약제급여결정 과정에서의 시민참여 -급여결정 과정에 참여한 전문가들의 시각을 중심으로-

이보람 ( Bo Ram Lee ),서혜선 ( Hae Sun Suh ) 한국보건경제정책학회(구 한국보건경제학회) 2015 보건경제와 정책연구 Vol.21 No.4

최근 보건의료자원의 효율적이고 공정한 분배를 위한 시민참여에 대한 논의가 꾸준히 이어져 오고 있다. 정책결정자들은 보건의료분야의 의사결정에 있어서 과학적 사실과 사회적 가치를 모두 고려해야 하는데 시민들이야말로 사회적 가치에 대한 적절한 견해를 제공할 수 있기 때문이다. 본 연구에서는 보건의료분야의 다양한 정책 중에서도 건강보험의 약제급여결정 과정에서의 시민참여에 대한 전문가 의견조사를 실시하였으며 면접조사 내용은 정리된 결과를 바탕으로 대상자들의 검증 작업을 거쳐 정성적으로 분석되었다. 면접에 참여한 모든 전문가들이 시민참여의 필요성에 대해 원칙적으로 동의하였으며 운영방식에 있어서는 대부분이 ``시민위원회``와 같은 별도의 자문기구 형태를 선호하였다. 전문가들은 시민참여를 통해 의사결정 과정의 형평성을 담보하고 투명성을 제고할 수 있을 것으로 기대하였으며 궁극적으로는 정책 수용성을 높일 수 있을 것으로 전망하였다. 그러나 동시에 전문가들은 대표성의 문제와 더불어 시민들의 전문성 부족을 우려하였다. 시민참여의 목적은 그들의 삶에 직접적으로 영향을 끼치는 정책을 시민들이 스스로 결정한다는 데 그 의의가 있다. 보건의료분야에서 시민참여가 실효성 있는 제도로 정립되기 위해서는 향후 보다 다각적인 노력이 필요할 것이다. For more efficient and equitable distribution of health care resources, there have been several discussion and attempts to engage publics in health care related decision making. This is because policy makers recognized that decisions are consisted of two components which are technical facts and values, and citizens can advise about the latter. Before considering public participation in Korea, we intend to examine experts`` view on citizen participation in the decision-making process for drug reimbursement. In-depth face-to-face interviews were carried out during May and September 2013 with fifteen experts individually having considerable experience of the drug reimbursement evaluation or public participation experience. Thematic content analysis was performed and validated by member checking. All interviewed experts agreed to the need for public participation. Most of interviewees preferred a separate advisory body like a ``Citizens Council``. They expected to ensure equity and enhance transparency in decision-making process and to increase acceptance of policies through public participation. However, they had concerns about the problem of representativeness and the lack of expertise in publics. The purpose of public engagement is to enhance citizens`` own power in policies that influence their lives. Various efforts should be accompanied to organize public participation in health care.

항암치료에서 약사처방중재의 경제적 편익분석

김귀숙(Kwi Suk Kim),서성연(Sung Yun Suh),임정미(Jung Mi Lim),이주연(Juyeun Lee),고영일(Youngil Koh),서혜선(Hae Sun Suh) 대한약학회 2020 약학회지 Vol.64 No.3

This study analyzed the economic benefits of pharmacists’ prescription intervention in appropriate chemotherapeutic efficacy and safety. We analyzed the types of prescription interventions and the severities of prescription errors by reviewing electronic medical record and intervention reports for anticancer patients from May 1st 2013 through December 31st 2014. Total of 114,536 prescriptions were reviewed during the study period and 3,305 (2.9%) prescription interventions were conducted. The evaluation of the economic values for prescription arbitration was calculated by the amount of prevention of drug loss, the risk avoidance cost against inappropriate prescriptions, and the cost of preventing unnecessary preparations. The labor cost of pharmacists for prescription interventions was 15,758,479 won. When we estimated the savings due to pharmacist’s prescription intervention, the cost of risk avoidance of using the Probability of Harm (POH) resulted from inappropriate prescriptions was estimated to be 2,514,652,575 won. The prevention cost of loss was 586,560,148 won, whereas reduction cost of the unnecessary preparation was 3,944,242 won. Consequently, the net benefit of clinical pharmacy services in oncology during 20 months was estimated to be 3,089,398,486 won when we used the method of POH. Overall, the pharmacist’s prescription arbitration appeared to be beneficial not only for the patient’s safety but also for the economic benefits.

