• Korean Management Science Review
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• v.28 no.2
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• pp.93-103
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• 2011

This paper has aimed to identify marketing variables which affect physicians' prescription of drug. Based on a literature review this paper derives the three factors (indirect commercial source, direct commercial source, academic information source) of information sources that physicians rely on for medicines, the three factors (research supporting activity, marketing supporting activity, medicine information supporting activity) of promotion activities physicians prefer, and the four factors (indirect quality of medicine, direct quality of medicine, experience of using medicine, price and design of medicine) of prescription criteria physicians use. Then it investigates using canonical correlation analysis whether or not physicians' prescriptions are affected by the information sources, the promotion activities, and the type of physicians. From the canonical correlation analysis this paper derives the meaningful three canonical functions of prescription for drugs. The first function explains the prescription which is insensitive to marketing activities, the second function does the prescription which is sensitive to them, and the final function does the prescription which is not affected by them.

• Korean Journal of Clinical Pharmacy
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• v.20 no.3
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• pp.205-212
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• 2010

The prescription sheets for outpatients from July 2008 to June 2009 from 7 community pharmacies in Ulsan City were surveyed for the anti-inflammatory drug (AID) prescription pattern. The AID prescription rate of pediatricians and ENT physicians were 30.0% and 34.8%, respectively. The oral steroidal anti-inflammatory drugs (SAIDs) were prescribed as much as 3.9% by pediatricians and 10.3% by ENT physicians. The chiefly prescribed oral SAID was prednisolone in pediatric clinics and methylprednisolone in ENT clinics. Meanwhile the prescription rate of oral non-steroidal anti-inflammatory drug (NSAID) was 22.5% by pediatricians and 21.4% in ENT physicians. The most favorable NSAIDs were propionate derivatives in both clinics. In case of externally-applied SAIDs, the prescription rate of pediatricians was 3.6% and that of ENT physicians was 2.8%. Among them, nasal spray, inhalant and gargle formulations for upper respiratory infection (URI) treatment occupied 35.8% of externally-applied SAIDs in pediatric clinics and 59.7% in ENT clinics. Further, it was observed that ENT physicians favored much stronger SAIDs in Group III of ATC classification (75.4% of externally-applied SAIDs) than pediatricians (49.2%). In the survey of AID combination rate, pediatric clinics showed much lower rate (1.4% of total AID prescriptions) than ENT clinics (7.5%). Among them, the combination rate of oral SAID and oral NSAID by ENT physicians (52.2% of total AID combinations) was much higher than pediatricians (36.6%), which might be over-prescription of AID agents. In conclusion, the AID prescription rate as well as AID combination rate, especially in SAID prescriptions, was much higher in ENT than pediatric clinics, which implies the higher confidency on AID drugs of ENT physicians even though the severity of patient's symptom could be considered.

• Journal of Preventive Medicine and Public Health
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• v.38 no.1
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• pp.1-8
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• 2005

Objectives : To explore the factors influencing antibiotics prescription by primary health physicians for acute upper respiratory infections(URI). Methods : We performed a survey of 370 primary health physicians randomly sampled in April, 2003. The questionnaire consisted of a prescription on the scenario of acute bronchitis case, along with opinions and reasons for prescribing antibiotics on URI. Results : We found that 54.7% of the physicians prescribed antibiotics on the example case of acute bronchitis which is known as not needing antibiotics. Female physicians and ENT physicians had a greater tendency to prescribe antibiotics. The factors influencing antibiotics prescription on URI were the belief about the effectiveness of antibiotics, preference for their own experiences rather than clinical guidelines, perception of patients' expectations, and perception of competitive environment. The prescription of antibiotics in the example case was affected by how much they usually prescribe antibiotics (OR=2.400, 95% CI=1.470-3.917) and the physicians who thought that antibiotics were helpful for their income prescribed antibiotics more than others (OR=6.773, 95% CI=1.816-25.254). Conclusion : These findings demonstrated that the false belief on the effectiveness of antibiotics, patient's expectation of medication and fast relief of symptoms, and perception of competitive environment all affected the physicians prescription of antibiotics on URI. It may help to find barriers to accommodate scientific evidence and clinical guidelines among physicians and to specify subgroups for education about appropriate prescription behaviors.

