노인장기요양시설에서의 미사용 의약품 발생에 영향을 미치는 요인

장선미(Sunmee Jang),강신우(Cinoo Kang) 대한약학회 2022 약학회지 Vol.66 No.6

As the number of elderly living in long-term care facilities increases, unused medicines are also increasing. This study investigated the status of unused medicines in long-term care facilities and the factors affecting it. Using National Health Insurance Claims Database(NHICB) and Long-term Care Insurance Claims Database(LTCHCD), 137,309 people who lived only in long-term care facilities and took prescription drugs in 2019 were analyzed in this study. Most of them were prescribed by the clinic (41%), and the days per prescription were 25 days in average. Only 1.8% of prescriptions were from tertiary general hospitals, but the days per prescription reached 85 days, accounting for 67% of prescriptions for more than 60 days. The average age of long-term care facility residents was 84.8 years, and 22.6% of them deceased in 2019. 33.7% of the subjects had unused medicines. The days of unused medicines due to duplication in pharmacologically equivalent groups were 13 days in average. The average days of unused medicine due to death were comparatively longer, which was 75.5 days. Unused medicine costs were about 0.9% of the total pharmaceutical expenditures and 77.8% of the costs was caused by death. Unused medicines increased as the number of outpatient visits increased (Relative Risk (RR): 1.14) or when the days per prescription were long (RR: 1.16). Older adults who died were 15 times more likely to have unused medicines than those who were alive. The amount of unused medicines in long-term care facilities is substantial, so it is necessary to establish appropriate policies to reduce it.

국가건강보장체계에서 의약품 시장 구조와 제네릭 사용추세 분석(2007-2017)

장수현(Suhyun Jang),장선미(Sunmee Jang) 대한약학회 2023 약학회지 Vol.67 No.3

We aimed to analyze the market structure and changes in the market share of new drugs, original drugs, and generic drugs in the pharmaceutical market over the past ten years. We utilized national health insurance claims data, including both national health insurance and medical aid, from 2007 to 2017 to establish pharmaceutical expenditure and usage data. The drugs are categorized into new drugs, original drugs (expired patents), and generic drugs. Furthermore, we classified the original drugs as single-source and multi-source original drugs based on whether generic drugs had entered the market. Market share is calculated based on the volume and value of drugs in each category. The results indicate that the total pharmaceutical expenditure increased by 1.75 times, from 10.4 trillion Korean won (KRW) in 2007 to 18.2 trillion KRW in 2017. The number of claimed ingredients and drug items also increased during the same period. In 2017, the market share of new drugs accounted for 10.3% of the total pharmaceutical expenditure, while original drugs and generic drugs accounted for 45.9% and 43.8%, respectively. The study reveals a slight decline in the market share of generics in the decade. Further sub-analyses based on formulation, medical center types, and the number of generic drugs provide additional insights into the market dynamics. These findings contribute to understanding the trends and implications of pharmaceutical expenditure and the role of generics in achieving sustainable development in national health insurance.

커뮤니티 케어에서 방문약료 경험에 관한 사례 연구

강희진(Hee-Jin Kang),장선미(Sunmee Jang) 대한약학회 2023 약학회지 Vol.67 No.3

As our society enters an aging society, community care is emerging to enable the elderly to spend the rest of their lives in their own neighborhoods. This is a case study of pharmacists who provided home-based pharmaceutical services as part of the leading community care programs in Jeonju and Cheonan city. By interviewing pharmacists who provided home-based pharmaceutical services, we identified the status of pharmaceutical services in community care based on their experiences. Cheonan city has provided pharmaceutical services for poly-pharmacy users, visiting them three to four times a year, and most of the initial recipients have been retained. Jeonju city has provided three types of pharmaceutical services: medication counseling, medication counseling during the transition period after discharge, and medication counseling for diabetics. Both medication counseling and the discharge transition period service were provided twice per patient. The services provided were medication reorganization and medication counseling. The pharmacist thought that they had a better understanding of the senior and could focus on patient care. They had difficulty in preparing for the service in advance due to inadequate records of medication history, and medication reconciliation, and needed various contents to increase patient interest and pharmacist expertise. In order for the visiting pharmacy program to operate more effectively in community care in the future, it is necessary to increase the effectiveness of visiting pharmacy program by establishing an information-sharing platform and developing and disseminating various visiting pharmacy program.

