[약료서비스 질 향상 방향] 지역약국에서의 약료서비스 개발

손현순,신현택,최상은,서동철,김수진 한국보건사회약료경영학회 2012 한국보건사회약료경영학회 학술대회 Vol.2012 No.1

건강보험심사평가원 자료를 활용한 보건사회약학연구

최남경 한국보건사회약료경영학회 2015 한국보건사회약료경영학회지 Vol.4 No.1

BACKGROUNDS Health insurance administrative databases are important sources of information in finding health-related evidence. The objective of this study was to introduce the Korean Health Insurance Review and Assessment Service (HIRA) claims database to perform public health and social pharmacy studies. METHODS This article introduces the contents and characteristics of the HIRA data, describes the data acquisition procedures, provides examples of studies carried out using the data, and discusses several aspects that requires attention in those studies. RESULTS The HIRA claims database contains information on all claims including patients’ diagnoses, treatments, procedures, and prescription drugs for approximately 50 million Koreans. This database can be used for the following analyses: estimation of incidence or prevalence for a variety of specific disease, description of the utilization of health care resources and services, and verification of hypotheses about the health outcomes. This database has advantages including low cost, ease of patient follow-up over long time periods, and absence of reporting bias. There are several limitations of using this database including uncertain or low validity of disease diagnoses, potential discrepancies between physician’s prescriptions and patient’s actual medication intake, and lack of laboratory results and health-related behavioral information. CONCLUSION The HIRA data provide tremendous opportunities to perform large-scale quantitative analyses in the fields of public health and social pharmacy. A better understanding of prescribing practice, health policy, and data structures allows the researchers to use the claim database appropriately.

개국약사의 의약품 부작용 예방관리에 영향을 미치는 요인 분석

하동문 한국보건사회약료경영학회 2012 한국보건사회약료경영학회 학술대회 Vol.2012 No.1

Background: In Korea, the proportion of high-risk drug use in pharmacies is high, in comparison with those overseas. However, the participation in reporting ADR and pharmacists’ perception of ADR management is low. Also the level of satisfaction of patient, regarding pharmacy services such as ADR information provided for patients, is judged to be low. This goal of this study is to evaluate pharmacists' perception on ADR prevention management. Methods: A survey targeting community pharmacists was conducted through SNS, e-mails, etc. Using the result of this survey, the difference between the pharmacists’ perception of the importance of ADR prevention management and management status was evaluated, and the factors that affect pharmacists’ ADR management were also evaluated. Results: The management status was weak compared to the perception of the importance of ADR prevention management, Though the management status excelled as the perception of importance was high, the number of managements that were poor was also quite high..The factors that affected the status of pharmacists’ ADR prevention management were: 'the number of prescription (below 50 and 100)', ‘pharmacists’ effort to acquire information / knowledge’, ‘cooperative relation between medical institutions, pharmaceutical companies, and government and pharmacies’, and perception of importance on ADR prevention management. Conclusions: Strengthening the ADR management education for pharmacists and making a political effort to compensate the insignificant parts in order to promote the pharmacists’ ADR management, can lead to an actual result that improves the overall drug safety management system.