• Korean Journal of Clinical Pharmacy
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• v.18 no.2
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• pp.124-131
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• 2008

The impacts of guideline for digestives on physicians' prescription of GI medication Clinical practice guidelines provide benefits to physicians, patients, and researchers. It also helps doctors to make decisions in medical services. In many countries, practice guidelines lead to activities of quality improvement and are developed using evidence based methods. This research was to assess the impacts of Korean Medical Association's guideline for digestives on the change of physicians' behavior. This study was progressed as one-group pre-test post-test quasi-experimental design using health insurance claims data. The unit of analysis was institution. Data was analyzed using paired t-test for change of prescription rate before and after the distribution of practice guidelines. And the multiple regression analysis was performed to examine the independent impact of the guideline on the prescribing rate of GI medication. Prescription rates of GI medication per claim by medical institution increased significantly, 1.98%point (from 50.27% to 52.25%) and multivariate regression analysis showed significant increase in the prescription rate of GI medication after the distribution of guideline (p<0.001). In conclusion, the distribution of guideline for digestive might not have the effects on the change in provider's behavior. Furthermore, to activate the use of practice guideline, it would be necessary to educate the contents to physicians as well as to develop practice guideline.

• Korean Journal of Clinical Pharmacy
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• v.20 no.2
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• pp.145-150
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• 2010

In order to investigate the antibiotic prescription pattern for upper respiratory infections (URI), the prescription sheets for outpatients from July 2008 to June 2009 were collected from 7 community pharmacies in Ulsan City, and the prescription pattern of Pediatric and ENT physicians was analyzed. The antibiotic prescription rates of Pediatric and ENT physicians were 63.8% and 61.7%, respectively. It was also observed that the oral antibiotic prescription was 95.6% in Pediatrics and 97.6% in ENT. The most favorable antibiotics by Pediatric physicians were penicillins (21.5%) penicillin-clavulanate (36.4%) and cephalosporins (16.5%), macrolides (11.6%), quinolones (3.5%), and nifuroxazide (3.5%). In case of ENT, the commonly prescribed antibiotics were also penicillin-clavulanate (47.6%), cephalosporins (31.6%), macrolides (11.9%) and sulfonamide (1.3%). The antibiotic combination rate was 7.6% in Peditrics and 1.9% in ENT, among antibiotic prescriptions. The combination of more than two oral antibiotics was examined as 66.8% in Pediatrics and 44.2% in ENT. The common oral antibiotic combination in Pediatrics was prescriptions of two ${\beta}$-lactam antibiotics (54.3%). Among them 83% was the combination of amoxicillin-clavulanate (7:1) and amoxicillin, which could be judged as antibiotic overuse. The next highly prescribed oral antibiotic combination was ${\beta}$-lactam/macrolide antibiotic combination probably for URI (11.3%) and ${\beta}$-lactam/nifuroxazide combination (10.0%) presumably for acute diarrhea. Comparatively the oral antibiotic combination prescribed by ENT physicians was negligible except one physician. In conclusion, the antibiotic over-prescription rate by antibiotic combination was much higher in Pediatrics than ENT, even though both clinical departments showed nealy the similar antibiotic prescription rates.

• The Korean Society of Law and Medicine
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• v.4 no.1
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• pp.255-294
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• 2003

This paper is relating to the debates upon the physicians' duty to issue the prescription documents to their patients. The duty should be approached in light of the patients' right to know about the prescription and pharmacy. The Korean Constitution is construed to protect the citizens' right to know as a fundamental right. The Constitution article 10 reads as follows: "All citizens shall be assured of human dignity and worth and have the right to pursue happiness. It is the duty of the State to confirm and guarantee the fundamental and inviolable human rights of individuals." The rights confirmed and guarantee by this article include the patients' right to know about what happens to their body, that is the treatments taken for them and so on. One of the treatments is the prescription and pharmacy. The information is necessary for them to establish their action for the damages in case of their harm resulted in by the negligence in prescription and pharmacy. Now that the prescription is written about by a physician and then the pharmacists compound the prescribed medicines, the patients need to get the documents signed by the pharmacists about the pharmacy. It should be noted that the patients right to know is the right to know and remember. Therefore the patients, who are laymen about the pharmacy, need two prescription documents one of which should be kept by them even after they take the prescribed and compounded medicines for the potential trial.

• Journal of Preventive Medicine and Public Health
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• v.40 no.6
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• pp.487-494
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• 2007

