• 보건행정학회지
• /
• 제3권1호
• /
• pp.25-52
• /
• 1993

Variation in the utilization of medical services is a very important issue in cost containment and quality assurance of health care. Practice variation directly affects health care expenditure especially in fee-for-service system, which is the payment system of health insurance in Korea. In addition to cost issue it is generally accepted that variations in medical practice and the cost of inpatient care suggest the possibility of inappropriate quality of care. This study is to closely examine the patterne and degrees of variation in cost structure of inpatient care among types of hospital and individual hospitals in some tracer diseases, and also to inquire into the service items which contribute much to the variation of total medical care cost. Foru common diseases, i.e. Cesarean Section, appendectomy, cataract extraction and pediatric pneumonia, were selected as tracer diseases. In most tracer diseases there were statistically significant differences in total medical care cost among hospitals in same type of hospital as well as among types of hospital(p<0.01). When total medical care cost were subdivided into the types of service, cost of medication and diagnostic examination varied the most prominenly. When the cost of medication were subdivided again, cost of parenteral antibiotics showed the most prominent variation. Of total medical care cost, medication was most contributory to the variation of total medical care cost(58.1~82.3%), and cost of antibiotics was most contributory to the variation of medication cost(63.9~92.2%). The results of study implicated that reducing the variation of medication may plays a significant role in containing the cost of inpatient care. In order to sort out the factors affecting practice variations including drug prescription pattes further researches are required.

• 한국산학기술학회논문지
• /
• 제15권8호
• /
• pp.5303-5309
• /
• 2014

노령화 사회의 진입에 따라 건강에 대한 관심이 높아지고 있다. 특히, 만성질환을 가지고 있는 노인의 투약 관리는 생명과 직접적인 연관성을 보이기 때문에 중요하게 여겨진다. 본 연구는 노령 환자를 위한 NFC 기반의 복약 관리 시스템을 제안한다. 제안하는 방법은 NFC기반 복약 캡 및 스마트폰 응용프로그램 개발을 통하여 고령환자의 올바른 복약 지도 및 알람을 통한 약품 미복용 및 오복용 방지를 통한 건강관리가 가능할 것으로 판단된다.

• 보건행정학회지
• /
• 제22권4호
• /
• pp.579-596
• /
• 2012

The purpose of the study is to examine the use of medication among adults by comparing the pattern of outpatient prescription drug use with the pattern of long term taking lifestyle drug use. Furthermore, the study investigates factors associated with the use of medication, particularity focusing on socioeconomic factors. Korea Health Panel data of 2008 was used to conduct the study analysis. By performing four different logistic regression models, the study noticed different patterns of the medication use between prescription drugs and lifestyle drugs. More specifically, the study showed that adults with lower education level tend to more frequently receive prescriptions while adults with higher education as well as income level tend to more use lifestyle drugs than their counterparts. Furthermore, other control factors such as age and gender were statistically significant for the use of both prescription and lifestyle drugs in different patterns. The study findings expect that reimbursement structure of drugs may be significantly associated with the different patterns and accordingly the accessability of medicine in particularly vulnerable population. Therefore, these policy factors should be considered in future study to more comprehensively understand about the diverse patterns in the medication use.

• 한국보건간호학회지
• /
• 제28권1호
• /
• pp.102-113
• /
• 2014

Purpose: The purpose of this study was to evaluate the effects of long term osteoporosis management education consist of exercise, drug therapy, and nutrition on bone mineral density (BMD) and medication compliance among postmenopausal women who have just been diagnosed with osteoporosis. Methods: The research design consisted of a pre-and post-test quasi-experimental design through a nonequivalent control group. The participants in this study were 60 individuals with osteoporosis, and who were classified according to two groups; the control group (n=30) who were given general clinical guidelines, and the experimental group (n=30) who received management education once for 60 minutes every three months using a standardized educational sheet. After one year, BMD was assessed using band dual energy X-ray absorptiometry (DXA) and medication possession ratio (MPR) for medication compliance. Analysis of collected data was performed using descriptive statistics t-test, chi-test, and paired t-test. Results: No significant difference in BMD (t=-1.02, p=.311) and MPR (t=-0.77, p=.440) was observed between the two groups. However, a significant increase in femur neck BMD was observed in the experimental group compared with the control group (t=-2.18, p=.033). Conclusion: Conduct of further study will be needed for examination of the effect of long-term osteoporosis management education on BMD Level and Medication Compliance in Postmenopausal Women.

