• The Korean Journal of Health Service Management
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• v.12 no.4
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• pp.31-41
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• 2018

Objectives: This study was designed to evaluate whether employment status is associated with the experience of unmet care needs. Methods: This study utilized the Korea Health Panel data from 2012 to 2016. A total of 4,083 workers were selected as baseline subjects in 2012 and were followed for four years. This study used the GLIMMIX procedure under the marginal model while adjusting for covariates. Results: A total of 12.4% of 4,083 people said they had failed at least once to have a treatment or checkup despite the needs. Those more likely to experience unmet care needs were women and people of lower income level, with worse health conditions and chronic disease. Precarious workers, the self-employed, and the unemployed were more likely to experience unmet care needs caused by economic burden than permanent workers (Odds Ratio: 2.14, 2.07, 2.74, respectively). Conclusions: This disparity means that precarious workers and the unemployed are more likely to face barriers in obtaining needed health services. Given their insecure employment status, meeting their needs for health care is an important consideration.

• Quality Improvement in Health Care
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• v.20 no.1
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• pp.28-40
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• 2014

Objectives: Prescriptions for Parkinson's can be dispensed at the outpatient pharmacy. In general, the treatment of Parkinson's disease requires a multitude of drugs, sometimes taken 4 to 6 times a day at specific times as prescribed by the medical practitioner. Said "time-specific therapy" is one of the major reasons of dispensing delay observed at the outpatient pharmacy. Because our establishment lacked a computerized system to support time-specific prescriptions, they were not recognized electronically. They had to be issued and dispensed manually, which required a greater amount of time than the automated process. To solve the problem, a new sig code was developed to handle time-specific prescriptions with a comprehensive automated dispensing system to support it. This study aims to create electronic programs and streamline the process to increase dispensing performance. And thus, ensure greater patient safety and dispensing accuracy within a shorter dispensing time and also increase employee satisfaction through a decreased workload. Methods: After identifying the problems caused by non-electronic prescriptions an automated system that allowed the issuance of time-specific prescriptions was developed. A new sig code was created that could be recognized by the Pharmacy electronic medical program, the label printer to group medications by administration times and the Automatic Tablet Counter(ATC) to count the grouped drugs accordingly. Result: With the new sig code, the practitioner became able to electronically select the times of drug administration while issuing the prescription. This 'time-specific prescription' can now be recognized by the pharmacy electronic medical program, the label printer and the ATC like any other prescription. Conclusion: The developed program started operating on September 2013. Although not all Parkinson's patients have been issued with the new electronic 'time-specific prescription', the overall dispensing process has become more streamlined and accurate. As the medical team continues to integrate the new system in their practice an additional decrease of the dispensing time is predicted. Future program upgrades and other new time-saving approaches are scheduled, which are expected to further increase the service quality of our outpatient pharmacy.

• Korean Journal of Clinical Pharmacy
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• v.28 no.3
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• pp.194-203
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• 2018

Background: Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidney disease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney function are associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic control and baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients with T2DM. Methods: Patients who underwent a general medical check-up between 2009 and 2013 were selected from the Korean National Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assess the relationship between glycemic control and eGFR and risk of fracture prevalence. Results: Cumulative fracture prevalence were higher in patients with T2DM, irrespective of whether they had tight or less stringent glycemic control (fasting blood glucose [FBG] ${\geq}110mg/dL$). After adjustment for baseline age and FBG, tight and less stringent glycemic control was significantly associated with increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05-1.21, p=0.0005 vs OR=1.13, 95% CI, 1.06-1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalence in either older or middle-aged patients. Conclusion: Less stringent glycemic control significantly increased the adjusted risk of fracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic control on fracture prevalence.

• Korean Journal of Clinical Pharmacy
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• v.19 no.2
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• pp.167-179
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• 2009

Hypertension is one of the most common chronic diseases and it causes cardiovascular and cerebrovascular disease. While antihypertensive drug use increased, it took 15% of national health insurance drug expenditure. This study aimed to examine the pattern of antihypertensive drug prescription using National Health Insurance claims database and compare it with recommendations of Korea Hypertension Treatment Guidelines. Among the antihypertensive drugs, calcium channel blocker(64.4%) was most commonly prescribed class, and diuretics(44.6%), angiotensin II receptor blocker(33.3%), angiotensin converting enzyme inhibitor(11.7%) was followed. Approximately 81% of antihypertensives prescription were without cardiovascular or cerebrovascular disease, and among the comorbid conditions, diabetes(10.7%) was most common. calcium channel blocker(62.3%) was mostly prescribed class for hypertension with angina pectoris, angiotensin receptor blocker(45.3%) with myocardial infarction, diuretics(70.2%) and calcium channel blocker(49.5%) with congestive heart failure. For Hypertension with cerebrovascular disease, calcium channel blocker(68.0%) and angiotensin receptor blocker(43.3%) were prescribed mainly. When it comes to diabetes, calcium channel blocker(57.2%) was still mostly prescribed and angiotensin receptor blocker(45.9%) followed. But in hospitals and tertiary hospitals, angiotensin receptor blocker(65.7, 66.1%) was mostly prescribed for the patients with diabetes. For Hypertension with chronic renal disease, angiotensin receptor blocker(59.5%), calcium channel blocker(56.5%), diuretics(54.6%) were mainly used. Average number of classes per prescribing was $1.89{\pm}0.89$ class, average days per prescribing was $33{\pm}19$ day. Among the hypertension without comorbidity, 40.5% of prescription was monotherapy and 58.8% of polytherapy included diuretics. Among the outpatient prescriptions, calcium channel blocker was the most commonly used class, and the prescription pattern in clinic did not closely followed recommendations of Hypertension Treatment Guidelines.