Objectives : Little is known about the physician-related factors that are associated with the management of Hypertension. The purpose of this study was to determine the physician-related factors associated with blood pressure control in hypertensive patients. Methods : We surveyed 154 physicians at 117 public health (subhealth) centers in Gyeonggi-do, Forty-one physicians completed the survey (response rates : 26.6%) and 31 physicians were finally included as the study subjects. Using the information obtained from the self-reported survey, we measured the physician-related factors associated with hypertension control, including their perception of hypertension, prescription patterns (combination prescription rates, specific antihypertensives prescription rates among patients with diabetes mellitus), and sociodemographic factors. We then collected data on blood pressure and medication use in patients seen by these physicians from the health center#s information system. We compared the physicians# perceived hypertension control rates with the actual rates, and then evaluated the rate of high overestimation (overestimation by more than 25% of the median degree of hypertension control rate overestimation) among the physicians. The physicians# antihypertensive prescription patterns were also evaluated. Multiple logistic regression analysis was used to evaluate the independent association between hypertension control and physician-related factors. Results : The physicians tended to overestimate the proportion of their patients with controlled blood pressure (79.5% perceived vs. 57.8% actual). The percentage of physicians with high overestimation was 35.5% (11 physicians). The physicians with lower control rates were more likely to highly overestimate their patients# control rates. Physicians with below-median actual control rates tended to prescribe fewer combination treatments for patients with uncontrolled blood pressure and angiotensin-converting enzyme inhibitors or fewer angiotensin receptor blockers for patients with diabetes mellitus. The rate of high overestimation by physicians was 1.31 times higher in patients with uncontrolled blood pressure than in patients with other conditions (OR=1.31, 95% CI : 1.17-1.48). Conclusions : Physicians have a tendency to overestimate the rates of hypertension control in their patients. Because physicians have a direct role in treatment outcomes, physicians# overestimation about hypertension management contributes to inadequate blood pressure control. Thus, interventions for improving physician# awareness regarding the management of patients with hypertension are needed.

• Health Policy and Management
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• v.8 no.2
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• pp.166-190
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• 1998

This study presents the status on drug prescription for clinic outpatients' bronchitis, gastritis, and gastric ulcer, and also the physician factors that affects their prescriptions. In this research project the physician factors are as follows: their demographic features, their work related features, education related features, drug information related features and drug promotion related features. The variables in drug prescriptions are drug expenses, daily drug expenses, days of medication, the highest price of the drugs used and the number of the different drugs used. Analysis of the use of prescription drugs was performed on NFMI(National Federation of Medical Insurance) 1994 medical expense claim data. Data on physicians' characteristics were collected by mailing surveys. Patients with secondary diseases were excluded. In this study, 388 adults with bronchitis, 1,038 children with bronchitis, 1,158 patients with gastritis, 369 patients with gastric ulcer were included. The older physicians tend to allow the lower drug costs: this explains that the older doctors who are more experienced less depend on the medicines. It can be also explained that doctors are likely to use the medicines that had been used for their intern and resident practice/training period. General practitioners give more intensive prescription compared to specialists. And specialists prescribed medicines to patients for longer period. The doctors' prescriptions for patients are largely affected by commercial sources. So objective and reliable sources for drug information is needed for patients' benefits. Physician factors explain better at the daily drug expenses, the drug price and the number of different drugs than days of medication. Gastric ulcer are better explained by the prescription model adopted in this study than other diseases.

• Journal of Korean Academy of Nursing Administration
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• v.19 no.5
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• pp.668-678
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• 2013

Purpose: This study was done to develop a realistic clinical case and investigate nurses' decision-making about nurses' ethical dilemmas with physicians in the fields of nursing practice. Methods: Case development and a hypothetical case study were used. Participants were 52 nurses. Data were collected in 2012 and 2013 using an open-ended questionnaire and interviews and analyzed using content analysis and descriptive statistics. Results: Various dilemma situations between nurses and physicians, such as violence, deathbed, medication prescription, and physicians' incapacity unfairness, were suggested. A clinical dilemma case about medication prescription was developed based on nurses' experiences. Nurses' responses to the developed case situation and responses were classified into five types. Various reasons were given for making the decisions and about 56% of the nurses decided to notify their supervisor without deleting nursing records. Conclusion: In this study, a realistic clinical dilemma case was developed, and nurses' ethical decision making was identified. These findings can be used in developing effective strategies for nurses to solve ethical dilemmas and to improve ethical decision-making abilities.

• Tuberculosis and Respiratory Diseases
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• v.55 no.2
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• pp.165-174
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• 2003

Background : Asthma is one of the most prevalent diseases in Korea. Although the guidelines of asthma management were reported in Korea, the present pattern of asthma management by primary physicians has not been studied. The purpose of this study is to elucidate the pattern of asthma management by primary physicians. Methods : In November 2002, 710 primary physicians specializing in internal medicine in Seoul, Korea were provided with two scenarios of asthmatic patients, one mild and the other severe. By mail or interview, the physicians were asked several questions about their present pattern of asthma management for the patients in each scenario. Results : Among 710 primary physicians, we obtained the answers from 325 physicians (response rate 46%). The most preferred prescription was oral theophylline. 71% and 81% of the physicians answered that they would prescribe oral theophylline for the mild and severe asthmatics, respectively. The next prescription preferred were mucolytics and oral ${\beta}_2$-agonist, in that order. However, 36% and 56% of the physicians answered that they would prescribe inhaled steroids for the mild and severe asthmatics, respectively. Among diagnostic tests, physicians preferred pulmonary function test to the rank next to chest radiography. Conclusion : The primary physicians in Seoul prefer oral bronchodilators to inhaled steroids in asthma management. More efforts should be made to reduce the difference between the present pattern of asthma management by primary physicians and the asthma guidelines.