• 약학회지
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• 제58권1호
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• pp.40-46
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• 2014

Drugs with a narrow therapeutic index (NTI) require very precise dosing. Warfarin and digoxin are the examples of NTI-drugs and dosing of them varies widely for different patients. However, in South Korea, only two strengths of warfarin and one of digoxin are commercially available. This is a big barrier for the precise dispensing and has potential safety risks to patients, particularly to elderly patients. To find a potential solution to the problem, an analysis of the prescribed doses and dispensing patterns of those drugs was performed. Data were collected by computer-facilitated prescription review in a university hospital. The period screened was from May 1st, 2012 to April 30th, 2013. All the prescriptions with either warfarin or digoxin tablets were selected for this study and dispensing patterns were analyzed according to the prescribed doses. A total of 17,017 warfarin prescriptions were analyzed; 8,148 for inpatient prescriptions, 8,869 for outpatient prescriptions, respectively. Of the 23 kinds of prescribed doses, 2 mg (19.9%) was most frequent, followed by 3 mg (13.2%) and 2.5 mg (11.7%). By analyzing the dispensing patterns, 60.3% (10,253) of the prescriptions required pill splitting and 72.0% of them were for the patients 65 years old and over. On the other hand, 4,350 digoxin prescriptions were included in this study. Of the 6 kinds of prescribed doses, 0.125 mg (71.2%) was most frequent, followed by 0.0625 mg (20.2%). Among the prescriptions for digoxin, 92.0% (3,998) should be split and 65.7% of them were for the patients aged 65 years and over. Despite limitations of strengths, various doses of warfarin and digoxin were prescribed. Furthermore, more than half of the prescriptions that required pill splitting were for elderly patients. The results from this study suggest that different strengths of warfarin and digoxin should be provided for accuracy of dispensing and safety for patients receiving them.

• 보건의료산업학회지
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• 제12권1호
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• pp.81-93
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• 2018

Objectives : This cross-sectional study aims to investigate the differences in general health status (GHS) and physical care burdens (PCB) of inpatient groups in long-term care hospitals (LTCH). Methods : The data of 228 patients were analyzed by integrating the electronic medical record (EMR) data of 2016, recorded by the nurses of hospitalized patients in the hospital. Results : There was a statistically significant difference in the GHS between the high-medical demand group and the other groups, but there was no difference in the GHS among other groups. The overall PCB was higher in the high-medical demand group than in the middle-medical demand, and cognitive impairment groups, but not in the problem behavioral group. Conclusions : The current classification of patient groups has shown limitations in terms of the basis of differential benefits of the groups. In particular, the PCB of the problem behavior group was not different from that of any group; hence, it should be adjusted through further study. To control the surge of medical care costs, it is necessary to improve the irrationality of the LTCH pay system in terms of the integration and continuity for elderly care.

• 한국병원경영학회지
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• 제15권2호
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• pp.15-26
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• 2010

Stroke is a high-risk disease. The future of the medical environment is that the proportion of elderly population is increasing, the average life expectancy is being increased, while the fatal rate of stroke will be low. These situation will due to the financial burden on medical insurance. The most important factor that affects on the medical costs of stroke patients is the length of stay. In this study the mean length of hospital for stroke stay was 21.81days(37.97days for intracerebral hemorrhage, 18.89 days for cerebral infarction). The payment per case of stroke was 6.86 million won(12.6 million won for intracerebral hemorrhage, 5.72 million won for cerebral infarction). The payment per case of intracerebral hemorrhage was 2.2 times more than that of cerebral infarction. The payment in the day of hospitalization was the highest and until the second day medical costs was high. After the third day medical costs tended to decline, after that seemed to show an almost constant level. The length of hospital stay was found to be the most important determinant of inpatient charges for stroke. Accordingly rational management of the length of stay will be beneficial to health care consumers, providers, states.