만성질환자의 처방의약품 본인부담금 부담

박은자,박실비아 한국보건사회약료경영학회 2012 한국보건사회약료경영학회 학술대회 Vol.2012 No.1

연구목적: 우리나라를 포함한 많은 아시아국가들에서 노인인구가 빠른 속도로 증가 하고 있으나, 노인에 대한 의료·복지체계는 아직 미흡한 실정이다. 많은 노인들이 만성질환을 가지고 있고, 만성질환의 치료 및 관리를 위해 처방의약품을 장기간 복 용하나, 의약품의 경제적부담에 대해서는 충분히 연구되지 않았다. 본 연구는 노인 과 비노인 만성질환자의 처방의약품 본인부담금을 비교·분석하고자 하였다. 연구방법: 2008년 한국의료패널자료를 사용하였으며 만성질환으로 의약품을 복용하 는 20-64세 성인 3,568명과 65세 이상 노인 2,072명을 대상으로 하였다. 일반화 선 형모형(GLM)을 사용하여 노인 만성질환자와 노인이 아닌 만성질환자의 연간 처방 의약품 본인부담금을 비교하였고, 로지스틱 회귀분석을 사용하여 처방의약품 본인 부담금에 대한 경제적 부담 및 주관적 인식을 분석하였다. 연구결과: 노인이 아닌 만성질환자에 비해 노인인 만성질환자의 처방의약품 본인부 담금이 많았으며, 본인부담금으로 인한 부담에 취약하였다. 만성질환으로 의약품을 복용하는 노인 10명중 1명이 본인 소득의 10% 이상을 처방의약품 조제에 지출하고 있는데 반해, 노인이 아닌 만성질환자는 3%만이 10% 이상을 지출하고 있었다. 성별, 결혼수준, 의료보장 형태를 보정하였을 때 노인 만성질환자가 처방의약품 본 인부담금 부담이 있을 오즈가 노인이 아닌 만성질환자의 3.8배였으며, 만성질환수, 교육수준, 소득수준을 추가로 보정하였을 때 노인 만성질환자와 노인이 아닌 만성 질환자의 처방의약품 본인부담금 부담 차이는 통계적으로 유의하지 않았다. 결론: 우리나라 노인은 전반적으로 소득수준이 낮으나, 처방의약품 본인부담금이 소 득수준이나 연령에 따라 차등화되지 않기 때문에 노인에서 처방의약품으로 인한 경 제적 부담이 큰 것으로 나타났다. 따라서 우리나라와 같이 사회보장수준이 충분하 지 않은 나라에서는 가난한 노인의 처방의약품 비용부담을 줄이기 위해 본인부담금을 차등화하는 정책이 필요할 것으로 생각된다.

우리나라 사회약학 교육 현황 : 전국 34개 약학대학 설문조사 결과

안상완,노윤하,전하림,이의경,신주영 한국보건사회약료경영학회 2019 한국보건사회약료경영학회지 Vol.7 No.1

BACKGROUNDS Despite the introduction of Social Pharmacy in South Korea since the 1990s, there have been no studies on the status of social pharmacy education and research so far. OBJECTIVE The aim of this study is to investigate current status of social pharmacy education and research in South Korea. METHODS A questionnaire was mailed to 35 deans (or professors of Social Pharmacy) at colleges of pharmacy in South Korea. All respondents were asked to provide information regarding the status of their faculties, curriculum and graduate school. To present the result of the questionnaire, the frequencies or percentages of all the questions were calculated as all variable were categorical. RESULTS Over two months, a total of 34 professors participated in the study (97% response rate). Among them, 24 colleges answered that they has full-time faculty members in social pharmacy (71%), and 10 colleges answered that they don’t have full-time professors (29%). The 15 respondents reported that their colleges had graduate school of social pharmacy (44%) CONCLUSION The significant difference among the colleges of pharmacy was shown in the status of social pharmacy faculties, mandatory clerkship, and graduate school. To reduce the gap among the colleges of pharmacy, it is necessary to expand the social pharmacy faculty and develop the infrastructure in the field of social pharmacy.

연령에 따른 우선순위 설정은 사회적 선호를 반영하나?

배은영 한국보건사회약료경영학회 2020 한국보건사회약료경영학회지 Vol.8 No.1

Cost-effectiveness is basically based on the principle of health maximization. A decision based on cost per QALY has an ethical implication that 1 QALY incurred by everyone is of equal value. However, many literatures found that the public preferences depend on who the beneficiaries are, and therefore the social values of a QALY are not equal to everyone. This study focuses on the age among the factors that determine the social value of a QALY. It examines the philosophical and theoretical debate that considers age as a criterion of priority setting, including the concept of “fair inning” and outlines the direction of social preference found in empirical studies. In addition, this paper will briefly examine how the prioritization formula proposed in other countries relates to age, and seek policy implications.

