• 약학회지
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• 제56권2호
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• pp.126-135
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• 2012

Purpose: To develop therapeutic duplication criteria for the drugs used for respiratory diseases. Method: Therapeutic duplication was defined as "more than 2 drug ingredient-usage in which each has the same therapeutic effect and combination therapy does not confer additional therapeutic benefit". Respiratory system drugs approved in Korea were examined for the study. The WHO's Anatomical Therapeutic Chemical Classification System was used for grouping of the corresponding drug ingredients. The principles and recommendations on combination usage or multiple drug regimens were reviewed by using the clinical practice guidelines, textbooks, product labelings, and clinical articles. Clinical expert group consultation was performed and expert opinions were incorporated into the final criteria. Results: Nine hundred sixty two drug products with Korean Food and Drug Administration classification codes of 141, 149, 222, and 229 were evaluated, of which 87 active ingredients were composed. The drug ingredients were classified into 12 groups (antihistamines, oral nasal decongestants, leukotriene receptor antagonists, inhaled anticholinergics, inhaled corticosteroids, oral ${\beta}2$-agonists, long-acting ${\beta}2$-agonists, short-acting ${\beta}2$-agonists, xanthines, antiallergics, mucolytics and cough suppressants). The use of more than 2 drug ingredients including the same group was therapeutic duplication, and thus combination should be recommended not to be used. Conclusion: Twelve drug groups were identified as therapeutic duplication criteria. Combination therapy within each group should not be used otherwise therapeutic benefits outweigh potential risks.

• 약학회지
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• 제51권5호
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• pp.327-335
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• 2007

This study was to evaluate economic impact of a comprehensive pharmaceutical care intervention provided by community pharmacists on drug-related morbidity and mortality in the elderly population, in a societal perspective. Clinical outcomes of pharmaceutical care included compliance increase, inappropriate medication discontinuation, and subsequent drug-related morbidity and mortality reduction. Economic outcomes included cost savings from direct medical costs reduction such as medication and healthcare resource utilization. Input costs for pharmaceutical care included pharmacist time and computerized prescription review supporting program costs. Model parameters of outcomes were derived from published literatures, and costs were from literatures and health insurance statistical data in Korea. Annual costs and benefits were estimated in the year 2005. Current usual care and standardized pharmaceutical care required 0.3 and 2.0 hours per year respectively, for elderly outpatient using average 4.4 prescription drugs per visit and average annual frequency of 17.8 pharmacy visits. Comprehensive pharmaceutical care provided to overall elderly outpatients at community pharmacies would have cost of \74,994 mil. and benefit of \357,002 mil. per year. Benefit:cost ratio was 4.8:1 and net benefit was \282,008 mil/year. It was corresponded to net benefit of \73,816/year for individual elderly patient. In addition, pharmaceutical care was estimated to reduce 1,531 drug-related deaths/year. Conclusively this study, a first attempt in Korea to evaluate an economic value of pharmaceutical care at community pharmacies, proved that it was a cost-effective intervention having significant economic benefit.

• 한국치위생학회지
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• 제12권3호
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• pp.503-511
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• 2012

Objectives : This research seeks to present the data needed for the development of coping strategy, following medical market opening by identifying dental hygienists' perspective and coping measures towards the opening. Methods : One hundred eighty-eight dental hygienists were targeted to identify their level of perception towards medical market opening, attitude towards medical market opening, question of whether they agree or not with the opening and reasons, and coping measures and benefits of the medical market opening. t-test, chi-square test and cross-tabulation analysis were used for the analysis Results : First, team leaders are more aware of the medical market opening and hold greater sense of crisis towards opening compared to the rank and file. Second, the reasons cited for agreeing with the medical market opening included improvement of medical services' quality and diversification of services. As for the reasons for disagreeing, they cited the increase medical expenses paid by public. Third, limitation of the hospital management technique was cited the most when it comes to the scope of Korean hospitals' management crisis, followed by the limitations of the diagnosis procedure, limitations of the medical services, limitations of the medical techniques and increase in the number of large hospitals, in the order cited. Fourth, team leaders perceive greater need to seek coping measures from the aspect of realizing medical insurance fee from the policy development, service and system level aspects when it comes to the coping measures depending on their ranks. Conclusions : Therefore, Dental Hygienist has a comparatively low awareness of medical market opening, coping measures need to be explored to cope with the medical market opening by ensuring the dissemination of accurate knowledge through the education on the fees for dental hygienist and seminars in relation to the medical market opening.

