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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.
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노인 류마티스 관절염 환자에서의 요양급여심사기준 변경에 따른 TNF-α 억제제 약물사용양상
윤진영 ( Jinyoung Youn ),김시인 ( Siin Kim ),서혜선 ( Hae Sun Suh ) 한국보건경제정책학회 2016 보건경제와 정책연구 Vol.22 No.4
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.
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