알레르기 비염, 천식에서 설하면역요법과 피하주사요법의 임상적 유용성

신상진 한국보건사회약료경영학회 2012 한국보건사회약료경영학회 학술대회 Vol.2012 No.1

알레르기 비염, 천식 치료법은 회피요법, 약물요법, 면역요법으로 구분할 수 있다. 이 중 면역요법은 알레르기 질환의 자연경로를 변화시킬 수 있는 치료법으로 최근 국내에서도 면 역요법에 대한 관심이 증대되고 있지만 현재까지 국내에서 면역요법에 대한 임상적 유용성, 안전성에 대한 체계적인 검토가 이루어지지 않고 있다. 따라서 본 연구에서는 체계적 문헌 고찰을 통해 피하주사면역요법과 설하면역요법에 대한 임상적 유용성, 안전성에 대한 근거 를 확인하였다. 국내외 주요 데이터베이스 검색과 국내 관련 학회지 수기검색 결과 최종 167건의 문헌이 선택되었다. 이 중 설하면역요법은 115건, 피하주사면역요법은 45건, 두 면역요법을 직접비 교한 문헌은 9건이었다. 이들 문헌에서 주로 제시하고 있는 1차 효과지표는 증상약물점수 (symptom medication score), 증상점수(symptom score), 약물점수(medication score)이고, 추가적으로 전신부작용(systemic adverse reactions), 국소부작용(Local adverse reactions), 전체 부작용(Total adverse reaction) 등이 있었다. 체계적 문헌고찰 결과를 종합해보면 알 레르기 비염, 천식환자에서 설하면역요법과 피하주사면역요법 모두 효과적인 치료법으로 판 단되지만 두 군간의 임상적 유용성을 비교평가하기에는 근거가 불충분하였다. GRADE를 통 해 문헌들에 대한 근거수준을 평가한 결과 전체적으로 매우 낮은 수준으로 평가되었다. 본 연구는 단일 면역요법에 대한 임상적 유용성을 확인하기 위해 체계적 문헌고찰을 수행 한 선행연구와 달리 면역요법에 대한 포괄적인 체계적 문헌고찰을 시행하였다는 점에서 그 의의가 있다고 판단되나 이와 관련하여 몇 가지 한계점도 존재하였다. 첫째, 본 연구에서의 체계적 문헌고찰의 선택/배제기준을 충족하는 국내 연구가 부재하였으며, 대부분이 북아메 리카, 유럽에서 이루어진 연구들로 국내 적용시 주의가 필요할 것으로 판단된다. 또한 표준 진료지침에서는 면역요법의 치료기간이 적어도 3-5년 정도 요구하고 있지만 대부분의 무작 위배정임상시험연구들은 단기간의 효과만을 관찰하고 있는 한계가 있었다. 둘째, 메타분석결 과 이질성이 크게 나타나 하위그룹분석, 메타회귀분석을 시행하였으나 임상적으로 혹은 연 구설계 측면에서 의미있는 원인을 확인할 수는 없었다. 이러한 한계점을 극복하고 국내에서 비염, 천식환자들을 대상으로 면역요법을 적절하게 사용하기 위해서는 향후 대규모 환자들 을 대상으로 기존 약물요법 대비 피하주사면역요법, 설하면역요법이 갖는 임상적 효과와 안 전성에 대한 연구가 이루어져야 할 것이다. 이러한 연구들이 축적되어 근거가 확립되면 알레르기 비염과 천식 면역요법 치료결정 여부를 정확히 판단할 수 있을 것으로 생각된다.

