약물군-약물군 조합으로 도출한 약력학적 기전의 추가 병용금기성분

제남경,김동숙,김주연,이숙향 한국임상약학회 2015 한국임상약학회지 Vol.25 No.2

Objectives: Drug utilization review program in Korea has provided ‘drug combinations to avoid (DCA)’ alerts to physicians and pharmacists to prevent potential adverse drug events or inappropriate drug use. Seven hundred and six DCA pairs have been announced officially by the Ministry of Food and Drug Safety (MFDS) by March, 2015. Some DCA pairs could be grouped based on the drug interaction mechanism and its consequences. This study aimed to investigate the drug-drug interaction (DDI) pairs, which may be potential DCAs, generated by the drug class-drug class interaction method. Methods: Eleven additive/synergistic and one antagonistic drug class-drug class interaction groups were identified. By combining drugs of two interacting drug class groups, numerous DDI pairs were made. The status and severity of DDI pairs were examined using Lexicomp and Micromedex. Also, the DCA listing rate was calculated. Results: Among 258 DDI pairs generated by the drug class-drug class interaction method, only 142 pairs were identified as official DCA pairs by the MFDS. One hundred and four pairs were identified as potential DCA pairs to be listed. QT prolonging agents-QT prolonging agents, triptans-ergot alkaloids, tricyclic antidepressants-monoamine oxidase inhibitors, and dopamine agonists-dopamine antagonists were identified as drug class-drug class interaction groups which have less than 50 % DCA listing rate. Conclusion: To improve the clinicians’ adaptability to DCA alerts, the list of DCA pairs needs to be continuously updated.

약학대학 학생들의 학습 포트폴리오에 대한 경험과 인식

제남경,이인향 한국임상약학회 2014 한국임상약학회지 Vol.24 No.2

프리셉터 오리엔테이션 교육 후 약사인식의 변화 및 교육의 효과분석

제남경,이인향,윤정현 한국임상약학회 2012 한국임상약학회지 Vol.22 No.2

약학대학 학생들의 학습 포트폴리오에 대한 경험과 인식

제남경 ( Nam Kyung Je ),이인향 ( Iyn Hyang Lee ) 영남대학교 약품개발연구소 2014 영남대학교 약품개발연구소 연구업적집 Vol.24 No.0

Background: Learning portfolio is a collection of evidence that learning has taken place. It has gained its reputation asa useful assessment tool in the education of health professionals. The purpose of this study is to describe the pharmacystudents` experiences and perceptions upon the introduction of a learning portfolio into the Introductory Pharmacy PracticeExperience course. Methods: Fifty five students from one pharmacy school who used a learning portfolio to documenttheir progress in the IPPE course participated in 16-item questionnaire exploring opinions and experiences oflearning portfolio preparation, assessment, and personal and professional development and reflection. Results: Most studentsagree that a learning portfolio is a valuable tool in promoting self-directed and reflective learning. However mostof them (46/55) also feel developing a portfolio is time-consuming, and when compared to their effort, an appropriatereward has not been given. Conclusion: To make the use of learning portfolios successful students should receive clearguidelines on their purpose, content and structure. Also the assessment criteria should be provided before the introductionof learning portfolio and their effort in developing learning portfolio should be rewarded.

국내 가와사키병 환아의 약물사용

차승희,제남경 한국임상약학회 2017 한국임상약학회지 Vol.27 No.3

Background: Kawasaki disease (KD) is an acute febrile, systemic vasculitis as a leading cause of acquired heart disease in children. Intravenous immunoglobulin G (IVIG) and aspirin are the standard initial therapy in the treatment of acute KD. The purpose of this study was to investigate drug utilization in children with KD, and to compare “IVIG + high-dose aspirin” and “IVIG + moderate-dose aspirin” in preventing cardiac complications. Methods: We analyzed pediatric patient sample data compiled by the Health Insurance Review & Assessment Service from 2010 to 2015. We identified patients with KD using the KCD-6 code of M30.3. We excluded patients in chronic phase or ≥10 years. We also excluded patients who were diagnosed KD in November or December. Drug utilization pattern were assessed in acute KD patients and 30-day and 60-day cardiac complications were investigated between “IVIG + high-dose aspirin” group and “IVIG + moderate-dose aspirin” group. Results: In acute phase, IVIG was administered to 95.8% patients, and 57.1% patients were prescribed moderate-dose aspirin and 25% patients were with highdose aspirin. Steroid use was rapidly increased from 4.0% in 2010 to 11.3% in 2015. Both 30-day and 60-day cardiac complications occurred less in “IVIG + high-dose aspirin” group compared to “IVIG + moderate-dose aspirin” group, but not statistically significant (0.9% vs 1.8%, p=0.252 for 30-day complication rate; 1.5% vs 2.7%. p=0.073 for 60-day complication rate). Conclusion: We were not able to demonstrate which aspirin therapy is superior for preventing cardiac complications in acute KD patients and further research is warranted.