파킨슨병 환자에서 위장관 운동조절제의 사용현황 및 처방에 미치는 요인

이창훈(Chang Hoon Lee),김시인(Siin Kim),서혜선(Hae Sun Suh) 대한약학회 2019 약학회지 Vol.63 No.6

Gastrointestinal motility drugs have been prescribed to manage functional dyspepsia in Parkinson’s disease (PD). However, anti-dopaminergic gastrointestinal motility drugs can exacerbate motor symptoms of PD. This study investigated the current use and factors affecting prescription of gastrointestinal motility drugs in PD patients. This retrospective cohort study extracted 3 patient groups (high-risk anti-dopaminergic drugs, low-risk anti-dopaminergic drugs and trimebutine group), by using the National Health Insurance Service-National Sample Cohort database. The most frequently prescribed drug was domperidone (n=437). Age and Charlson comorbidity index (CCI) were significantly different across three patient groups (p-value<0.05). Post hoc test (Tukey test) showed that high-risk group and trimebutine group were significantly different in age and CCI (p-value<0.05). The chi-square test for types of institution and clinical departments were significantly different across patient groups (p-value<0.001). Compared to tertiary hospital, general hospital [odds ratio (OR): 2.05, confidence interval (CI): 1.07-3.93], hospital/psychiatric hospital (OR: 4.28 CI: 2.11-8.65), and clinic (OR: 4.94 CI: 2.64-9.26) were more likely to prescribe high-risk drugs than low-risk drugs. Among clinical departments, neurology (OR: 0.08 CI: 0.05-0.14) was less likely to prescribe high-risk drugs than low-risk drugs. When comparing low-risk drugs group and trimebutine group, low-risk drugs were less likely to be prescribed in general hospital (OR: 0.40 CI: 0.18-0.92), hospital/psychiatric hospital (OR: 0.24 CI: 0.10-0.58), and clinic (OR: 0.16 CI: 0.08-0.36) than in tertiary hospital; Neurology (OR: 20.38 CI: 9.65-43.06) was more likely to prescribe low-risk drugs. Consequently, tertiary hospital and neurology were more likely to prescribe low-risk drugs than clinics and internal medicine, respectively.

노인 류마티스 관절염 환자에서의 요양급여심사기준 변경에 따른 TNF-α 억제제 약물사용양상

윤진영 ( Jinyoung Youn ),김시인 ( Siin Kim ),서혜선 ( Hae Sun Suh ) 한국보건경제정책학회(구 한국보건경제학회) 2016 보건경제와 정책연구 Vol.22 No.4

2014년 1월부터 류마티스 관절염 환자의 TNF-α 억제제 사용에 관한 급여기준이 기존의 다양한 검사 결과를 요구하는 방법에서 DAS28이라는 지표를 활용하는 방향으로 완화되었다. 본 연구에서는 이 급여기준의 변경 전후 1년간 류마티스 관절염(한국표준질병사인분류 M05, M06)노인 환자들의 TNF-α 억제제 이용 변화를 분석비교하였다. 건강보험심사평가원의 2013, 2014년 고령환자데이터셋을 활용하여 분석하였고, 구간별 회귀분석을 이용한 개입 시계열 분석방법을 적용하여 급여기준의 변경 전후 1년간 월별 TNF-α 억제제의 처방건과 사용량을 분석하였다. 사용량은 천명의 류마티스 관절염 환자의 일당 정립 용량(Daily Defined Dose)를 사용하였다. 분석결과, 급여기준 변경 후 월별 TNF-α 억제제의 처방건과 사용량은 유의한 변화를 보이지 않았다. 그러나 의료기관 종별에 따라 하위분석을 실시한 결과, 급여기준 변경 후 상급종합병원에서의 월별 처방과 사용량은 증가하였고, 종합병원, 병원/의원에서의 월별 처방과 사용량은 감소한 것으로 나타났다. 전체적으로 급여기준의 변경이 TNF-α 억제제의 처방과 사용에 영향을 미치지 않은 것으로 나타났으나 의료기관 종별에 따라 유의한 변화가 있었다. 급여기준의 개선으로 인해 장기간으로 보았을 때 류마티스 관절염 환자들의 TNF-α 억제제에 대한 접근성이 증가했는지에 대한 추가적인 연구가 필요할 것으로 보인다. In January 2014, there was a change in the reimbursement criteria of TNF-α inhibitor (TNFi) for RA patients. The new reimbursement criteria require DAS28 of a patient to assess disease activity, while previous reimbursement criteria required laboratory data and several subjective assessments. We examined the effect of a change in reimbursement criteria on the utilization of TNFi in RA patients. Data sources were 2013-2014 Aged Patient Sample data of Health Insurance Review and Assessment. Monthly trends in prescription and consumption of TNFi were estimated using segmented regression of interrupted time series. The consumption of TNFi was measured in terms of Daily Defined Dose per 1,000 RA patients per day. Subgroup analysis was conducted by the types of institution. There were increased baseline trends in prescription and consumption of TNFi, which were not significant. In subgroup analysis, tertiary hospital showed a significant increase in prescription and consumption immediately after the change in reimbursement criteria, while general hospital, hospital, and clinic showed a significant decrease in prescription and consumption. These trends were consistent throughout one year after the change in reimbursement criteria. This study shows that the change in reimbursement criteria of TNFi in RA patients had little impact on the overall utilization of TNFi. However, the change in reimbursement criteria significantly affected the pattern of TNFi utilization by the types of institution. Further research is needed to examine whether this change improved the accessibility to TNFi in RA patients.