• 한국임상약학회지
• /
• 제21권2호
• /
• pp.81-89
• /
• 2011

Medication adherence is an important public health issue. This study is conducted to explore non-adherence of elderly with hypertension and/or diabetes mellitus and to better understand its' influencing factors. To explore non-adherence, 605 elderly patients in community were surveyed with Modified Morisky Scale (MMS), from Aug 18 to Sept 19, 2008. MMS is designed to predict medication-taking behavior and outcomes, and also to explain persistence of the patient's long-term continuation of therapy, which is a significant factor in the long-term management of chronic diseases. Also, MMS is designed to classify patients into a high/low continuum for knowledge and motivation. Patients self reported medication adherence were average 4.66 with MMS (range 0-6), only 78% of patients hold high motivation of medication adherence although 95.5% of patients hold high knowledge of medication adherence. This study explores which factors influence to high motivation of medication adherence and it proved that patients' participation in work, education level, participation in private health insurance, number of medication and medication frequency per day, pharmacists' explanation, experience of non adherence due to cost are important factors to explain high motivation of medication adherence of elderly with hypertension and/or diabetes mellitus.

• 디지털융복합연구
• /
• 제11권9호
• /
• pp.255-265
• /
• 2013

본 연구는 고혈압 약물치료율의 지역 간 변이요인을 규명하고 이를 지역별 맞춤형 고혈압 환자 관리 사업계획을 수립할 수 있는 기초자료로 활용하기 위해 수행되었다. 자료는 지역사회건강조사 자료, 통계청 자료, 국민건강보험공단 자료를 수집하였으며 지리적 가중 회귀분석 기법을 이용하여 분석하였다. 고혈압 약물치료율의 지역 간 변이요인을 분석한 결과 지역 간 고혈압 약물치료율에 영향을 미치는 요인은 지역의 양호한 주관적 건강수준 인지율, 의료급여자의 비율, 인구10만명당 보건기관 수로 나타났다. 지리적 가중 회귀모형에 따라 고혈압 약물치료율에 영향을 미치는 주요 변수로 구성된 총 230개의 지역별 회귀모형이 산출되었다. 그럼에도 불구하고 모형의 설명력이 높지 않는 등 연구의 제한점이 있었다. 따라서 고혈압 환자의 실제 투약순응도를 반영한 후속연구가 필요할 것이다.

• International Journal of Advanced Culture Technology
• /
• 제10권1호
• /
• pp.108-115
• /
• 2022

The purpose of this study is to investigate the actual status of antithrombotic management before and after the procedure or surgery, the difference between the duration of medication suspension by clinical and demographic characteristics, and the patient's understanding and satisfaction after medication management by a dedicated nurse. The results were as follows. The most commonly used antithrombotic agents were aspirin and flavitol. The drug discontinuation period according to antithrombotic, procedures, and underlying diseases, there was a significant difference in duration for each variables(p<.000). In the case of antiplatelet drugs, 5-day suspension was the most frequent, and anticoagulants 2-day suspension was the most frequent. Depending on the procedure,colonoscope,nucleoplasty,rotator cuff repair,and total knee arthroplasty commonly showed more than 80% of 5-day discontinuation. The differences according to underlying diseases are as follows. 64.7% of all diseases discontinued on the 5th. The patient's understanding of the nurse's medication management performed before and after the procedure was found to be lower in Angina patients than those with other diseases. In terms of age, those in their 50s showed higher understanding than other age groups. There were no differences in understanding and satisfaction with the remaining characteristics.

