YAKHAK HOEJI (약학회지)

The Pharmaceutical Society of Korea (대한약학회)
권호 표지

Comparative Evaluation of Drug Use for Outpatients Prescribed by General Practitioner and Specialized Practitioner in ENT Area

이비인후과 영역에서 일반의와 전문의에 의한 외래처방전의 비교 평가

  • Min, Hyun-Seong (College of Pharmacy, CBITRC, Chungbuk National University) ;
  • Song, Tae-Beom (College of Pharmacy, CBITRC, Chungbuk National University) ;
  • Lee, Myung-Koo (College of Pharmacy, CBITRC, Chungbuk National University) ;
  • Jang, Je-Kwan (College of Pharmacy, CBITRC, Chungbuk National University) ;
  • Lee, Chong-Kil (College of Pharmacy, CBITRC, Chungbuk National University) ;
  • Lim, Sung-Cil (College of Pharmacy, CBITRC, Chungbuk National University)
  • Received : 2010.03.25
  • Accepted : 2010.06.10
  • Published : 2010.08.31
Download PDF
⟨ Previous Next ⟩

Abstract

As people are easy to access the National Health Insurance, medical health service has been increased. It contributed to extend human's average life expectancy and to get better health care. But also increased unnecessary health service or inappropriate drug use. Therefore, DUR (Drug Use Review) is needed to induce appropriate drug use. The purpose of this study is to evaluate outpatient prescriptions by General Practitioner (GP) and Specialized Practitioner, especially indication for ENT referral including common cold which is the frequent indications that have patient see doctor. This study was reviewed retrospectively prescriptions for ENT referral collected at the A pharmacy for ENT Clinic in Cheong-Ju, B pharmacy for GP Clinic in BoEun from Feb 2nd, 2009 to Feb 28th, 2009. Each pharmacy located closed to the each enrolled clinic. The numbers of collected prescriptions were each A pharmacy (n=2501), B pharmacy (n=1343). This study was classified Drug Related Problems (DRPs) those prescriptions had as total 6 groups according to following 6 categories; 1) Unnecessary Drug, 2) Wrong Drug, 3) Low Dose, 4) Overdose, 5) Wrong Instruction, 6) Wrong Combination. In results, Specialized Practitioner's prescriptions had more DRPs than General Practitioner's prescriptions (ENT 155.34% vs GP 130.01%). In detail, Specialized Practitioner's prescriptions had more DRPs in Low Dose (ENT 16.95% vs GP 4.77%), Overdose (ENT 6.72% vs G.P 5.51%), Wrong Instruction (ENT 7.91% vs GP 5.81%), Wrong Combination (ENT 29.31% vs GP 25.09%). These DRPs would be caused from lack of consideration for dosage and drug interaction. General Practitioner's prescriptions had more DRPs in Unnecessary Drug (ENT 70.37% vs GP 78.85%), Wrong drug (ENT 4.12% vs GP 9.98%). These DRPs would be associated with drug selection. This study was assumed that Specialized Practitioner is better prescriber than General Practitioner because Specialized Practitioner complete additional intern and residency training. But, Specialized Practitioner is not always better prescriber than General Practitioner. Furthermore, prescriptions of both Specialized Practitioner and General Practitioner had many problems. In conclusion, It could be cut down the excessive medical expense and expected more efficient medical care by reducing DRPs, thus contributing to the improvement of national health. In order to pharmacist must have good professional ability of pharmacotherapy to help the physician for the drug selection.

