Browse > Article

Annual Visit Days, Prescription Days and Medical Expenses of Hypertensive Patients  

Chun, Byung-Yeol (Department of Preventive Medicine, School of Medicine, Kyungpook National University)
Kam, Sin (Department of Preventive Medicine, School of Medicine, Kyungpook National University)
Im, Jeong-Soo (Department of Preventive Medicine, Gachon Medical School)
Park, Soon-Woo (Department of Preventive Medicine, Catholic University of Daegu School of Medicine)
Park, Jung-Han (Department of Preventive Medicine, Catholic University of Daegu School of Medicine)
Lim, Bu-Dol (Department of Preventive Medicine, Catholic University of Daegu School of Medicine)
Publication Information
Journal of Preventive Medicine and Public Health / v.35, no.4, 2002 , pp. 340-350 More about this Journal
Abstract
Objectives : To evaluate the annual visit days, the annual prescription days and the medical costs of hypertensive patients. Methods : The medical insurance records of 40,267 incident patients with the diagnostic code of hypertension from September 1998 through August 1999 in Daegu city were reviewed. Results : The proportion of the most proper medical care pattern group (Group VIII) who visited for 6-15 days with 240 prescription days or more a year was only 6.2%. The proper care group (Group IX) who visited for more than 16 days with 240 prescription days or more a year was 9.3%. The overall proper care group (Group VIII+IX) was therefore 15.5%. The proportion of the insufficient care group (Group I, IV) in both the number of visiting days and prescription days was 57.4%. The mean prescription day of the most proper group (Group VIII) was 29 days; the mean annual medical expenses,453,587won; the mean annual amount paid by patients, 218,013won; and mean medical expenses per prescription day, 1,483won. The proportion of the overall proper care group (Group VIII+IX) was significantly higher in adults aged 50-59, those who were enrolled in industrial workers health insurance as well as government employees and private school teachers health insurance, and those who made a higher contribution per month (p<0.01). According to the type of medical facilities, the proportion of the most proper medical care pattern group was highest in the general hospitals (9.3%) but the overall proper care group was higher in the public health centers (22.1%) and private clinics (17.1%). Conclusions : The management system of hypertension should be reinforced urgently. Therefore, it is necessary to develop guidelines including the number of visiting days per year and prescription days per visit day, and make the system provide medical facilities to more properly care for hypertensive patients.
Keywords
Hypertension; Clinic visits; Prescriptions-drug; Direct service costs;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 국민건강보험공단. 1999년-2000년 건강보험통계연보;2000-2001
2 Yu WS. A New Guidelines for Hypertension JNC-6. J Korean Med Asso 1998; 41(4): 400-412 (Korean)   DOI
3 Kim CY, Lee KS, Khang YH, Yim J, Choi YJ, Lee HK, Lee KH, Kim YI. Health behaviors related to hypertension in rural population of Korea. Korean J Prev Med 2000; 33( I): 56-68 (Korean)
4 Petitti DB, Grumbach K. Variation in physicians recommendations about revisit interval for three common conditions. J Fam Pract 1993; 37: 235-240   PUBMED
5 Cho HJ, Song YM. A comparison between attitude to the guideline and reported practice pattern of hypertension management in family physicians working in private clinic. J Korea Acad Fam Med 2001; 22(4): 498-506 (Korean)