• Archives of Plastic Surgery
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• 제33권4호
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• pp.445-448
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• 2006

Purpose: The nose is the most prominent skeletal feature of the face and is thus prone to frequent injury. Closed reduction of nasal bone fractures can be performed under general or local anesthesia. However, the benefits and the drawbacks in either form of anesthesia chosen are seldom perceived by the surgeon. A retrospective study was performed to assess the differences in the outcome among the two groups subjected to surgery under different type of anesthesia and to introduce our method of local anesthesia and its adequacy. Methods: Two hundred and fifteen patients during a 2-year period were included in the study. 2% Lidocaine mixed with 1:100,000 epinephrine was injected on the anterior ethmoid nerve and the periosteum. Assessment factors included intra-operative adequacy of analgesia, post-operative analgesic requirement and functional and aesthetic outcome of surgery. Results: 19 patients were manipulated under general anesthesia and 196 patients were manipulated under local anesthesia on the anterior ethmoidal nerve and dorsal periosteum. No statistically signigicant variable in performance of surgery could be attributed to the mode of anesthesia employed(p > 0.05). Four patients experienced complications after reduction. One developed septal deviation and three nasal obstruction. But, no secondary operations were needed. Conclusion: Anterior ethmoidal nerve block and dorsal periosteal injection of 2% Xylocaine, combined with topical intranasal 4% lidocaine and epinephrine provided sufficient analgesia comparable to that of general anesthesia.

• 대한예방한의학회지
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• 제24권3호
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• pp.27-38
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• 2020

Background : The study aimed at examining the awareness and satisfaction level of Korean medicine treatment of musculoskeletal patients and non-musculoskeletal patients. Method : The frequency and percentage were calculated to identify the overall characteristics, and to identify the characteristics of the respondents who visited the hospital to treat musculoskeletal diseases and those who visited for the treatment of non-musculoskeletal diseases, the correlation between the variables was analyzed using the chi-square analysis (χ2-test). Furthermore, analysis items were compared depending on detailed diseases within the musculoskeletal disorder (lumbar pain, sprains, arthritis, frozen shoulders, spondylitis, disc) Result : Respondents who used Korean medicine for the purpose of treating musculoskeletal diseases had answered that costs involved in Korean medicine was expensive, and answered that herbal decoction was the preferred Korean medicine treating method for expanding health insurance benefits. Regarding the safety awareness of Korean medicinal herbs, responses that said it was safe was high, and their willingness to use and recommend Korean medicine in future was also high. Respondents who used Korean medicine for the purpose of treating musculoskeletal diseases said they were overall satisfied along with the attitude of Korean medical doctors, treatment results, and costs of treatments. Conclusion : The study was aimed at securing basic data to indirectly identify the national demand for Korean medicine, through investigating the level and degree of differences that exist in the perception and satisfication level and further find a point where policy intervention is possible in future.

• 동의신경정신과학회지
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• 제33권4호
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• pp.361-376
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• 2022

Objectives: To understand experiences of daily life and Korean medicine treatment process and perspectives of caregivers caring for children with tic disorder. Methods: A semi-structured interview was conducted with caregivers of patients under 13 years who were experiencing Korean medicine treatment for tic disorder. A total of five participants were interviewed. The analysis was performed according to a four-step phenomenological method. Results: The following four components were derived from the experience of caring for children with tic disorder: general perception of tics, negative emotions caused by tics, social deprivation, and living with a child with tics. The following four components were derived from Korean medicine treatment experience for tic disorders: criteria for selecting treatment, awareness of Korean medicine, treatment experience in Korean medicine, and what needs to be improved. Conclusions: According to results of this study, caregivers caring for children with tic disorder experienced negative emotions such as frustration, guilt, and anxiety. They also experienced social deprivation such as stigma and prejudice. Korean medicine treatment can be an effective alternative for improving symptoms of tic disorders. The application of insurance benefits to Korean medicine is needed for patients and caregivers to autonomously choose treatment.

• 한국의료질향상학회지
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• 제11권1호
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• pp.46-60
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• 2004

