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한병원의 외래를 이용한고혈압혹은 심장질환 환자대상 복약상담 실태조사
안성심,최고운,김순주,방준석,나현오 한국병원약사회 2009 병원약사회지 Vol.26 No.3
Abstract: The medication counseling to the patients with hypertension or cardiovascular dis-eases influences affirmative events for the treatment. In general, this kinds of education is pro-vided by the medical caregivers and is needed to evaluate the efficacy if fulfill the demands of the patients. The aims of this study are to analyze the actual condition and to present adequate methodological directions for developing effective counseling programs. The study subject was eighty-five out-patients who suffering with hypertension or cardiovascular diseases. The ques-tionnaire was developed and the face-to-face interviews were conducted by trained clinical pharmacists. About 74% of the patients recognized the dosage of their prescribed medications, 30% recognized the name, side effects, interaction, and precautions of the medications. Only 45.9% of patients(n=39) recognized their late blood pressure, 30%(n=18) recognized their thera-peutic target number of the blood pressure. Around 40% answered the medication counseling is necessary. Thirty-two percent of patients(31.8%) necessitated the knowledge of drug-drug inter-actions, or the adequate count-actions to manage the un-wanted side effects(29.4%, n=25). In conclusion, for the patients with hypertension or cardiovascular disease, well-designed medica-tion-counseling or education programs are essential to lessen the possibilities of the side effects and to increase the pharmacotherapeutic outcomes.
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안성심 한국병원약사회 2002 병원약사회지 Vol.19 No.3
점차 증가 추세에 있는 당뇨 환자들은 만성 소모성 질환이라는 측면에서 장기간의 치료와 꾸준한 자기관리가 필요하다. 최근 환자들은 인터넷 및 각종 출판물로부터 얻은 정보를 통해 그 지식수준이 다양해지고 있어 현행의 전달 강의식 교육방식이나 일회성의 교육으로는 체계적인 관리가 이루어지기 어렵다. 특히 의약분업 이후의 상황을 고려해 볼 때 외래환자의 교육은 개국약국을 통해 이루어지는 것이 그 효율성면에서 바람직할 것으로 생각되며 그 방식은 소그룹 교육의 성격으로 환자들이 혈당조절을 지속적인 관리 하에 이루어 낼 수 있도록 돕는 형태를 생각해 볼 수 있다. 따라서 병원 내에서 진행되는 당뇨교실은 입원환자 위주의 교육으로 그 대상을 변경하여 운영하도록 하는 것도 가능할 것이다. 한편 입원환자의 경우 현재 당뇨 CP(critical pathway) 내에 포함되어 복약지도를 시행하고 있으며 일부 제한적이긴 하지만 환자 상태를 근거로 약물 용량 변경 및 약물 선택에 대한 정보를 제공하고 있다. 그러나 현행의 방식은 의사와는 별도로 환자의 임상병리검사 결과와 약력 조회를 통해 이루어지고 있어 환자들이 갖는 약물에 의한 문제 등을 바로 확인할 수 없다는 점에서 문제점을 가지고 있다. 향후 복약지도 담당약사가 의료진과 함께 회진에 참여하여 환자들의 상태를 보다 정확하게 평가하고 그것을 근거로 복약지도의 효율성을 높일 수 있을 것으로 기대하며 의사와의 유기적인 협력 하에 약물 선택 및 용량 결정에 대한 정보를 제공하여 환자의 치료에 적극적인 도움을 줄 수 있을 것으로 생각된다.
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심방세동환자에 있어 고주파전극도자술 시 와파린 용량변화
성미영,고경미,안성심,김순주,나현오 한국병원약사회 2012 病院藥師會誌 Vol.29 No.2
Radiofrequency ablation (RFA) is an effective strategy for the treatment of drugrefractory atrial fibrillation (AF). Our department evaluated warfarin maintenance dose on peri procedure in patients with AF, who underwent RFA, and analyzed factors that affected International normalized ratio (INR) to obtained factors, which are applicable in ACS (anticoagulant service). A total of 84 patients were enrolled, who underwent the RFA and were followed up at cardiological outpatient department from January 2009 to June 2010. Of those 84 patients, only 37 patients maintained target INR* in survey period. They were treated with warfarin during ablation and visited at ACS regularly. This study is based on ACS counsel record and EMR, retrospectively. Investigated characteristics are age, gender, smoking, drinking, the number of RFA, comorbidities, and the mean total weekly dose (TWD), during the period of attained target INR and mean value of INR in pre- and post-ablation. The mean TWD of the 37 patients were 28.1 mg (±0.98) pre-ablation and 24.9mg(±0.83) postablation,which decreased 12.0% compared to that of pre-ablation (p<0.001). Factors like age, gender, hypertension, and early adverse effect, didn`t affect the degree of warfarin dose reduc-tion between pre- and post RFA. However, TWD differed significantly, according to the maintenance dosage change on peri-procedure between the diabetic group and the non-diabetic group (p=0.05). TWD of non-diabetics decreased during the procedure (28.5±1.07→24.8±0.91, p<0.001), and TWD of diabetics did not differ significantly, during the procedure (p=1.0). Based on this study, it’s possible for patients after RFA to be treated with lower dose warfarin. But further clinical trials are needed to customize the degree of warfarin dose reduction. Diabetics can maintain the same dosage of warfarin compared with beforehand, but it needs confirmed results through large study. Target INR*: 2.0~3.0(±0.2)
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박희주,최유리,안성심,최선,김순주,나현오 한국병원약사회 2014 病院藥師會誌 Vol.31 No.4
As interest in patients’safety has been increasing, the timely administration ofscheduled medication is being more and more emphasized. In 2013, the research hospital establishedthe guideline for‘ time-critical medications (TCM)’based on the‘30-minute rule’from theInstitute for Safe Medication Practices (ISMP) and the ‘medication management and use (MMU)standard’of the Joint Commission International. According to this guideline, if the maintenancedoses of these medications are administrated early or delayed for more than 30 minutes before orafter the scheduled dose, such effect may cause harm or result in substantial sub-optimal therapyor pharmacological effect. The research hospital has a total 125 TCMs, including those medications that need therapeutic drug monitoring. At the pharmacy, before prepared TCMs aredelivered to each ward, warning labels are attached to each TCM during the inspection procedureby charging pharmacists. If delayed or early administration of TCM occurs, it should be reportedas a near miss to the internal patient safety management program. Among these time-criticalmedications, this research was conducted on vancomycin of which dosing time could significantlyaffect the maintenance of therapeutic plasma concentration. From April to August 2013, vancomycinadministration status (administration time adherence, and the reason of early or delayedadministration, where applicable) was inspected at the wards of pulmonary medicine, internalmedicine intensive care unit, and emergency center. Overall, vancomycin was administrated a total 1,638 times in 167 patients in 3 investigateddepartments. Except for the 563 first doses, the administration time of 997 cases was adhered(administration time adherence rate = 92.74%, 997/1,075). The reason for early or delayed administrationwas omitted in most cases (61.54%, 48/78). The most frequently marked reason for suchaction was the‘ change of the administration time based on the TDM result or change the ward’(26.92%, 21/78) and‘ other medical care procedures(operation, lab test , etc)’(11.54%, 9/78). The adherence rate of vancomycin timely administration was high and well maintained in theresearch hospital. Pharmacists also played an important role in this favorable result. Furthersustained education of healthcare professionals will be needed for a more detail management ofsome early of delayed administration.
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