• YAKHAK HOEJI
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• v.54 no.4
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• pp.244-251
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• 2010

Standardized parenteral nutrition is required to improve patient's safety, clinical appropriateness and to increase uniformity between institution and institutions. We assessed the consistency with the American society for parenteral and enteral nutrition (A.S.P.E.N.) practice guideline for PN by evaluating current practice process for parenteral nutrition formulation in inpatients pharmacies in Korea. Each question in this survey was based on 2007 A.S.P.E.N. recommendations of standard parenteral nutrition formulation, the American society of health-system pharmacists (ASHP), and the United State Pharmacopoeia (USP) Chapter 797 guideline for compounding parenteral nutritions. All 90 Korean society of hospital pharmacist (KSHP) member directors of pharmacy were requested to respond to the survey in order to compare the survey results to ASHP national survey of pharmacy practice in hospital settings (2002) in compliance with A.S.P.E.N. guideline. We had final response rate of 35.6%. 25 (100%) hospitals complied with this Garb guideline (response rate was 84.4%) which was the highest compliance. Only 17.9% of hospital pharmacies were actively involved in complications monitoring. Monitoring complications and efficacy were least in compliance with the A.S.P.E.N. guideline. 69.0% of Korean pharmacists adjusted medication dosage based on disease state or monitoring laboratory data in compliance with the A.S.P.E.N. guideline. Over 50% of the hospital pharmacies failed to provide and evaluate staff training in aseptic manipulation skills periodically. Korean hospital pharmacies need to comply with the standard practice guideline for compounding sterile preparation in order to provide better quality of parenteral nutrition service for specific patient population.

• Korean Journal of Clinical Pharmacy
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• v.26 no.3
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• pp.220-229
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• 2016

Background: The treatment goal for patients with chronic hepatitis B infection is to prevent progression of the disease to cirrhosis and hepatocellular carcinoma. Current therapies include standard and pegylated interferon-alfa and nucleoside/nucleotide analogues: lamivudine, adefovir, entecavir, telbivudine, clevudine, and tenofovir. This study aims to analyze changes in the prescribing patterns of chronic hepatitis B (CHB) medications in South Korea between 2013 and 2014. Methods: A cross-sectional study was conducted using National Patients Sample data compiled by the Health Insurance Review and Assessment Service from 2013 and 2014. Patients with CHB were identified with Korean Standard Classification of Diseases code-6 (B18.0 and B18.1) and those who were maintaining active prescriptions with CHB medications covering the index date (December $1^{st}$, each year) were included. The utilization of antiviral therapy was investigated during 2013 and 2014. Results: A total of 4,204 and 4,552 patients in 2013 and 2014 respectively, were included in the analysis. The proportion of male patients was two of third and the patients 41-60 years old accounted for 60% of all analyzed patients. The most utilized drug was entecavir (55.1% in 2013 and 44.8% in 2014) and the second most utilized drug was tenofovir in both years (18.8% in 2013 and 29.0% in 2014). The percentage of combination therapy was 13.6% and 13.1% in 2013 and 2014, respectively. The proportion of tenofovir prescriptions was increased in 2014 compared with 2013. Conclusion: With the development of new drugs and the changes in clinical practice guidelines, the prescription pattern of the antiviral agents for patients with CHB has changed. The rate of utilization of tenofovir has increased.

• Korean Journal of Clinical Pharmacy
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• v.28 no.3
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• pp.188-193
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• 2018