올바른 약물 이용 지원 시범사업 성과 연구

양소영 ( Yang So-young ),장선미 ( Jang Sunmee ),권순홍 ( Kwon Sun-hong ),이주연 ( Lee Juyeun ),아영미 ( Ah Youngmi ),강신우 ( Kang Cinoo ),홍성현 ( Hong Sung-hyun ),박혜경 ( Park Hyekyung ) 한국보건사회연구원 2020 保健社會硏究 Vol.40 No.3

본 연구의 목적은 약사가 환자의 거주지를 방문하여 약물 사용의 적절성과 부작용 발생 여부를 파악하고 약물에 대한 정보제공 및 복약지도를 실시하는 ‘올바른 약물 이용지원’ 시범사업의 효과를 평가하는 것이다. 시범사업에서는 다제약물을 복용하는 만성 질환자를 건강보험청구자료를 이용해 선정하여, 사업 참여에 동의한 사람에 대해 총 4차례의 상담교육을 진행하였다. 대상자의 복약순응, 약물 관련 인지, 중복투약 등을 현황을 파악하고, 1차와 4차에서 조사한 현황을 비교하였다. 4차에 걸친 상담 결과, 약물 인지도, 복약순응도, 일반적인 약물 지식 수준이 개선되었으며, 전체적으로 중복투 약 환자 분율이 감소하였다. 의약사 지시에 따른 불용의약품 발생률이 증가하였으며, 자의적 판단으로 불용의약품을 발생시키는 비율이 줄어들었다. 본 시범사업은 환자의 약물 사용을 포괄적으로 관리할 수 있는 새로운 프로그램을 개발했다는 점에서 의의가 있다. 그러나 보건의료 직능 간 협업체계가 제대로 구축되지 않아 약사에 의해 파악된 약물관련문제가 충분히 개선되지 못한 부분이 존재하며, 이는 향후 사업 추진에서 개선 되어야 할 과제이다. 이를 위해 현재 운동과 영양 관리를 수행하고 있는 지역사회일차의 료지원센터에 본사업을 결합시키는 방안도 고려해볼 수 있겠다. The purpose of our study was to evaluate the effectiveness of the pilot project for polypharmacy management, in which pharmacists visit participants’ residences to identify the appropriateness of medication use and the incidence of adverse events, provide medication reconciliation, and educate how to manage medication. In the pilot program, health insurance claims data were used to identify the polypharmacy patients with chronic diseases, and a total of four counseling sessions were conducted for patients who agreed to participate in the program. The status of the patients’ medication adherence, medication-related awareness, and medication duplication was identified, and the results from the first and fourth rounds of consultation were compared. The medication-related awareness, medication adherence, and general knowledge of medication were improved. The incidence rate of unused medication according to the decision of healthcare provides increased, while that of unused medication due to patients’ own decisions decreased. This pilot project is a new comprehensive program for medication management. However, the medicationrelated problems identified by pharmacists have not been sufficiently reconciled due to the lack of a cooperative system among healthcare providers, which is a task to be improved in the future. Combining this program with Community-based Primary Medical Support Center, which currently conducts exercise and nutrition management, can be also considered.

고혈압 환자의 의료이용 행태 변화 및 관련 요인

송현종(Hyunjong Song),장선미(Sunmee Jang),신숙연(Sukyoun Shin) 한국보건교육건강증진학회 2012 보건교육건강증진학회지 Vol.29 No.2

국내외 의약품 유익성-위해성 평가 기법에 대한 고찰

정소현(Sohyun Jeong),장선미(Sunmee Jang) 대한약학회 2019 약학회지 Vol.63 No.2

The development of systematic and structural tool evaluating drug Benefit-Risk Assessment (BRA) has long been a hot issue in pharmaceutical and regulatory division worldwide. It has been proposed to conduct drug BRA during the whole drug life due to the unknown adverse events by long term drug use or unconfirmed drug efficacy and safety in specific groups of people by the golden rule of drug approval evidence, randomized controlled trials being widely comprehended. We aimed to collect and review BRA tools and strategies in the advanced countries, international organizations, and Korea in order to get the trends and knowledges of BRA to advance the BRA system in Korea. ICH and WHO did not support a specific BRA model but stated the basic principles and formats. EMA & IMI conducted a rigorous project to present and suggest quantitative and qualitative BRA methods. They highlighted using ProACT-URL and Effects Table in regulatory decision process and suggested to utilize quantitative Multiple Criteria Decision Analysis in BRA. FDA suggested simple and qualitative approach of Benefit Risk Framework (BRF), in the concern of potential bias induced by quantitative approach. Korea also has been following up the advanced BRA tools consistently but requires establishment of localized BRA strategy satisfying its own perspectives. From these contexts, Korea needs to build up a task force or tangible environment to actively discuss and implement BRA tools.

이주민의 약국 이용 및 의약품 사용 경험과 인식

조혜민(Hyemin Cho),이유민(Yumin Lee),장선미(Sunmee Jang) 대한약학회 2022 약학회지 Vol.66 No.5

Pharmacy utilization among immigrants in Korea is increasing amid the rapidly rising number of immigrants living in the country. However, few studies have investigated immigrants’ pharmacy utilization. This qualitative study used group interviews to explore immigrants’ experiences and perceptions of drug use and pharmacist services in Korea. The study participants consisted of 30 immigrants who had lived in Incheon and Gyeonggi for at least one year and had used pharmacies. The analysis results are grouped under three themes: “Reasons for visiting and selecting a pharmacy,” “Experience and perception of pharmacy and pharmacists’ services,” and “Experience and perception of taking medicine.” Our study shows that immigrants in Korea face language barriers when visiting pharmacies and struggle with Korea’s prescription-dispensing systems, forcing them to rely on their home country communities. However, immigrants who build a relationship of trust with a certain pharmacy tend to visit it regularly. Therefore, Korean pharmacists must strive to build good relationships with immigrants in order to help them adapt to Korea’s healthcare system.

