables from the data collected from study participants were expressed as mean values and standard deviations, while categorical variables were presented as numbers and percentages. All statistical analyses were performed using IBM SPSS Statistics, version 26.0 (IBM Corp., Armonk, NY, USA).
RESULTS
In depth interviews with patients
A total of 24 participants, 12 inpatients and 12 outpatients, were enrolled from the two institutions. The average age was 79.3 years, and 17 participants (70.8%) were female. All participants, except for one inpatient who was a recipient of medical aid, were enrolled in medical insurance (Table 3). The average Clinical Frailty Scale score was 4.5, and the average Charlson Comorbidity Index was 6, with inpatients exhibiting slightly higher frailty and comorbidity burden compared to outpatients. Among the 24 participants, 10 (41.7%) had diabetes, 7 (29.2%) had congestive heart failure, and 3 (12.5%) had cerebrovascular disease or dementia. Prior to enrollment in the study, the participants were taking an average of 16 medications, which decreased to 9 medications after the deprescribing intervention.
Table 3
Clinical characteristics of participants in the deprescribing intervention
Theme 1: patient health status, medication behavior, and attitudes
Participants reported visiting at least 2–3 medical institutions to receive prescriptions for various chronic conditions such as hypertension, diabetes, and arthritis, as well as temporary symptoms like indigestion, muscle pain, and respiratory symptoms such as cough. They stated that they used different hospitals and departments for each disease and symptom. Including over the counter medications, herbal medicines, and health functional foods, participants were taking anywhere from 5 to more than 30 types of medications. They had a strong desire to maintain their health through medication and held a firm belief that all medicines prescribed by doctors should be taken. They also had a strong expectation that the prescribed medications would help manage their diseases or alleviate symptoms.
"He started taking medications for hypertension, diabetes, and hyperlipidemia in 1999. He also occasionally visits the anesthesiology and orthopedic departments. So, my father seeks hospital care immediately if he feels even slightly ill, so there's nowhere he hasn't been." - Participant ID 24
"I was taking various supplements that are good for the body, such as probiotics, and recently added vitamin D and calcium due to osteoporosis. I also took omega-3, vitamin B, and vitamin D separately, and sometimes took multivitamins.” - Participant ID 05
Few participants thought that taking too many medications could cause problems; they simply perceived it as inconvenient to take many medications. It was found that patients who were recipients of medical aid had even less awareness of their polypharmacy. Participants lacked understanding of specific prescription details or goals, and if symptoms did not improve within a day or two of taking medication, they tended to switch hospitals and receive different prescriptions. In these cases, adverse drug reactions were perceived as a worsening of existing diseases or the onset of new diseases. To alleviate these symptoms, patients visited other medical institutions and received prescriptions, leading to a prescribing cascade. Although patients or caregivers claimed to be taking the prescribed medications accurately, an analysis of their actual usage behavior revealed that they frequently changed their medication regimen arbitrarily or discontinued medications based on the severity of symptoms or discomfort.
"I never asked why they prescribed so many medications. I just thought, 'The hospital will do what's good for me.' I'm a basic livelihood recipient, so I don't pay for medications. Since there's no burden, I take them whenever I need them." - Participant ID 10
"My mother is quite sensitive. If she goes to one hospital for a few days and doesn’t get better, she’ll move on to another hospital. For example, if she has indigestion and it doesn’t improve, she’ll go elsewhere and get sedatives. This way, she ends up visiting multiple hospitals and taking a lot of different medications." - Participant ID 15
Theme 2: experiences and evaluation of the deprescribing intervention
Compared to outpatients, inpatient participants were more likely to revert to their original prescriptions or have new PIMs added at the time of the interview. While some outpatients voluntarily sought help due to taking too many medications, inpatients were encouraged to participate in the intervention activities through medication reviews by medical staff during hospitalization. As a result, inpatients lacked intrinsic interest or motivation, leading to lower sustainability of the intervention effects. Many inpatients resumed their previous prescriptions after being discharged and returning to their original hospitals, and they were reluctant to inform their original hospitals about the intervention, which also contributed to the lack of sustainability. In contrast, patients who visited the geriatric outpatient clinic had actively sought out the intervention through their own information search. They had high trust in the physicians and could receive integrated outpatient care and prescriptions at the intervention hospital instead of their previous follow-up hospitals, enabling continuous management.