Background : Recently, we have experienced various changes in the healthcare environment. Healthcare organizations are facing a financial crisis due to more competitive relationships among themselves as well with low health insurance fees. The purposes of the current study were: (1) to develop a data warehouse-based system for evaluating and monitoring the case management activities, and (2) to measure and analyze its effects. Methods : In order to collect the data for the study, the database on discharged patients was utilized at a university hospital located in Seoul from June 1, 2002 through December 31, 2002. Initially, a data warehouse was built for the case management system. The case management activities were analyzed using structured methodology to establish the case management system. Results : The findings of this study were as follows: (1) A case management system was developed to make it possible to monitor of healthcare quality and resource utilization. The Case management System included monitoring functions regarding utilization reviews, critical pathways, and clinical indicators. (2) Utilizing the case management system, unplanned readmissions were documented among total discharged patients during two months from November 1, 2002 through December 31, 2002. The unplanned readmission rate was 2.3%(276 patients) in total of 11,960 discharged patients. Among them 81 patients(0.7% of total discharges, 29.3% of unplanned readmission) were readmitted to the same physician in charge under the same diagnosis. No significant differences were found in the demographic variables such as gender and age among the patients. (3) After implementing the case management system, 2.9% of average length of stay reduced. Applying cost-benefit analysis, the 2.9% reduction of length of stay represents net profit of ${\backslash}$ 279,592,000 in the year of 2004. In addition, applying value acceleration analysis, cumulative net benefit of ${\backslash}$ 1,481,000,000 was expected by the year of 2007. Also we were able to expect ${\backslash}$ 247,800,000 of cumulative benefit for the prospective 5 years in value linkage analysis. It represents average ${\backslash}$ 787,700,000 of pure net benefit a year. Conclusion : The value of present study would be not only implementing the knowledge management system into the existing case management activities, but also evaluating its effects and estimating its financial benefits. This study suggested that the case management system would be a supportive tool for monitoring and improving the quality of healthcare, and a cost-effective tool for increment of healthcare organization's financial benefit.

• 지역사회간호학회지
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• 제10권1호
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• pp.70-79
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• 1999

This study attempts to encourage the development of a rehabilitation delivery system as a substitute service for hospitalization such as a community based intermediate facility or home health care. We need substitute services for hospitalization to curtail the length of stay for inpatients due to car accidents. It focused on developing an estimation for early discharge based on a detailed statement of treatment from medical records of 109 inpatients who were hospitalized at General Hospital in 1997. This study has three specific purposes: First, to find the mean length of stay and mean medical expenditure. Second, to estimate the mean of early discharge from the mean length of stay. Third, to analyize the income effect per bed from early discharge. In order to analyze the length of stay and medical expenditure of inpatients the author conducted a micro and macro-analysis with medical expenditure records. To estimate the early discharge we examined with a group of 4 experts decreases in the amount of treatment after surgery, in treatments, in tests, in drug methods. We also looked their vital signs, the start of ROM exercise, the time removel, a patient's visitations, and possible stable conditions. In addition to identifing the income effect due to an early discharge, the data was analyzed by an SPSS-PC for windows and Excell program with a regression analysis model. The research findings are as follows: First, the mean length of stay was 47.56 days, but the mean length of stay due to early discharge was 32.26 days. The estimation of early discharge days was shown to depend on the length of stay. The longer the length of stay, the longer the length before discharge. For example, if the patient stayed under 14 days the mean length of stay was 7.09 while an early discharge was 6.39, whereas if the mean length of stay was 155.73, the early discharge time was 107.43. The mean medical expenditure per day of car accident patients was found to be 169,085 Won, whereas the mean medical expenditure per day was shown to be in a negative linear form according to the length of stay. That is the mean expenditure for under 14 days of stay was 303,015 Won and the period of the hospitalization of 15 days to 29 days was 170,338 Won and those of 30 days to 59 days was 113,333 Won. The estimation of the income effect due to being discharged 16 days was around 2,350,000 Won with a regression analysis model. However, this does not show the real benefits from an early discharge, but only the income increasing amount without considering prime medical cost at a general hospital. Therefore, we need further analysis on cost containments and benefits incending turn over rates and medical prime costs. From these research findings, the following suggestions have been drawn, we need to develop strategies on a rehabilitation delivery system focused on consumers for the 21st century. Varions intermediate facilities and home health care should be developed in the community as a substitute for shortening the length of stay in hospitals. In home health care cases, patients who want rehabilitation services as a substitute for hospitalization in cooperation with private health insurance companies might be available immediately.

• 보건행정학회지
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• 제11권2호
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• pp.141-168
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• 2001

