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한 대학병원에서 조사된 재택산소요법을 받고 있는 환자의 특성과 재택산소요법 처방에 대한 순응도: 건강보험급여전환 후 조사

Clinical Characteristics and Adherence of Patients Who Were Prescribed Home Oxygen Therapy Due to Chronic Respiratory Failure in One University Hospital: Survey after National Health Insurance Coverage

  • 구호석 (인제대학교 의과대학 부산백병원 호흡기내과) ;
  • 송영진 (인제대학교 의과대학 부산백병원 호흡기내과) ;
  • 이승헌 (인제대학교 의과대학 부산백병원 호흡기내과) ;
  • 이영민 (인제대학교 의과대학 부산백병원 호흡기내과) ;
  • 김현국 (인제대학교 의과대학 동래백병원 내과) ;
  • 박이내 (인제대학교 의과대학 서울백병원 내과) ;
  • 정훈 (인제대학교 의과대학 일산백병원 호흡기내과) ;
  • 최상봉 (인제대학교 의과대학 상계백병원 내과) ;
  • 이성순 (인제대학교 의과대학 일산백병원 호흡기내과) ;
  • 허진원 (인제대학교 의과대학 일산백병원 호흡기내과) ;
  • 이혁표 (인제대학교 의과대학 상계백병원 내과) ;
  • 염호기 (인제대학교 의과대학 서울백병원 내과) ;
  • 최수전 (인제대학교 의과대학 상계백병원 내과) ;
  • 이현경 (인제대학교 의과대학 부산백병원 호흡기내과)
  • Koo, Ho-Seok (Division of Pulmonary and Critical Care Medicine, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Song, Young Jin (Division of Pulmonary and Critical Care Medicine, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Seung Heon (Division of Pulmonary and Critical Care Medicine, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Young Min (Division of Pulmonary and Critical Care Medicine, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Kim, Hyun Gook (Department of Internal Medicine, Dongrae Paik Hospital, College of Medicine, Inje University) ;
  • Park, I-Nae (Department of Internal Medicine, Seoul Paik Hospital, College of Medicine, Inje University) ;
  • Jung, Hoon (Division of Pulmonary and Critical Care Medicine, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Choi, Sang Bong (Department of Internal Medicine, Sanggye Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Sung-Soon (Division of Pulmonary and Critical Care Medicine, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Hur, Jin-Won (Division of Pulmonary and Critical Care Medicine, Ilsan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Hyuk Pyo (Department of Internal Medicine, Sanggye Paik Hospital, College of Medicine, Inje University) ;
  • Yum, Ho-Kee (Department of Internal Medicine, Seoul Paik Hospital, College of Medicine, Inje University) ;
  • Choi, Soo Jeon (Department of Internal Medicine, Sanggye Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Hyun-Kyung (Division of Pulmonary and Critical Care Medicine, Pusan Paik Hospital, College of Medicine, Inje University)
  • 투고 : 2009.01.05
  • 심사 : 2009.02.18
  • 발행 : 2009.03.30