• 임상간호연구
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• 제27권1호
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• pp.77-84
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• 2021

Purpose: Malnutrition affects all age groups, but older adults are particularly more vulnerable to nutritional deficiencies. This study evaluated the age-specific factors affecting malnutrition in hospitalized older adults. Methods: A retrospective study was conducted on inpatient elderly people who received artificial nutrition from 2010 to 2017. Data of demographics, diagnosis, type of nutrition therapy, number of comorbidity, fall risk assessment, Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) score, and intensive care unit admission were collected. Malnutrition was defined as a body mass index (BMI) of less than 18.5 kg/m². Patients were classified as the young-old (65~74 years old), the old-old (75~84 years old), or the oldest-old (85 years old or older). Results: A total of 7,130 older adults were included, and 4,028 patients were classified as the young-old, 2,506 into the old-old, and 596 into the oldest-old. Proportion of malnutrition was higher in the oldest-old compared to the other groups. In multivariate analysis, parenteral nutrition, alcohol, and high risk of falls were factors affecting malnutrition in all groups. Parenteral nutrition and alcohol in the young-old, high risk of falls in the old-old, and male sex in the oldest-old were the factors affecting malnutrition by the age group. Conclusion: Older age was the most significant factor affecting malnutrition. Specific strategies by age are needed to improve nutritional status in hospitalized older adults as influencing factors for malnutrition vary among different age groups.

• 한국산학기술학회논문지
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• 제16권3호
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• pp.2165-2171
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• 2015

최근 생활환경의 개선과 의학기술의 발달로 인해 성인병 질환을 앓고 있는 환자의 경우 병원 입원 치료 보다는 통원치료를 통한 주기적인 약물 복용이 증가하고 있다. 이러한 성인병 환자의 경우 주기적인 약물 치료가 유지되기 위해 복약관리에 보다 많은 관심이 요구되고 있다. 본 논문에서는 환자의 주기적이고 안정적인 복약을 위한 NFC 기반의 u-Drug Cap 을 이용한 복약정보 서비스 시스템을 제안하고 개발된 시스템과 테스트 결과를 기술한다. 개발된 시스템은 성인병을 앓고 있는 환자나 고령 환자의 올바른 복약 지도 및 알람을 통해 약품 미복용 및 오복용 방지함으로써 환자의 건강 유지가 가능할 것으로 기대된다.

• 한국콘텐츠학회논문지
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• 제11권5호
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• pp.270-279
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• 2011

본 연구는 건강보험심사청구자료에 대한 공변량분석과 다중회귀분석을 통해 노인 암환자의 건강보험과 의료급여 이용차이를 분석하고, 의료보장유형이 노인 암환자의 의료이용량에 미치는 영향을 분석함으로써 의료급여 환자의 도덕적 해이가 존재하는지 파악하는 데 목적이 있다. 연구결과, 첫째, 노인 의료급여 암환자가 건강보험 환자에 비해서 장기간 입원으로 총진료비를 많이 사용하고 있었다. 그러나 진료건당 외래진료비와 진료일당 입원진료비는 건강보험 암환자가 많아서 비용이 많이 소요되는 의료서비스를 더 많이 이용하고 있었다. 둘째, 노인 의료급여 암환자일수록 의료기관을 자주 외래방문하고 장기간 입원하여서 총진료비를 많이 사용하고 있었다. 그러나 진료건당 외래진료비와 진료일당 입원진료비는 건강보험 암환자일수록 증가하였다. 노인 의료급여 암환자들의 의료이용량 증가원인이 높은 비급여본인부담을 피해서 본인 부담이 없는 보험급여 의료서비스를 많이 이용 것에 있음을 알 수 있다.

• 대한간호학회지
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• 제43권1호
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• pp.39-49
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• 2013

Purpose: To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. Methods: Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. Results: For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. Conclusion: The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.

