대기오염이 자살, 우울증 및 정신질환에 미치는 영향

강신우(Cinoo Kang),송인성(In Sung Song),장정주(Jeongju Jang),서다은(Da Eun Seo),김호(Ho Kim) 서울대학교 보건환경연구소 2020 보건학논집 Vol.57 No.1

Objectives: The aim of this study was to examine the effects of air pollution on suicide, depression, and mental disorder by comprehensively reviewing the studies conducted from 2010 to 2019. Methods: Literatures were searched using the Pubmed and Google Scholar Search engines. The search terms were used in combination with the words air pollutant, air pollution, mental illness, mental disorder, depression, and suicide. The literature search period was from 2010 to 2019 and collected based on published literature during that period. Among the retrieved literatures, the studies related to animal experiment or biological mechanisms were excluded and finally a total of 25 literatures were selected, including nine related to air pollution and suicide, eight related to air pollution and depression and eight related to air pollution and other mental disorders. Results: The effects of air pollution on suicide were reported in all 9 studies with significant results at least two air pollution factors among PM<SUB>2.5</SUB>, PM<SUB>10</SUB>, O₃, NO₂, SO₂ and CO. In addition, except for CO, it showed relatively obvious association between air pollution and suicide. In case of depression, it has been shown to have an association with PM<SUB>2.5</SUB>. In addition, seven of the nine studies reported the effects of depression on air pollution, but due to the small number of studies, pollution factors except PM<SUB>2.5</SUB> need to be reviewed further. For other mental disorders, one thing this study clearly shows is that the effects of PM<SUB>2.5</SUB> are affecting a wide variety types of mental disorders. Conclusion: In this study, we have identified some associations of air pollution with suicide or mental disorder, therefore we hope that the results of this study can be an important basis for future environmental policy.

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.

정주형 이민자에서 상용치료원이 투약순응도에 미치는 영향

강희진 ( Hee-jin Kang ),강신우 ( Cinoo Kang ),조혜민 ( Hyemin Cho ),장선미 ( Sunmee Jang ) 한국보건경제정책학회 2020 보건경제와 정책연구 Vol.26 No.4

Diabetes is a chronic disease that requires continuing medical care and self-management. Diabetes patients with a usual source of care or high medication adherence are less likely to be hospitalized or visited the emergency room or to develop diabetes-related complications. However, Little study has been done on a usual source of care and medication adherence in domestic immigrants with diabetes. Therefore, this study aims to identify a usual source of care and medication adherence in immigrants with diabetes. We analyzed using the health insurance claim data from 2011 to 2015 and included immigrants enrolled in health insurance. We selected immigrants who had prescriptions at the time of diabetic diagnosis in 2012 and followed them for 3 years. A usual source of care and medication adherence by Medication Possession Ration (MPR) were calculated and high medication adherence was defined by greater than or equal to 80% of MPR. To explore an association between medication adherence and a usual source of care among immigrants, multiple logistic regression was conducted. For 3 years, 15.6% of the patients visited one medical institution (regular) and 27.2% of the patients visited more than five. The mean MPR for 3-year durations was 64.0%. The MPR decreased by 60% at 24 months. As a result of the analysis of factors influencing medication adherence, the likelihood of becoming a non-adherence group was higher in marriage immigrants than in permanent residents, and higher in patients visited more than five medical institutions compared to one. As patients who had a usual source of care could further increase the medication adherence, the importance of the usual source of care was confirmed, and it was also applied to domestic immigrants.

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.