"I think it's close to dissatisfaction because my mother was in severe pain, but there were no pain medications, so she went back to the hospital she used to go to. She's still taking appetite stimulants to improve her appetite since she has no appetite." - Participant ID 01
"My mother was taking too many medications and visiting many hospitals. My sister found a hospital that could review her medications comprehensively to check for any potential issues. So, we visited this hospital for the first time, and we want to get regular check-ups in the future. We're very satisfied." - Participant ID 22
Theme 3: patient-perceived barriers and facilitators to use rational medication
Regarding the reasons for the prevalence of polypharmacy among older adults in South Korea, participants mentioned factors related to diseases and symptoms, such as "multimorbidity in older adults" and "the need to relieve pain and discomfort." They also pointed out patients' habitual behaviors and lack of awareness, such as "excessive health concerns," "overuse of medical institutions," "habitual medication use," "misbeliefs," and "lack of education and information about medications." Additionally, they highlighted systemic factors and causes on the provider side, such as "a health insurance system with low out-of-pocket costs," "difficulty in communicating with medical staff and doctors," and "profit-oriented behavior of the pharmaceutical and medical industries."
"Although life expectancy has increased, you can't live healthily for a long time, right? The threshold for visiting hospitals has lowered a lot, so I think it's natural to go to the hospital out of concern for your health." - Participant ID 02
"First of all, they take medications because they're sick. However, I think there's also an aspect of older adults taking medications unconsciously out of habit. Doctors also prescribe medications carelessly without even listening to a few words from the patients. I also think hospitals and pharmaceutical companies might exploit this commercially.” - Participant ID 23
Participants believed that this opportunity would raise their interest in medications in the future, and many expressed that they would consult their “main treating physician for their primary condition” or a “geriatric specialist” if their prescribed medications increased. When asked about alternatives to reduce polypharmacy and PIMs, the most important factors considered by participants were “raising awareness among patients and the public who view medications as a panacea,” “improving prescribing practices of medical staff,” “sharing prescription information between medical institutions,” and the need for a “geriatric medicine and primary care physician system” for regular and professional management of medications used by older patients. While some participants suggested that primary care institutions with good accessibility in the community would be suitable for this role, a minority opinion preferred tertiary hospitals to reduce complexity within the fragmented healthcare delivery system.
“I think the government should conduct campaigns through media like broadcasting. I believe people’s awareness needs to change.” - Participant ID 09
“I don’t know if it's possible, but wouldn’t it be good if the government could designate certain hospitals to comprehensively review all the medications that patients are taking? Local clinics seem to be the most convenient to visit, but I don’t think they would know everything, so I think university hospitals would be better.” - Participant ID 19
Focus group interviews with geriatrics experts
Theme 1: experts’ perceptions and causes of polypharmacy/PIM use
Healthcare providers with experience in deprescribing interventions unanimously agreed that the level of polypharmacy and PIM use among older patients in South Korea is more serious than what is reported in the literature, and that it is indeed causing severe problems. They mentioned that older adults receive prescriptions from various medical institutions and departments, store the medications at home, and later take them arbitrarily or even share them with acquaintances, leading to more frequent encounters of such cases in clinical settings. They also noted that this issue is more common among socioeconomically deprived populations, especially those with frequent proxy prescriptions or medical aid recipients.
“I once visited a house during a volunteer service in a vulnerable area, and I found a box full of medications. There were so many medications. They were labeled as ‘received at this time,’ ‘received from this place a few months ago,’ and so on. The medications were piled up. The older adults often couldn’t remember when or why they received the medications, and they would just take them whenever they remembered.” - Expert ID 04
The main reasons cited for the prevalence of polypharmacy and PIM use were the good accessibility to medical institutions, the fragmented healthcare delivery system with multiple institutions and specialized departments, and the short consultation times that prevent thorough confirmation of the medications patients are taking. Additionally, patients and caregivers have excessive trust in medications, leading them to request unnecessary prescriptions. When healthcare professionals choose non-pharmacological treatments instead of prescribing medications with low levels of evidence, they are often misunderstood as lacking a sense of responsibility.
“Medical professionals tend to rely heavily on pharmacotherapy and consider adding medications very easily, but it’s difficult to remove them. As a result, medications cause side effects, and these side effects are perceived as diseases, leading to the prescription of more medications. This prescribing cascade is a real problem.” - Expert ID 07
“From a physician’s perspective, there are few reasons not to prescribe medications. Older patients don't understand if they come to the outpatient clinic and only pay for the consultation fee without receiving a prescription. I know many physicians who have opened their own clinics. They say that if they prescribe a Cox-2 inhibitor instead of a potentially inappropriate NSAID, patients don't come back and flock to hospitals that prescribe NSAIDs. This is because NSAIDs, despite their side effects, quickly alleviate pain.” - Expert ID 01
Theme 2: deprescribing experiences and observed barriers
Regarding their experiences with deprescribing, the experts mentioned that adherence is high in the short term and patient/caregiver satisfaction is initially good. However, the lack of consensus within the medical community on the need to reduce polypharmacy and PIMs leads to many patients eventually returning with increased prescriptions from other medical institutions or ceasing follow-up entirely. The experts expressed disappointment whenever their time-consuming efforts went to waste, and they shared feelings of helplessness, wondering if they had been doing meaningless work. They also lamented the absence of a support system or compensation for medication management activities, such as identifying existing medication history, discontinuing PIMs, or switching to alternative medications, despite these decisions being as crucial as initiating new pharmacotherapy.