Background: Previous studies have noted that the simultaneous use of sulfonylureas and antimicrobials, which is common, could increase the risk of hypoglycemia. In particular, an age of 65 years or older is a known risk factor for sulfonylurea-related hypoglycemia in hospitalized patients. Therefore, we performed this study to determine the potential risk of hypoglycemia from the concurrent use of antimicrobials and sulfonylureas. Methods: We performed a cross-sectional study on the National Health Insurance Service-National Sample Cohort from 2013. The eligibility criteria included patients of 65 years of age or older taking a sulfonylurea with 25 different antimicrobials. Different risk ratings of severity in drug-drug interactions (potential DDIs), level X, D, or C in Lexi-$Interact^{TM}$ online, and contraindicated, major, or moderate severity level in $Micromedex^{(R)}$ were included. SAS version 9.4 was used for data analysis. Results: A total of 6,006 elderly patients with 25,613 prescriptions were included. The largest age group was 70 to 74 (32.7%), and 39.7% of patients were men. The mean number of prescriptions was 4.3 per patient. The most frequently used antimicrobials were levofloxacin (6,583, 25.7%), ofloxacin (6,549, 25.6%), fluconazole (4,678, 18.0%), and ciprofloxacin (2,551, 9.8%). Among sulfonylureas, glimepiride was prescribed most frequently, followed by gliclazide, glibenclamide, and glipizide. Conclusion: Of the antimicrobials with a high potential of hypoglycemia, levofloxacin, ofloxacin, fluconazole, and ciprofloxacin were used frequently. Thus, the monitoring of clinically relevant interactions is required for patients concurrently administered sulfonylureas and antimicrobials.

• Korean Journal of Clinical Pharmacy
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• v.21 no.4
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• pp.311-318
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• 2011

Misinformation and inappropriate use of medication has become one of the most pressing concerns in drug safety. The purpose of this study was to survey public perception on drug safety as well as the channels most relied upon providing such information. The survey was performed for patients or their families visiting pharmacies in a local city in Korea. Analysis was performed from 367 respondents to the survey. The contents of this survey revealed that consumers were aware of the fact that medications should not be taken at any higher dosage or more often than directed by their prescriptions. The survey revealed a general awareness that symptoms might not be relieved immediately by their medications. However, the perception that there could be adverse drug reaction (ADR) at therapeutic dose was low except among the young or highly educated members. Respondents recognized that skin rashes were the most whereas drowsiness was the least common ADR symptom. There was a high awareness of drug-food or drug-drug interactions except in the case of certain nutraceuticals. Doctors and pharmacists were ranked as the most reliable resources to the consumer for providing drug related information. However, public relations or education programs were in need since there were still not negligible numbers of consumers depending on personal experience rather than health professionals.

• Korean Journal of Clinical Pharmacy
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• v.28 no.2
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• pp.95-100
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• 2018

Background: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis that can affect many organs of the body but usually affects the lungs. The prevalence of TB in Korea is considerably higher than that in other countries with similar economic levels, and is much higher in elderly people. Pharmacotherapy is important in the treatment of TB and requires relatively high compliance for a prolonged duration. Methods: We analyzed sample data of elderly patients obtained from the Health Insurance Review and Assessment Service. We used logistic regression analysis and frequency analysis to identify factors that could affect prevalence of TB in elderly patients, compliance with prescribed medication regimes in these patients, and use of medical institutions. Korean Standard Classification of Diseases, version 7 (KCD-7) was used to diagnose pulmonary TB, and medications were analyzed using Korean standardized drug classification codes. Results: 1,276,331 patients were analyzed in the sample of the elderly population, and 16,658 TB patients were included in the study. The mean age of the TB patients was 76.19 years (SD 6.899). A total of 699 patients were prescribed isoniazid, rifampicin, ethambutol, or pyrazinamide at least once. Of these, 352 (50.4%) were prescribed all four medications and 101 (14.4%) were prescribed only isoniazid, rifampicin, and ethambutol. The mean duration of prescription was 28.75 days (SD 36.13). Conclusion: In the elderly population, old age and poor socioeconomic conditions correlated with TB prevalence. Most patients did not meet the criteria for effective pharmacotherapy of TB.

• Korean Journal of Clinical Pharmacy
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• v.20 no.1
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• pp.39-49
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• 2010

The present study was aimed to examine the occurrence and influencing factors therapeutic duplication (TD) of medications for anxiety disorders by analyzing the relevant prescription data. In this study, the prescription data issued on March 19, 2008 in domestic medical institutes were utilized. TD was defined as more than two medications under the same therapeutic classification per prescription based on the Anatomical Therapeutic Classification (ATC) code. The assessment of TD was performed based on the number of cases and on the ratio determined. To identify the influencing factor of TD, the variables related to the differences in the TD ratio were analyzed based on the results of the Chi-Square test conducted with the variables; patients, medical institutes, diseases, and treatments. The number and ratio of TD were determined to be 1,333 out of the total of 19,219 anxiety disorder cases, and 6.94%, most cases involving benzodiazepine derivatives, respectively. The TD ratio was found to be higher in relation to males than to females. Patients with national health insurance benefits have a higher TD ratio compared to the medical-aid beneficiaries. The TD ratios were highest in clinics, psychiatry divisions, and Gyeongsang district. The TD ratio of the cases with more than two anxiety disorders was found to be higher than that of the cases with only one anxiety disorder. As the number of medications per prescription increased, the TD ratio was shown to have become gradually higher. In conclusion, in order to prevent TD, the concurrent DUR system should be implemented. The prescribers and pharmacists must be educated regarding duplicated medications to promote the safe and effective use of medicines, without unnecessary TD.