급성상기도감염 환자의 항생제 처방에 영향을 주는 요인

최원정 ( Won Jung Choi ),임은실 ( Eunshil Yim ),김태현 ( Tae Hyun Kim ),서혜선 ( Hae Sun Suh ),최기춘 ( Ki Chun Choi ),정우진 ( Woo Jin Chung ) 한국보건행정학회 2015 보건행정학회지 Vol.25 No.4

Background: Initial treatment of acute upper respiratory infection (AURI) should not include antibiotics because most AURIs are caused by virus. However, the prescription rate of antibiotics in Korea is higher than in any other countries. Inappropriate use of antibiotics in Korea accelerated the emergence of antibiotics resistance and increased the social and economic burden. The objective of this study was to investigate the factors related to antibiotics use for the AURI among children-adolescents and adults. Methods: This study analyzed the Health Insurance Review and Assessment Service-National Patient Sample data which was nationally representative sampling stratified by sex and age. Results: The influencing factors of antibiotics use for AURI are gender, age, types of medical security, primary disease, existence of concomitant disease, treatment seasons, first visit or revisit, indicated specialty, types of medical institution, and location of medical institution. Conclusion: The results showed health policy makers are required to place more efforts to resolve inappropriate antibiotics use. Especially they need to establish a health policy to reduce the gap between areas and specialties and recommend standardized clinical guidelines according to the subgroup code of AURI and the age group of patients.

골다공증성 골절 예방에 대한 지불의사금액 추정

박주연 ( Joo Yeon Park ),안정훈 ( Jeong Hoon Ahn ),서혜선 ( Hae Sun Suh ),박선영 ( Sun Young Park ),현민경 ( Min Kyung Hyun ),성윤경 ( Yoon Kyoung Sung ),이의경 ( Eui Kyung Lee ),김윤희 ( Youn Hee Kim ) 한국보건경제정책학회(구 한국보건경제학회) 2011 보건경제와 정책연구 Vol.17 No.3