국내 임상약료서비스의 임상적 경제적 효과: 체계적 문헌고찰

김형태,권미성,오호진,서혜선 한국보건사회약료경영학회 2019 한국보건사회약료경영학회지 Vol.7 No.1

BACKGROUND Since the concept of pharmaceutical care was issued by Helper and Strand in 1990, the role and expertise of pharmacist have been discussed, the role has changed dispensing and providing drugs to offering services focused on patients. Also, in South Korea, there are major changes in legal system as well as the field of education. OBJECTIVE This review therefore aimed to identify clinical and economic effects of services that are provided by pharmacists in South Korea and seek a wide range of pharmacists’ role expansion. METHODS A comprehensive searching was performed using Korean Journal of Clinical Pharmacy, Journal of Korean Society of Health-system Pharmacists and three Korean databases. We analyzed studies as intervention type, research status, outcomes of interventions and economic outcomes. RESULTS According to the first standard of classification of this study, 24 of 30 studies performed interventions belong to ‘Ensuring appropriate therapy and outcomes’. As the second standard of classification, 14 of 44 interventions belonged to ‘Patient education program or cognitive service’. 16 of 30 studies performed interventions belong to ‘Ensuring appropriate therapy and outcomes’ and evaluated clinical outcomes. There are several effects of pharmacy service. Most studies reported that pharmacy service has positive effects on errors related to prescription, occurrence of adverse drug reaction, and medication adherence. But interventions performed in studies were limited to certain types, study which evaluated economic effects was few. CONCLUSION Despite increases in the volume of reports on effects of pharmacy service, improvement in variety and quality of research is needed.

국내 단독거주 노인의 과부담의료비와 관련된 요인 분석

김은지,서혜선 한국보건사회약료경영학회 2020 한국보건사회약료경영학회지 Vol.8 No.2

BACKGROUND Korea has reached an aged society, with its population aging rapidly. However, the social policy associated with population aging has limitations of social welfare. Our society has suffered from social problems such as elderly poverty and inequality in old age. Thus, policy to improve these challenges are needed. OBJECTIVE We aimed to provide a basis for healthcare policy decisions by exploring the factors associated with the elderly house-hold facing catastrophic health expenditure. METHOD We examined baseline characteristics of single-living elderly. Moreover, we performed logistic regression analysis to assess the factors associated with the elderly household facing catastrophic health expenditure using the Korea Health Panel Survey data. RESULTS The major factors in the elderly household facing catastrophic health expenditure were elderly poverty, economic activity, severe disease, the share of drug prices, and quality of life. According to the Chi-square results, there was a statistically significant difference between age, sex, insurance type, elderly poverty, economic activity, education level, and presence of chronic or severe disease. CONCLUSION The main factors associated with the elderly household facing catastrophic health expenditure related primarily to economic characteristics. Thus, practical policy decision-making is needed to improve income secu-rity for an aging population.

의약품 유통업 종사자 교육개선 방안 연구

고정아,박혜경,이재현 한국보건사회약료경영학회 2019 한국보건사회약료경영학회지 Vol.7 No.1

BACKGROUNDS Korea Pharmaceutical Industry has been making the various system and huge efforts to improve the quality of distribution. However, the wholesaler, which is a key party of the pharmaceutical distribution system, didn’t comply the needs of the time due to the difficulties in management and the deterioration of external competitiveness. OBJECTIVE The government has set up measures to strengthen the capacity of drug wholesalers and establish distribution order. As one of the measures, it is necessary to confirm the compulsory items for the systematic education of drug distribution workers. METHODS The survey was conducted among the member companies of the Korea Pharmaceutical Distribution Association. In this study, the needs for the required knowledge and the educational contents for pharmaceutical distributors is analyzed by dividing the pharmaceutical distributors into the logistics managers and the upstream managers. RESULTS As a result of the survey analysis, there was a high need for knowledge of supply management, without any differences by department, position, experience, and product regarding the required knowledge. In education contents, the high demands for the marketing/sales was shown regardless of department, job title, career, and products they handle. CONCLUSION It is necessary to conduct differentiated education based on the comparatively highly recognized essential knowledge, educational contents, and the results of the differences in the educational content needs for each position, career, and handling product.