Keywords

References

  1. Brook, R. H. and Lohr, K. N. : Efficacy, effectiveness, variations and quality: boundary-crossing research. Graham ON (Ed.) Quality Assurance in Hospital. 2nd. An Aspen Publication (1985).
  2. Steel, K., Gertman, P. M., Crescenzi, C. and Anderson, J. : Iatrogenic illness on a general medicine service at a university hospital. New England Journal of Medicine. 304, 638 (1981). https://doi.org/10.1056/NEJM198103123041104
  3. Knapp, D. E., Knapp, D. A. and Speedie, M. K. : Relationship of inappropriate drug prescribing to increas length of hospital stay. American Journal of Hospital Pharmacy 36, 1334 (1979).
  4. Linda T. Kohn, Janet M. Corrigan and Molla S. Donaldson : Editors committee on quality of health care in america, to error is human : Building a safer health system. INSTITUTE OF MEDICINE, NATIONAL ACADEMY PRESS Washington, D.C. (2000).
  5. Hammerlein, A., Griese, N. and Schulz, M. : Center for drug information and pharmacy practice, ABDA-federal union of german associations of pharmacists: Survey of Drug-related problems identified by community pharmacies. The Annals of Pharmcotherapy 41, 1825 (2005).
  6. Westerlund, L. T. and Bjork, H. T. : Pharmaceutical care in community pharmacies: practice and research in Sweden. The Annals of Pharmcotherapy 40, 1162 (2006). https://doi.org/10.1345/aph.1G680
  7. Wertheimer, A. I. : Quality control and drug utilization review. Department of Graduate Studies in Social and Administrative Pharmacy, College of Pharmacy, University of Minnesota, 308 Harvard Street S.E., 55455 Minneapolis, Minnesota, USA (1988).
  8. Erwin, W. G. : The definition of drug utilization review: statement of issues. Clinical Pharmacolpgy and Therapeutics. 50, 569 (1991).
  9. 백경란 : 급성 상기도 감염에서 항생제의 적절한 사용, 대한의사협회지, 49, 553 (2006).
  10. Hogerzeil, H. V. : Promoting rational prescribing: an international perspectives. British Journal of Clinical Phamacotherapy 39, 1 (1995). https://doi.org/10.1111/j.1365-2125.1995.tb04402.x
  11. Pearson, S. A., Rolfe, I. and Smith, T. : Factors influencing prescribing : an intern's perspective. Med Edu. 36, 781 (2007).
  12. 장선미, 이의경 : 의약분업 전후의 의약품 오남용 실태 분석: 의사처방의 변화양상 분석을 중심으로, 한국보건사회연구원 (2001).
  13. Gonzales, R., Bartlett, J. G. and Besser, R. E. : Principles of appropriate antibiotic use for treatment of nonspecific upper respiratory tract infections in adults:background, Ann. Intern. Med. 134, 490 (2001). https://doi.org/10.7326/0003-4819-134-6-200103200-00015
  14. 김남순, 장숙랑, 장선미 : 급성 상기도 질환에서 일차의료의사의 항생제 처방에 영향을 주는 요인. 예방의학회지 38, 1 (2005).
  15. Babara starfield, Primary care: Concept, Evaluation, and Policy, New York Oxford University Press (1992).
  16. 오영호 : 외국의 일차의료제도 고찰과 정책방안, 한국보건사회연구원 (2009).
  17. 최창식 : 개원의는 변해야 한다. 대한의사협회지 43, 219 (2000).
  18. 박실비아, 문옥륜, 강영호 : 일부 다빈도 질환에서 개원의의 의약품 처방에 영향을 미치는 요인. 보건행정학회지 8, 166 (1998).
  19. Okuda, M., Wada, T., Maguchi, S., Asakura, K., Terada, N., Nakabayashi, S., Matsuzaki, Z., Nakamura, H. and Nakashima, M. : Clinical study of leukotriene antagonist ONO-1078 (pranlukast hydrate), on perennial allergic rhinitis. A doubleblind, dose finding study (late phase II study). Otologia Fukuoka. 45, 299 (1999).
  20. Rosemary R. Berardi, Pharm D, FCCP, FASHP Professor of Pharmacy, Department of Clinical Science, The University of Michigan Colledge of Pharmacy, Ann Arbor. : Handbook of Nonprescription Drugs - an interactive approach to self-care 14th edition., American Pharmacists Association (2006).
  21. Clinardm F., Sgro, C., Bardou, M., Hillon, P., Dumas, M. and Kreft-Jais, C. : Associtation between concomitant use of several systemic NSAIDS and an excess risk of adverse Drug reaction. A case/non-case study from the French Pharmacovigilance system database. European Journal of Clinical Pharmacology 60, 279 (2004).
  22. Richard A. Harvey, Pamela C. Champe, Richard Finkel, Luigix. Cubeddu and MIchelle A. Clark : Lippincott's Illustrated Review: Pharmacology 4th Edition. Lippincott Williams & Wilkins (2009).
  23. Robert M. Johnson, Robert Brummett and Alexander Schleuning : Use of Alprazolam for Relief of Tinnitus. A Double-blind Study. Arch Otolaryngol Head Neck Surg. 119, 842 (1993). https://doi.org/10.1001/archotol.1993.01880200042006
  24. Spiegel, B. M., Chiou, C. F. and Ofman, J. J. : Minimizing complications from nonsteroidal antiinflammatory Drugs: costeffectiveness of competing strategies in varying risk groups. Arthritis Rheum. 53, 185 (2005). https://doi.org/10.1002/art.21065
  25. 조홍준, 우석균, 홍춘택, 서영경 : 상기도 감염 증상의 모의 환자를 이용한 개원의사와 개원약사의 약제 처방 형태 비교. 가정의학회지 22, 1394 (2001).