초록

연구배경: 재택산소요법의 건강보험 급여 혜택이 있기 이전에 이뤄진 국내 보고는 특수한 일부 환자군만을 대상으로 하였을 가능성이 높아 재택산소 사용의 정확한 실태를 반영하지 못했을 가능성이 높다. 저자들은 재택산소요법의 보험 혜택 이후 시점부터 본 병원에서 재택산소처방을 받은 환자군의 임상적 특성, 산소사용의 실태 및 순응도에 대해 조사하여 이전의 국내 보고들과 비교해 보고자 하였다. 방 법: 자가산소요법의 건강보험 급여 혜택이 시작된 2006년 11월부터 2008년 9월까지 인제대학교 백병원 호흡기 내과를 방문하여 재택산소처방을 받고 외래에서 추적관찰 중인 환자를 대상으로 하여 의무기록 검토와 설문조사를 하였다. 결 과: 대상 환자수는 총 105명, 평균 나이 69세이고, BMI 19.1 $kg/m^2$, 남녀의 비는 60:45명이었다. 산소를 처방하게 된 기저 질환은 COPD 64명, 폐암 14명, 결핵으로 파괴된 폐가 13명, 기관지확장증 3명이고 그 외 폐성심, 기관식도루, 천식, 울혈성 심부전, 폐렴이 있었다. 평균 동맥산소분압은 54.4 mmHg, 산소포화도는 86.3%, 평균 헤모글로빈은 11.9 g/dL이었고, 평균 심실구혈률은 61.1%, 우심실수축기압력 42.7 mmHg이었다. 88명에서 시행한 폐기능검사에서 평균 FVC 2.05 L (66.5%), $FEV_1$ 1.12 L (52.0%), $FEV_1$/FVC 55.6이었다. 평균 산소처방기간은 8.2개월이었고, 하루 평균 산소시간은 9.8시간이었다. 그 중 평균외출시간 5.4${\pm}$3.7시간 동안은 산소를 사용하지 못했다. 산소사용을 중단한 사람은 66명으로 62.8%를 차지하였고 그 원인으로 사망이 33명(50%), 임의중단 24명(36%), 저산소증 호전 8명(12%), 입원한 경우가 1명 있었다. 임의 중단 환자는 산소처방 후 평균 7.0${\pm}$4.7개월 의 시점에 산소를 중단하였다. 임의중단 사유는 증상호전 11명(45%), 사용불편 6명(25%), 증상호전 없음 4명(17%), 경제적 비용부담 3명(13%) 순이었다. 결 론: 재택산소 처방 후 충분한 산소사용 시간 확보 및 산소의 지속적인 사용을 유지하려면 산소사용에 대한 환자 및 보호자에 대한 교육, 일반인을 대상으로 한 홍보, 경제적 부담 완화 등의 추가적인 노력이 있어야겠고, 야외활동 중에도 사용이 가능한 휴대용 산소장치에 대한 보험 혜택 확대가 필요하다고 하겠다.

Background: Despite the benefits of home oxygen therapy in patients suffering chronic respiratory failure, previous reports in Korea revealed lower compliance to oxygen therapy and a shorter time for oxygen use than expected. However, these papers were published before oxygen therapy was covered by the national insurance system. Therefore, this study examined whether there were some changes in compliance, using time and other clinical features of home oxygen therapy after insurance coverage. Methods: This study reviewed the medical records of patients prescribed home oxygen therapy in our hospital from November 1, 2006 to September 31, 2008. The patients were interviewed either in person or by telephone to obtain information related to oxygen therapy. Results: During study period, a total 105 patients started home oxygen therapy. The mean age was 69 and 60 (57%) were male. The mean oxygen partial pressure in the arterial blood was 54.5 mmHg and oxygen saturation was 86.3%. Primary diseases that caused hypoxemia were COPD (n=64), lung cancer (n=14), Tb destroyed lung (n=12) and others. After oxygen therapy, more than 50% of patients experienced relief of their subjective dyspnea. The mean daily use of oxygen was 9.8${\pm}$7.3 hours and oxygen was not used during activity outside of their home (mean time, 5.4${\pm}$3.7 hours). Twenty four patients (36%) stopped using oxygen voluntarily 7${\pm}$4.7 months after being prescribed oxygen and showed a less severe pulmonary and right heart function. The causes of stopping were subjective symptom relief (n=11), inconvenience (n=6) and others (7). Conclusion: The prescription of home oxygen has increased since national insurance started to cover home oxygen therapy. However, the mean time for using oxygen is still shorter than expected. During activity of outside their home, patients could not use oxygen due to the absence of portable oxygen. Overall, continuous education to change the misunderstandings about oxygen therapy, more economic support from national insurance and coverage for portable oxygen are needed to extend the oxygen use time and maintain oxygen usage.

키워드

참고문헌

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피인용 문헌

  1. Characteristics of long-term home oxygen therapy users in the municipality of Curitiba, Brazil vol.32, pp.None, 2009, https://doi.org/10.1590/1980-5918.032.ao04