Healthcare service organizations can apply the cost of quality(COQ) model as a method to evaluate a service quality improvement project such as Total Quality Management (TQM). COQ model has been used to quantify and evaluate the efficiency and effectiveness of TQM project through estimation between cost and benefit in intervention for a quality Improvement to provide satisfied services for a customer, and to identify a non value added process. For estimating cost of quality, We used activities and activity costs based on Activity Based Costing(ABC) system. These procedures let the researchers know whether the process is value-added by each activity, and identify a process to require improvement in TQM project. Through the series of procedures, health care organizations are service organizations can identify a problem in their quality improvement programs, solve the problem, and improve their quality of care for their costumers with optimized cost. The study subject was a quality improvement program of the department of radiology department in a hospital with n bed sizes in Metropolitan Statistical Area (MSA). The principal source of data for developing the COQ model was total cases of retaking shots for diagnoses during five months period from December of the 1998 to April of the 1999 in the department. First of the procedures, for estimating activity based cost of the department of diagnostic radiology, the researchers analyzed total department health insurance claims to identify activities and activity costs using one year period health insurance claims from September of the 1998 to August of the 1999. COQ model in this study applied Simpson & Multher's COQ(SM's COQ) model, and SM's COQ model divided cost of quality into failure cost with external and internal failure cost, and evaluation/prevention cost. The researchers identified contents for cost of quality, defined activities and activity costs for each content with the SM's COQ model, and finally made the formula for estimating activity costs relating to implementing service quality improvement program. The results from the formula for estimating cost of quality were following: 1. The reasons for retaking shots were largely classified into technique, appliances, patients, quality management, non-appliances, doctors, and unclassified. These classifications by reasons were allocated into each office doing re-taking shots. Therefore, total retaking shots categorized by reasons and offices, the researchers identified internal and external failure costs based on these categories. 2. The researchers have developed cost of quality (COQ) model, identified activities by content for cost of quality, assessed activity driving factors and activity contribution rate, and calculated total cost by each content for cost for quality, except for activity cost. 3. According to estimation of cost of quality for retaking shots in department of diagnostic radiology, the failure cost was ￦35,880, evaluation/preventive cost was ￦72,521, two times as much as failure cost. The proportion between internal failure cost and external failure cost in failure cost is similar. The study cannot identify trends on input cost and quality improving in cost of qualify over the time, because the study employs cross-sectional design. Even with this limitation, results of this study are much meaningful. This study shows possibility to evaluate value on the process of TQM subjects using activities and activity costs by ABC system, and this study can objectively evaluate quality improvement program through quantitative comparing input costs with marginal benefits in quality improvement.

• 대한예방한의학회지
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• 제19권1호
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• pp.95-107
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• 2015

Objective : To use and its affecting factors of patients' outpatient treatment that have single and multiple chronic illnesses Method : We used the 2011 study by the Ministry of Health and Welfare, "Report on Usage and Consumption of Korean Medicine." This report was conducted on outpatients and inpatients that visited Korean traditional medicine, from August 25th, 2011, to September 30th, 2011. Our research was based on 1729 patients with chronic diseases aged 30 and over who received outpatient treatment during the last three months. Results : There were 1365 patients with non-complex chronic diseases, while there were 364 patients with complex chronis diseases. Patients had 1 - 8 chronic diseases, and the average number (standard deviation) was 1.26 (0.59). There were statistically significant differences by sex(P<0.0001), age(p=0.0045), marriage (p=0.0060), education level(p<0.0001), income level(P=0.0063), and types of health insurance(p=0.0023). The diseases most common among patients with non-complex chronic diseases were: low back pain, arthritis, gastrointestinal disorder, frozen shoulder, side effects from motor accidents, high blood pressure, fracture, stroke, diabetes, cancer, atopic dermatitis, and asthma. The diseases most common among patients with non-complex chronic diseases were: arthritis+low back pain, low back pain+gastrointestinal disorder, low back pain+side effects from motor accidents, low back pain+frozen shoulder, arthritis+gastrointestinal disease, gastrointestinal disease+frozen shoulder, arthritis+low back pain+gastrointestinal disease, high blood pressure+arthritis, arthritis+low back pain+frozen shoulder, arthritis+fracture, and arthritis+side effects from motor accidents. There were statistically significant differences among the usage of medical clinics by: frequently used clinic (p<0.0001), number of treatment (p<0.0001), the cost of outpatient treatment (p=0.0073), the satisfaction rate (p=0.0171), whether the clinic is the preferred clinic (p=0.0040). In model 1, men than women, people who had local benefits instead of type 1 medical aid, and patients with complex chronic diseases were more likely to use Korean medical clinics. In model 2, men than women, people who had local benefits than people with types 1 and 2 medical aids, people who went to pharmacies and Korean medicine pharmacies than people who went to hospitals, people who went to get treatment 1-10 times than people who visited 11-20 times and more than 41 times, and people who spent less than ten thousand Korean won than people who spent 1 to 2 million Korean won, and people without complex chronic diseases were more likely to use Korean medical treatment. Conclusion : There were differences in sociodemographic characteristics and the usage of medical clinics between patients with non-complex chronic diseases and patients with complex chronic diseases. Among patients with complex chronic diseases, women, patients with types 1 and 2 medical aid, patients who used Korean medical clinics, patients who were treated 11-20 times and more than 41 times, and patients who spent 1 million to 2 million Korean won on outpatient treatment used less treatment than patients with non-complex chronic diseases. However, patients with complex chronic diseases used pharmacies and Korean medicine pharmacies more.