본 연구는 적절한 급여기준 설정과 관련한 의사 결정에 근거를 제공하기 위해 일반인을 대상으로 골다공증 골절 위험 감소에 대한 편익의 가치를 추정하고자 수행되었다. 서울특별시와 충청도의 중소도시에 거주하고 있는 일반인 101명을 대상으로 조건부 가치측정법을 사용하여 골절예방에 대한 지불의사금액(Willingness To Pay, WTP)을 조사하였다. Generalized Linear Model(GLM)을 사용하여 WTP에 영향을 미치는 요인을 확인하였으며 남성과 여성에 대하여 별도로 분석하였다. 분석 결과 척추골절 위험률을 10%, 50% 낮춰주는 치료법에 대한 WTP로 본인의 경우 연평균 66만원, 135만원을, 가족의 경우 82만원, 160만원을 각각 제시하였다. 대퇴부골절의 경우 각각 연평균 116만원, 235만원을 본인에 대한 WTP로 응답하였으며 가족에 대해서는 10% 더 높은 수준의 금액을 제시하였다. WTP에 대한 회귀분석 결과 성별에 따라 유의미한 인자가 달랐으나 두 집단 모두 골절 감소 효과가 높을수록 WTP 수준이 더 높은 것으로 나타났다. 골다공증성 골절 위험 감소에 대한 WTP는 골다공증 약물 치료 선택에 기초자료로 활용될 수 있으며, 약물치료를 골감소증 환자에게 확대하고자 할 때도 기준으로 활용할 수 있어 궁극적으로 합리적인 의료비 지출을 위한 정책 결정과정에 기여할 수 있을 것으로 기대한다. This study was performed to estimate willingness to pay(WTP) for treatment that would reduce osteoporotic fractures to provide evidence-based decision making related to the reimbursement of osteoporosis use. 101 people in Seoul and Chung Cheong-Do were interviewed face to face and asked about their WTP for treatment that would reduce their or their family``s risks of vertebral or hip fracture by 10% or 50%. Each question was repeated for the fracture risk of a family member. A generalized Linear Model(GLM) was used to identify factors affecting the level of WTP in male and female group separately. The WTP for treatment that would reduce the risk of vertebral fracture by 10% and 50% were 660,000 and 1,350,000 Korean won, respectively, per year; and the WTP for treatment that would reduce the risk of hip fracture by 10% and 50% was 1,160,000 and 2,350,000 Korean won, respectively, per year. The average WTP for a family member was around 10% higher than the WTP for oneself. The factors affecting the WTP have differences in male and female group but the WTPs of both groups were associated with higher effect of reducing fracture. These consumers``WTPs would provide information regarding the treatment of osteoporosis and contribute to appropriate drug use and rational pharmaceutical spending.

유방암 환자의 항암 치료 부작용 및 한의학적 보완치료 경험에 관한 포커스 그룹 연구

한솔아 ( Sola Han ),장보형 ( Bo-hyoung Jang ),황덕상 ( Deok-sang Hwang ),서혜선 ( Hae Sun Suh ) 대한한방부인과학회 2017 大韓韓方婦人科學會誌 Vol.30 No.1

Objectives: To explore experiences of treatment-related side effects and supportive care among Korean breast cancer survivors (BCS). Methods: Focus group interview was conducted with six Korean women with breast cancer. Participants were recruited through snow-balling. Interview was audio-recorded and transcribed verbatim. NVivo-11 was used to code the data into themes. Results: Two major themes were identified: (1) experiences of Western medicine, including treatment, side effects, needs and costs; (2) experiences of supportive care with Korean medicine, including the same as above. All participants experienced Western medicine in treatment phase and reported impairment of physical, emotional, and social functioning during and after Western medicine treatment. Only three participants used Korean medicine after treatments end. The negative responses from Western medicine doctors were the most important factor keeping participants from accessing Korean medicine when treatment-related side effects occurred. For this reason, some participants used Korean medicine without disclosure. Participants usually acquired information about Korean medicine from online community or other BCS, which was another important factor because it raised concerns about side effects and credibility of Korean medicine. High cost was also reported as barrier in using Korean medicine. During the cancer treatment, participants tended to endure their treatment-related side effects. Conclusions: Korean BCS may be at high risk of physical or emotional distress during treatment period. Findings suggest that there is a high need for supportive care to relieve treatment-related side effects and improve patients` quality-of-life. Furthermore, developing a systematic guidance or credible information sources should be warranted to help patients find the best supportive care options including Korean medicine.

5-Fluorouracil과 그 유도체를 함유하는 Solid Lipid Nanoparticles 제조와 평가

서혜선,최명신,한규원,박소민,김길수 이화여자대학교 약학연구소 2005 藥學硏究論文集 Vol.- No.16

Solid lipid nanoparticles(SLNs) are particulate systems for parenteral drug administration and have good biocompatibility and stability. SLNs were prepared with lauric acid, as the lipid core. Tween 20 and tween 80 were used as surfactant. 5-fluorouracil and 1-benzoyl-5-fluorouracil were used as model drugs. Drug-loaded SLNs were prepared by the hot homogenization technique in order to evaluate the physical stability, entrapment efficiency of drugs as well as release profile. The particle size of SLNs was 40~600 nm. By increasing speed, the mean particle size of SLfs was decreased. And entrapment efficiency in the case of using 1-Benzoyl-5-fluorouracil was higher than using 5-Fluorouracil. The higher surfactant concentration, the faster release rate at the range of 1.5~2.5%.