• 한국병원경영학회지
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• 제21권2호
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• pp.37-49
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• 2016

The purpose of this study is to investigate the level of competition between Public Health Centers (PHCs) and private clinics (PCs) by examining the number of patients that used PHCs vs. PCs, estimating the total amount of revenue generated from outpatient services at both PHCs and PCs, thereby analyzing the financial impacts on PCs derived from the PHCs. We utilized 2011 National Inpatient Sample data (NIS). Using the 20 table containing general information on each individual claims, we integrate it with the 40 table which contains all the diagnostic codes for each claim. Then, we disaggregate the bundled claims into the original individual claims. Overall, 3.1% of outpatient visits are made at PHCs while the rest was made at the PCs (96.9%). Among the total claim costs of 6.34 billion USD (as of 2011), PHCs occupy 2.0% (124 million USD), and 98.0% are contributed to PCs (6.21 billion USD). The estimated economic losses of PCs due to PHCs are summarized as follow; the maximum potential loss is estimated at 198 million USD in total and 7,099 USD per clinic when we include all patient types; the minimum loss is estimated at 71 million USD in total and 2,540 USD per clinic where Medical Aid recipients and the elderly (aged 65 and over) are excluded. Our results confirm the potential economic effect on PCs due to PHCs providing outpatient services. PCs and PHCs are the most important players providing primary care in Korea. Unnecessary competition between PCs and PHCs is not desirable. Health authorities should carefully examine the healthcare services currently provided by PHCs and their impacts on PCs.

• 한국융합학회논문지
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• 제12권10호
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• pp.353-363
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• 2021

본 연구는 입원환자 섬망의 아형별 위험요인, 증상 및 중재를 조사하기 위해 시행되었다. 상급종합병원에 입원한 뒤 섬망을 진단받은 환자 108명의 전자의무기록을 SPSS WIN 26.0 프로그램을 이용해 분석하였다. 분석결과, 대상자는 고령, 남성, 정형외과, 골절이나 절단 환자의 비율이 높았다. 섬망의 아형은 과활동형 51.9%, 저활동형 6.5%, 혼재형 41.7%이었다. 위험요인 중 우울과 향정신성 약물 복용은 저활동형 섬망군에게 더 많이 선행되었다. 섬망의 중재 중 행동문제 관리와 공격적 행동 중재는 과활동형, 혼재형 섬망군에게 주로 시행되었고 정서적 지지는 저활동형, 혼재형 섬망군에게 주로 시행되었다. 공격적 행동을 동반할 경우 즉각적으로 중재를 제공받을 가능성이 높았다. 따라서, 추후 입원환자의 섬망을 조기발견하고 중재할 수 있도록 중재전략과 프로토콜을 개발하기 위한 연구가 요구된다.

• 보건행정학회지
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• 제28권4호
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• pp.352-359
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• 2018

Background: The purpose of this study is to propose an analysis of trends and characteristics of high-cost patients who take over 40% of total national health insurance medical expenses. Methods: It has been analyzed the tendency of high-cost patients by open data based on the medical history information of 1 million people among national health insurance subscriber from 2002 to 2015. To conduct detailed study of characteristics of high-cost patients, multiple regression has been performed by sex, age, residence, main provider, and admission status based on the top 5% group. Results: The amount of medical expenses and the number of high-cost patients have gradually increased in decades. The number of high-cost patients for Korean won (KRW) 5,000,000 category has increased by 7.6 times, KRW 10,000,000 category has increased by 14.1 times in comparing of year 2002 and 2015. Top 5% medical expenses have increased by 4.6 times. In consideration of the characteristics of patients, the incidence of high medical expenses has been higher in female patients than male ones, the older patients than in the younger. Patients residence in Gyeonsang or Jeonla province have had a high incidence of medical expenses than other area. The disease including dementia, cerebral infarction, and cerebrovascular disease for high-cost patients has been also increased. Conclusion: The major increase factor for high medical expenses is the aging of population. The elderly population receiving inpatient care residing in the province that increases high medical costs have to management. There is an urgent need to develop a mechanism for predicting and managing the cost of high-cost medical expenses for patients who have a heavy financial burden.