커뮤니티 케어에서의 약물관리 체계 고찰 : 영국, 일본, 싱가포르, 호주를 중심으로

이유민(Yumin Lee),장수현(Suhyun Jang),이은지(Eunji Lee),신명인(Myungin Shin),이정은(Jungeun Lee),강희진(Hee-Jin Kang),장선미(Sunmee Jang) 대한약학회 2021 약학회지 Vol.65 No.2

As a policy response to an aging population, the Korean government has implemented community care, integrating housing, health, nursing care, and other care services. Medication management services are included in community care programs as an area of chronic disease management; however, till date, the content and methods of this service have not been structured systematically. In this study, we aimed to obtain recommendations for the development of a medication management system in Korea by analyzing and comparing with the medication management systems in the UK, Japan, Singapore, and Australia. These countries currently provide medication management services and have strict qualifying criteria for patients. Common qualification criteria for service recipients include, two or more chronic diseases, or high-risk medications. The system by which pharmacists obtain medication records differs depending on the medical coverage system adopted by the country. In countries that have adopted a, such as the UK and Australia, medical information is obtained through the national public health record platform. Singapore also utilizes a similar national health record platform. In Japan, which has adopted a National Health Insurance system, each patient has a personal medicine note. Pharmacists and other medical staff can obtain patient information through this handbook. Through this study, it was found that community care and medication management services have been established according to social and geographic conditions in each country.

장기요양보험 수급자와 비수급자의 의료이용 및 의약품 처방 양상 비교

강희진(Hee-Jin Kang),장수현(Suhyun Jang),장선미(Sunmee Jang) 대한약학회 2021 약학회지 Vol.65 No.6

Older adults who receive long-term care (LTC) services are expected to differ from older adults who do not receive such services. These differences are expected in healthcare utilization and drug prescription, as older adults in LTC services, have more difficulty in daily life. This study aimed to compare the differences in healthcare utilization and drug prescription between LTC beneficiaries and those who do not receive LTC services. Using the senior cohort from the National Health Insurance Service, LTC beneficiaries and non-beneficiaries were defined, and their patterns of healthcare utilization and drug prescription were analyzed for the year 2015. The total number of participants in the study was 239,873, and the number of LTC beneficiaries was 20,619 (8.6%). For LTC beneficiaries, the average number of hospitalizations per year was two, total hospitalization days 70, and the number of outpatient visits per year 28.8, and for non-beneficiaries, these were 1.7, 49, and 34.9, respectively. LTC beneficiaries had more frequent hospitalizations, longer hospital stays, and fewer outpatient visits. In terms of drug prescription for LTC beneficiaries, the average number of prescription days was 280, the number of the daily pills was 4.7, and total prescription days per year per prescription were 22.9, and for nonbeneficiaries, these were 277, 3.8, and 18.1, respectively. LTC beneficiaries took more daily pills and had longer prescriptions than non-beneficiaries. LTC beneficiaries showed differences in healthcare utilization and drug prescription patterns in comparison to non-beneficiaries. Further research based on the characteristics of LTC beneficiaries is needed.

장기요양시설 노인의 포괄적 약물관리 프로그램 운영현황

조현지(Hyunji Cho),김태현(Taehyun Kim),장수현(Suhyun Jang),강희진(Hee-Jin Kang),이주연(Ju-Yeun Lee),배은영(Eun-Young Bae),이주헌(Joohyun Lee),아영미(Young-Mi Ah),박혜경(Hyekyung Park),장선미(Sunmee Jang) 대한약학회 2023 약학회지 Vol.67 No.2

Polypharmacy and potentially inappropriate medication use have increased among the residents of long-term care facilities (LTCF). Nevertheless, Comprehensive Medication Management (CMM) for LTCF residents was not implemented in Korea. The United Kingdom, Canada, the United States, and Australia have already introduced CMM for managing drug-related problems in LTCF. This study discussed the implications of developing the CMM service for LTCF residents in Korea by reviewing the system of these countries. The contents and requirements of CMM are investigated through relevant papers and official reports of the public institution of each country. The CMM service of these countries is regularly conducted based on their system and laws. In Canada, there are no additional requirements such as special education and qualifications for pharmacists providing CMM. But in other countries, it is preferred that pharmacists providing CMM are geriatric pharmacists or take the education that is equivalent to them. In addition, all these countries utilize national computer networks or electronic healthcare records that are used for executing CMM and for sharing with other medical experts, and then they are retained as official medical records. It is necessary to consider the system of other countries when introducing the CMM service for LTCF residents in Korea.