6 Norman M, Kaplan NM, Ray W, Gifford RW. Choice of initial therapy for hypertension. JAMA 1996; 275(20): 1577-1580   DOI
7 Kim CB, Jo HS, Hyun SJ, Park AH. Meta-analysis on effectiveness of intervention to improve patient compliance in Korean. Korean Health Policy & Admin 2002; 12(2): 23-42 (Korean)   DOI
8 Taira DA, Davis JW. The impact of patient and physician characteristics on compliance with anti-hypertensive medications among health plan enrollees. 42nd Annual Conference on Cardiovascular Disease Epidemiology and Prevention, 2002; Outcome research: Subject 6
9 Lim BH. The comparison of medical services of frequent disease in outpatient department pre and post Separation of Prescribing and Dispensing Practice. Doctoral Thesis, Graduate School of Public Health, KyungPook National University; 2001
10 Chun JK. The changes in patients and medical services in health center by Separation of Prescribing and Dispensing Practice. Master' s Thesis, Graduate School of Public Health, KyungPook National University; 2002
11 Troche CJ, Tacke J, Hinzpeter B, Danner M, Lauterbach KW. Cost-effectiveness of primary and secondary prevention in cardiovascular diseases. Eur Heart J 1998; 19: C59-65
12 Sechrest L, Hannah M. The critical importance of nonexperimental data. US Department of Health and Human Services, AHCPR, Conference proceedings, 1990: 1-7
13 Montgomery AA, Fahey T, Peters TJ, Macintosh C, Sharp DJ. Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: randomized controlled trial. BMJ 2000; 320: 686-690   DOI
14 Lee SW, Kam S, Chun BY, Yeh MH, Kang YS, Kim KY, Lee YS, Park KS, Son JH, Oh HS, Ahn MY, Lim PD. Therapeutic compliance and its related factors of patients with hypertension in a rural area. Korean J Prey Med 2000; 33(2): 215-225 (Korean)
15 Kim YI, An MY, Lee ro, Kim DW. A case report: hypertension control program in Younchun-Gun. Korean J Rural Med 1993; 18(1): 31-34 (Korean)
16 Wilber lA, Barrow lG. Hypertension-a community problem. Am J Med 1972; 52: 653-663   DOI   ScienceOn
17 대한병원협회. 건강보험요양급여비용; 2002년 4월, (17-22, 23-44, 175-179쪽)
18 Bae SS, Kim J, Min K, Kwon SH, Han DS. Patient compliance and associated factors in the community-based hypertension control program. Korean J Prey Med 1999; 32(2): 215-227 (Korean)
19 Moser M. Hypertension can be treated effectively without increasing the cost of cexe. J Hum Hypertens 1996; 10: suppl 2 : 533-538
20 Yoon SJ, Ha BM, Kim CY. Measuring the burden of hypertension using DALY in Korea. Korean Health Policy & Admin 2001; 11(3):89-101 (Korean)
21 Cho H, Moon SS, Jung KI, Hyun IS. A research study on 60 years old people management of hypertension. J Korea Community Health Nursing Academic Soc 1996; 10(1): 95-105 (Korean)
22 Jones JK, Gorkin L, Lian JF, Staffa JA, Fletcher AP. Discontinuation of and changes in treatment after start of new courses of antihypertensive drugs: a study of a united kingdom population. BMJ 1995; 311: 293-295   DOI   ScienceOn
23 Zanchetti A. Presidential lecture. Presidential lecture. Antihypertensive therapy: pride and prejudice. J Hypertens 1995; 13: 1522-1528   PUBMED
24 Field MJ. Guidelines for clinical practice: from development to use. Washington DC National academy press; 1992
25 Aucott IN, Pelecanos E, Dombrowski R, Fuehrer S, Laich J, Aron DC. Implementation of local guidelines for cost-effective management of hypertension. J Gen Intern Med 1996; 11: 139-146   PUBMED
26 Sackett DL. Compliance with therapeutic regimens. The Johnes Hopkins University press; 1976. p.1-6