OECD 회원국에서 COVID-19 팬더믹 위기시대 지역약사의 확장된 역할에 대한주제범위 문헌고찰

이인향,제남경 한국임상약학회 2022 한국임상약학회지 Vol.32 No.4

Objective: Community pharmacists are frontline health care providers, but have been considered as underutilized professionals on adaily basis. The purpose of this scoping review was to identify information about the impact of the COVID-19 pandemic oncommunity pharmacy services and to evaluate new services that could be applicable. Methods: We searched MEDLINE andEMBASE for studies published up to January 10, 2020. Search terms consisted of keywords relevant to this review, including“COVID-19”, “community pharmacy”, and “community pharmacist”. This review targeted studies of pharmacist services providedby community pharmacies in OECD member countries during the COVID-19 pandemic period. Results: Twenty-seven studieswere included in this review. Changes in community pharmacist services due to the COVID-19 pandemic were broadly classifiedinto four categories. First, as the face-to-face services became challenging, various non-face-to-face services were being tried. Second, community pharmacists directly participated in the services to prevent the spread of COVID-19. Third, communitypharmacists made efforts to support continuity of care for patients who experienced difficulties due to the reduced professional careas health and medical resources are concentrated in response to COVID-19. Fourth, community pharmacist services were emerging,targeting patients suffering from greater health inequality during the pandemic. Patients expressed high demand and satisfaction forthe service of the community pharmacist, and pharmacists reported self-efficacy and professional pride. Conclusion: This studydemonstrated that in the era of the COVID-19 pandemic, various community pharmacist services have been tried and receivedpositive evaluations from patients in several OECD countries.

비전이성 유방암 수술환자의 보조화학요법 현황

구민희,제남경 한국병원약사회 2021 병원약사회지 Vol.38 No.2

Background : In July 2017, breast cancer surgery codes have been revised to more accurately describe a procedure of breast cancer surgery. This study aimed to investigate the current practice patterns of breast cancer surgery and the subsequent adjuvant chemotherapy after the revision of breast cancer surgery codes. Methods : We analyzed the 2018 inpatient datasets provided by the Health Insurance Review and Assessment Service (HIRA-NIS-2018-0047). Female patients with non-metastatic breast cancer who underwent breast cancer surgery and adjuvant chemotherapy were selected. Multinomial logistic regression analysis was performed to explore the relationships among variables regarding the selection of adjuvant chemotherapy relative to the doxorubicin and cyclophosphamide (AC) regimen. Results : Breast-conserving surgery was performed more frequently than mastectomy (70.2% vs. 29.8%) in 2018. For study subjects who underwent axillary lymph node dissection, the odds ratio for selecting sequential anthracycline-cyclophosphamide and taxane (AC-T) as adjuvant chemotherapy over AC was 23.27 (95% confidence interval [CI]=8.61-62.91). For patients aged 65 years or older, the odds ratio for selecting cyclophosphamide, methotrexate, and 5-Fluorouracil (CMF) as adjuvant chemotherapy over AC was 12.16 (95% CI=3.22-46.00). Conclusion : Factors influencing the choice of adjuvant chemotherapy were associated with age and presence of positive lymph nodes.