• 한국임상약학회지
• /
• 제32권3호
• /
• pp.260-269
• /
• 2022

Background: Comprehensive medication management is essential to achieve safe and optimal drug use for the elderly in long-term care facilities (LTCF). This study aimed to develop eligibility criteria for "Comprehensive medication management program in LTCF" using the RAND/UCLA Appropriateness Method (RAM). Furthermore, we attempted to estimate the number of beneficiaries who met the criteria by analyzing the National Health Insurance claims data. Methods: Twelve criteria were selected initially. We composed a panel of 14 experts with expertise in long-term care. We conducted two survey rounds to reach a consensus. Rating for appropriateness and decision regarding agreement were applied per RAM. We analyzed the National Health Insurance data to estimate the number of LTCF residents who met each eligibility criterion. Results: Of the 11 items agreed upon, ten items were determined to be appropriate. In 2018, 83.6% of 165,994 residents of LTCF met one or more eligibility criteria. The largest number of subjects met the "New residents of LTCF" criterion, followed by "Take high-alert drugs" and "Chronic excessive polypharmacy." Since the items evaluated as most appropriate by the expert panel and those with a large number of subjects were similar, we confirmed the external validity of our criteria. Conclusion: It is worth noting that this is the first attempt to establish the eligibility criteria for medication management in LTCF. Further preliminary research is needed to identify the selected subjects' drug-related problems and revise the criteria according to the results.

• 보건행정학회지
• /
• 제31권3호
• /
• pp.292-300
• /
• 2021

Background: Medication adherence in hypertension is the most important to control blood pressure and prevent major complications. The purpose of this study was to identify factors affecting medication adherence and to examine the relationship between medication adherence and blood pressure control in Korea. Methods: This study used data from the 7th Korea national health and nutrition examination survey (2016-2018) of the Korea Disease Control and Prevention Agency. We selected 4,063 hypertensive patients from the data. And we choose socio-demographic, health behavior, healthcare utilization, and severity characteristics as hypertensive patient characteristics. Results: Of the patients with hypertension, 92.3% had shown adherence to medication as of 2016-2018 and shows variation according to the characteristic of patients. The cases with male, under 50 years old, urban area, single household, unmet medical services, less than 5 years of hypertension duration, no comorbidities (diabetes mellitus, myocardial infarction) showed significantly low medication adherence. After adjusting for confounders, adherent patients tended to have lower current systolic blood pressure (β=-10.846, p<0.001) and diastolic blood pressure (β=-5.018, p<0.001) than nonadherent patients. And, adherent patients increased the control odds of blood pressure compared with nonadherent patients (odds ratio, 3.02; 95% confidence interval, 2.21-4.12). Conclusion: This study confirmed that adherence to antihypertensive drugs was effective in controlling blood pressure. In order to more actively manage hypertensive patients at the national level, it is necessary to make an effort to improve the medication compliance of nonadherent groups, such as early-diagnosis patients, young patients under 50 years of age, and patients living alone.

• 대한간호학회지
• /
• 제43권4호
• /
• pp.547-556
• /
• 2013

Purpose: This study was conducted to examine the changing patterns of knowledge related to disease, medication adherence, and self-management and to determine if outcomes were more favorable in the experimental group than in the comparison group through 6 months after providing a web-based self-management intervention. Methods: A non-equivalent control group quasi-experimental design was used and 65 patients with gout, 34 in experimental group and 31 in comparison group, were selected from the rheumatic clinics of two university hospitals. Data were collected four times, at baseline, at 1 month, 3 months, and 6 months after the intervention. Results: According to the study results, the changing patterns of knowledge and self-management were more positive in the experimental group than in the control group, whereas difference in the changing pattern of medication adherence between two groups was not significant. Conclusion: The results indicate that the web-based self-management program has significant effect on improving knowledge and self-management for middle aged male patients with gout. However, in order to enhance medication adherence, the web-based intervention might not be sufficient and other strategies need to be added.