27 Lee SG, Bae SS. The relationship between treatment intention and compliance in newly detected hypertensive patients. Korean J Prey Med 2001; 34(4): 417-426 (Korean)
28 Simpson FO. Guidelines for antihypertensive therapy: Problems with a strategy based on absolute cardiovascular risk. J Hypertens 1996; 14: 683-689   DOI
29 Joint National Committee. The sixth report of the Joint National Committee on detection, evaluation, and treatment of high blood pressure(JNC VI). Arch Intern Med 1997; 157: 2413-2446   DOI   PUBMED   ScienceOn
30 http://www.kafm.or.kr. Kim CH. Korean Acad Fam Med. Recent advances in hypertension (Korean)
31 Jonsson B. Measurement of health outcome and associated costs in cardiovascular disease. Eur Heart J 1996; 17 Suppl A: 2-7   PUBMED
32 보건복지부. '98 국민건강?영양조사 총괄보고서; 1999, (106-108쪽, 주요결과표 12-23,38쪽)
33 Kaplan NM. Clinical hypertension, 7th ed. Pennsylvania: Williams & Wilkins; 1998,p.133-158
34 Yang YJ, Hong MH. Establishment and Application of the Guideline for Hypertension by Delphi Method in the Field of Primary Medical Care. Korean J Quality Assurance Health Care 1995; 2(1): 68-84 (Korean)
35 Song YM, Kim Y, Cho HJ, Jeong HS, Kim YI. Quality evaluation for the diagnosis and management of hypertensives by public health doctors. Korean J Quality Assurance Health Care 1996; 3(1): 126-143 (Korean)
36 Moon JJ , Kim KS, Kim JJ. A study of hypertensive patient compliance to therapy. Family Physician 1986; 7(12): 10-219 (Korean)
37 Gochman DS. Personal and social determinants of health behavior. In: Gochman, editor. Handbook of Health Behavior Research I. N.Y.: Plenum Press; 1997.p.381-400
38 Zanchetti A. Antihypertensive therapy: how to evaluate the benefits. Am J Cardiol 1997; 79(10A): 3-8   DOI   ScienceOn
39 Fahey TP, Peters TJ. What constitutes controlled hypertension? Patient based comparison of hypertension guidelines. BMJ 1996; 313: 93-96   DOI   ScienceOn
40 Kam S, Kim IK, Chu BY, Lee SW, Lee KE, Ahn SK, Jin DG, Lee KS. Treatment status and its related factors of the hypertensives detected through community health promotion program. Korean J Rural Med 2001; 26(2): 133-146 (Korean)
41 MacMahon S. Guidelines for antihypertensive thcrapy.J Hypertens 1996; 14: 691-693   DOI   PUBMED   ScienceOn
42 http://www.ksh.to. The Korean society of hypertension. A guideline of hypertension treatment (Korean)
43 통계청. 2000년 사망원인통계연보-인구동태신고에 의한 집계; 2001, (38-39쪽)
44 Kim JR, Moon JG, Gang GH, Lee MS, Hong DY. Community-Based Follow-up Study of the compliance and its determinants in hypertension.J Korean Public Health Assoc 1997; 23(1): 79-100 (Korean)
45 Maronde RF, Chan LS, Larsen FJ et al. Underutilization of antihypertensive drugs and associated hospitalization. Med Care 1989 Dec; 27(2): 1159-1166   DOI   ScienceOn
46 Park EC, Yu SH. Cost analysis of hypertension screening program. Korean J Prev Med 1989; 22(3): 380-388 (Korean)
47 Collins R, Peto R, MacMahon S, Herbert P, Fiebach NH, Eberlein KA, Godwin J, Qizibash N, Taylor 10, Hennekens CH. Blood pressure, stroke and coronary heart disease. Part2. Short term reduction in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet 1990; 335: 827-838
48 Cloher TP, Admin M, Whelton PK. Physician approach to the recognition and initial management of hypertension. Arch Intern Med 1986; 146: 529-533   DOI   ScienceOn
49 대구광역시. 1998년 통계연보; 1999년, (332-333쪽)
50 Schueler K. Cost-effectiveness issues in hypertension control. Can J Public Health 1994; 85 Supple 2: S54-6
51 Cho HJ, Lee SI Quality assessment of hypertension management of officebased physicians in Korea. Korean J Quality Assurance Health Care 1997; 4(1): 36-49 (Korean)