외래 급성 비부비동염 환자의 잠재적으로 부적절한 항생제 사용

정다이,제남경 한국임상약학회 2023 한국임상약학회지 Vol.33 No.4

Background: Acute rhinosinusitis (ARS) is a common condition encountered in ambulatory practice and is one of the most common reasons for antibiotic prescriptions. This study aimed to evaluate the potentially inappropriate antibiotic prescribing for ARS in South Korea and identify influencing factors. Methods: We analyzed Health Insurance Review and Assessment Service-National Patient Samples data. We selected outpatients aged 20 to 64 with ARS, prescribed antibiotics between February and November 2020. Potentially inappropriate antibiotic prescribing was categorized as: 1) inappropriate antibiotic selection and 2) inappropriate antibiotic dosage or duration. Multiple logistic regression was conducted to estimate the impact of various factors on inappropriate antibiotic prescribing. Results: Of 1,210 patients, 80.83% received potentially inappropriate ARS antibiotic prescriptions. Inappropriate antibiotic selection accounted for 43.55%, and inappropriate antibiotic dosage and duration contributed to 37.28%. Otolaryngologists had higher odds ratio (OR) of potentially inappropriate antibiotic prescribing compared to internal medicine practitioners, while dentists had lower OR. Patients aged 20 to 29 years had a higher OR than other age groups, and those who visited primary care clinics had a higher OR than those who visited hospitals. Conclusion: Potentially inappropriate antibiotic prescribing for ARS is prevalent in South Korea. This study identified physician specialty, patient age group, and the level of healthcare facility as factors influencing potentially inappropriate antibiotic prescriptions. Addressing this issue through targeted interventions, such as improved guidelines adherence and patient education, is imperative to mitigate the risks associated with antibiotic misuse and antibiotic resistance.

Patterns and Persistence of Pharmacotherapy for Children and Adolescents with Attention Deficit Hyperactivity Disorder in South Korea

이경은,제남경,Lee, Kyeong Eun,Je, Nam Kyung Korean College Of Clinical Pharmacy 2018 한국임상약학회지 Vol.28 No.3

Objective: This study aimed to assess treatment persistence in Korean children and adolescents with attention deficit hyperactivity disorder (ADHD) and the factors influencing their adherence to ADHD pharmacotherapy. Methods: The study included patients between 6 and 18 years of age with ADHD who were taking various formulations of methylphenidate and atomoxetine on June 1, 2014. Patients were dichotomized as "persistent" or "non-persistent", depending on whether they continued ADHD therapy for 6 months (therapy persistence). We also investigated if the patients were taking the same medication(s) as before and also classified the patients as "medication persistent" or "non-persistent". Patient' characteristics were correlated with therapy persistence and medication persistence. Multiple logistic regression analyses were performed to assess potential risk factors for treatment persistence. Results: Overall, 3,317 patients were included in the analysis. A majority of patients were taking stimulants (82.0%), 16.2% were taking non-stimulants and 1.8% were taking a combination therapy of stimulants and non-stimulants. After 6 months, 2,290 patients (69.0%) continued to take medication for ADHD with 1,953 patients taking the same medication(s) as 6 months previously. Common positive factors for therapy persistence and medication persistence were identified as younger age, retardation, and developmental delay, and long-acting formulations of methylphenidate as either monotherapy or in a combination therapy may be used. Conclusion: ADHD medications were proven to improve academic performance and social skills of children. Collaboration between patients, parents, school staffs, and prescribers is required to improve the persistent use of ADHD medications.

노령 보훈의료지원 인구의 외래 처방의약품 사용경향과 적정성

이인향,제남경,황예령 대한약학회 2019 약학회지 Vol.63 No.3

This study aimed to analyze national claims data of elderly veterans to generate scientific evidence over thetrends and appropriateness of their drug utilization in outpatient setting. National claims data of elderly veterans during2014-2015 were provided by the Health Insurance Review & Assessment (HIRA). We selected two comparable groupsthrough random sampling and matching the data between elderly veterans and National Health Insurance (NHI) or MedicalAid (MAID) patients. We made comparisons among groups in drug use and costs using multivariate gamma regressionmodels, and in two inappropriate prescribing indicators using multivariate logistic regression models. Given the sameenvironment, elderly veteran patients, in comparison to NHI patients, visited medical institution less with 0.82 times, had1.83 times more drug use, and paid 1.22 times more drug costs (p<0.05). In comparison to elderly MAID patients, elderlyveteran patients visited medical institution less with 0.94 times, had 1.24 times more drug use, and paid 1.04 times moredrug costs (p<0.05). Elderly veteran patients were exposed to the risk of potentially inappropriate medications (PIM)prescribed 1.3 times more than comparison groups (OR=1.26 in those compared to NHI patients, or 1.28 in thosecompared to MAID patients, p<0.0001), and to the risk of therapeutic duplication 1.6 times more than comparison groups(OR=1.62 in those compared to NHI patients, or 1.56 in those compared to MAID patients, p<0.0001). There were greaterworries in drug use behaviors of elderly veteran patients over inefficient and potentially unsafe drug utilization.