“Reviewing medications and adjusting even those outside my area of expertise requires a great deal of effort. However, when patients are discharged, medications they were originally taking from other hospitals are added again, and we're back to square one. It’s quite disheartening when they return with a completely different set of medications than what we had prescribed. When we educate them again, some patients don't come back at all.” - Expert ID 08
“Discontinuing medications is actually a tremendous decision. From a healthcare professional’s perspective, keeping patients on their existing medications might be the safest choice in terms of medical lawsuits, which have been frequently reported in the media lately. However, deprescribing is an act of good will that involves taking on potential risks and investing time, knowledge, and labor to prevent adverse drug reactions and potential future harm. It’s unfortunate that there is no systematic support or appropriate compensation for this.” - Expert ID 10
Theme 3: experts’ suggestions for rational medication use
The experts stressed that to reduce polypharmacy and PIM use, patients themselves should increase their interest in their diseases and the medications they are taking and move away from the perception that pharmacological treatment is always superior. They also stated that healthcare professionals should be cautious when prescribing new medications, considering the patient’s comorbidities, frailty status, and existing medications, and that periodic education on this matter is necessary. Finally, they emphasized that the authorities should establish an integrated management system to prepare for a super-aged society by developing and supporting a system for medication interventions. They suggested considering a geriatric primary care physician system for multidimensional care and healthy medication management for older patients and also called for special attention to vulnerable groups such as medical aid beneficiaries, low-income individuals, and older adults living alone.
DISCUSSION
The authors conducted a deprescribing intervention on patients visiting the outpatient clinic or admitted to the hospital who were classified as having polypharmacy and taking PIMs. Three months later, they conducted individual in-depth interviews to assess adherence to the intervention activities, inquiring about the reasons for polypharmacy, the experience of the intervention activities, and ways to improve safe medication use in older adults. Patients using polypharmacy and PIMs for older adults were simultaneously using multiple healthcare institutions and wanted to alleviate not only chronic diseases but also newly developed minor symptoms with medications. However, they had low awareness of the potential side effects of polypharmacy and PIMs. They exhibited a desire to overestimate causal relationships, believing that taking medications helps control diseases or alleviate symptoms, even if there is weak evidence of the medications' effectiveness. They also tended to arbitrarily adjust the dosage of symptom-controlling medications. Furthermore, some patients misinterpreted excessive medication prescriptions as healthcare professionals paying more attention to them.
Most patients expressed high satisfaction with their deprescribing intervention experience. However, the intervention's effectiveness was lower when patients lacked awareness of their own polypharmacy. Medical aid beneficiaries with low barriers to visiting medical institutions and receiving prescriptions, as well as older adults living alone without caregivers to assist with medication management, showed lower sustainability in maintaining the intervention’s effects. To promote healthy medication use practices, respondents suggested actively promoting the fact that all medications have side effects and that frail older adults with multimorbidity are more vulnerable to these side effects through media campaigns. They also emphasized the need for a change in perception among healthcare providers and the establishment of a prescription information sharing system between medical institutions. Additionally, they expressed a desire for integrated support through comprehensive medicine clinics or primary care systems for older patients with multimorbidity.
Geriatrics experts perceived that the prevalence of polypharmacy and PIM use is even more widespread than commonly reported. They expressed the difficulty of comprehensively identifying and analyzing medications prescribed from various hospitals and modifying them according to each patient's condition within short consultation times, as it requires significant time and effort without systematic support. Furthermore, they complained that as time passes after deprescribing, many patients revert to their previous prescriptions or have new PIMs added. Frequent encounters with such cases lead to decreased motivation for deprescribing. Therefore, they suggested that along with changes in public awareness, a system that facilitates easy identification of patients' disease and medication lists and support for deprescribing activities are necessary. They also expressed the need for periodic medication reviews and follow-ups, rather than one-time interventions, using systems such as a geriatric primary care physician program.
Numerous studies have proven that polypharmacy and PIM use adversely affect the health of older adults.121314 However, as confirmed in this study, unnecessary polypharmacy and PIM use do not occur simply because doctors prescribe too many medications or patients request too many drugs. Instead, they arise from the socioecological interplay of various actors’ behavioral patterns and factors within a specific healthcare system.151617 In South Korea, the time and economic hurdles for visiting hospitals and receiving prescriptions are low due to good healthcare accessibility. Moreover, within the fee-for-service system, healthcare providers have economic incentives to provide more tests, treatments, and drug prescriptions because health authorities set low fees.1819 Additionally, large pharmaceutical companies strive to expand drug indications, all of which can collectively contribute to the increase in polypharmacy and PIM use. Consequently, there is a lack of specific and practical international guidelines on how to reduce the use of many existing medications, consider interactions with existing conditions and medications when prescribing new drugs to patients, and compare the benefits and risks of medications during prescribing.2021
From the provider’s perspective, clinicians generally pay close attention to diagnosing specific diseases and deciding which medications to use. However, they often devote less interest to determining when to discontinue pharmacotherapy and how to manage multiple medications in patients with multimorbidity while remaining vigilant about prescribing cascades.11 It is also crucial to recognize that anticholinergic drugs commonly used for symptomatic treatment—such as first-generation antihistamines or skeletal muscle relaxants—and Z-drugs may not only exacerbate cognitive impairment and increase the risk of falls in older adults, but can also lead to further inappropriate prescriptions.222324
The public’s perception, which mistakenly believes that medications are always beneficial without any side effects and seeks pharmacological treatment even for minor discomforts that can be adequately managed with conservative methods, must also change. In an environment where prescribing more medications can be misinterpreted as providing better care to patients, it is impossible to expect optimal pharmacotherapy principles based solely on the goodwill or ethical obligations of healthcare professionals. This is because patients can easily avoid doctors or hospitals that prescribe medications conservatively, which can pose a serious threat to hospital management.
A meta-analysis including 32 studies on various interventions to reduce polypharmacy and PIM use found that deprescribing interventions not only reduced adverse drug reactions but also improved medication adherence.10 However, simply distributing educational brochures, posters, and questionnaires to patients or healthcare professionals proved ineffective.2526 Intervention results were successful when healthcare professionals provided education on the risks of drug side effects and interactions, proposed alternative treatments, engaged in shared decision-making, and followed up with monitoring to ensure the maintenance of intervention outcomes over a sufficient period.2728 Interpreting these findings, it can be concluded that merely explaining the risks of PIM and polypharmacy is not an effective deprescribing strategy. Instead, a comprehensive approach is necessary, which involves dedicating sufficient time to explain the anticipated risks tailored to each patient’s situation, offering alternatives, building therapeutic alliances, and conducting follow-up observations.2930
There are several limitations to this study. First, because participants were recruited from only two tertiary hospitals, caution is warranted in generalizing the findings to other settings. Although half of the participants were enrolled from a general hospital medicine department, both institutions maintain a dedicated geriatric department, which is an uncommon feature in most Korean tertiary hospitals, and half of the participants were outpatients from a geriatric clinic. As a result, these patients may have had different baseline knowledge or expectations regarding geriatric care compared with those in other healthcare environments. Second, because this was a qualitative study investigating the short-term experiences of patients with polypharmacy and PIM who received a deprescribing intervention, we did not quantify clinical outcomes such as changes in adverse reactions or hospitalization rates. Furthermore, as a small-scale qualitative study, we were unable to perform quantitative comparisons. Future research on a larger scale is needed to conduct comparative analyses of deprescribing intervention adherence rates based on patient characteristics. Future longitudinal or mixed-methods research that includes objective clinical measures over an extended follow-up period would offer deeper insights into the sustainability and effectiveness of deprescribing interventions across diverse healthcare settings.
Various initiatives, such as the Polypharmacy Management Program and the PIM review based on drug utilization review, have been implemented to promote the rational use and management of medications. However, these initiatives were conducted as small-scale, short-term pilot projects, resulting in outcomes that fell short of expectations or were discontinued before confirming their sustained effects.3132 Therefore, as Korea enters a super-aged society, it is crucial to develop behavioral economics-based long-term policies that incentivize healthy medication use behaviors among healthcare professionals and patients or motivate them to maintain these behaviors autonomously over an extended period. Health authorities should not rely solely on the voluntary quality improvement efforts of medical institutions. Instead, they should actively consider implementing public campaigns on drug side effects, adding medication review items to annual national health check-ups, improving prescription drug list sharing systems, and utilizing a geriatric primary care physician system. Along with support measures for socioeconomically deprived groups, such as older adults living alone, to encourage prudent medication use among medical aid beneficiaries, one possible approach could be to provide vouchers proportional to the amount of drug cost savings achieved.
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