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이후경,손기호,민일기,신완균,최경업,서옥경 韓國病院藥師會 2004 병원약사회지 Vol.21 No.1
Hospital drug formulary is a continually revised compilation of pharmaceuticals, reflecting the current clinical judgement of medical staffs. This study was conducted to evaluate the appropriateness of hospital formulary in Korea. Out of 113 hospitals with more than 400 beds, 20 hospitals published formularies in 2002. Fifteen hospital formularies out of 20 were obtained for evaluation. Hospitals being surveyed were categorized by the number of beds(greater than 700 beds vs. 400~699 beds) and by the type of hospital(tertiary vs. acute care hospital). The criteria for formulary content and organization suggested by American Society of Health System Pharmacist(ASHP) was modified and applied. Drugs were categorized based on both the drug classifications suggested by Ministry of Health and Welfare and Drug Facts and Comparisons. Formularies were revised annually or biannually in 51 out of 113 hospitals(45.2%). Of 15 hospitals studied, 8 were tertiary hospitals(53%) and 7 had greater than 700 beds. Information on organizational policies and procedures concerning drugs and using the formulary were provided in all 15 hospitals. However, restrictions on drug use and procedures for requesting a drug to be added to the formulary were included in only one hospital. Drug products were listed alphabetically by generic name in all 15 hospitals. Generic name of the drug, dosage form(s), strength(s), packing(s), size(s) and formulation(active ingredient) of a combination product, and drug classification number were provided in all 15 hospitals. Among special information, comparison of amino acid solutions, skin tests, stability of antineoplastic and antibiotic agents, pediatric dosing, and pregnancy categories were included in more 50% of the hospitals. However, the number of drugs in the formularies from Korean hospitals were higher than those from other countries. Evaluation of hospital formulary was attempted for the first time in Korea and this could be applied as a guideline to the hospitals preparing formulary publication and update. Also, the selection of items to be included in the formulary should be based on objective evaluation of their relative therapeutic merits, safety, and cost.
급성 심근경색의 Practice Guideline 이행에 대한 평가
정선영,이숙향,민일기 이화여자대학교 약학연구소 2004 藥學硏究論文集 Vol.- No.13
The management of Acute Myocardial Infarction (AMI) has been updated with evidence based medicine. The purpose of this study is to evaluate adherence to ACC/AHA Guidelines for the Management of Patients with AMI from emergency arrival to discharge and compared quality indicators with clinical targets of each indicator. Medical records and complete prescription records for AMI patients (n=82) between Jan and Oct. 2002 were retrospectively reviewed. Aspirin, nitrates, β-blockers, thrombolytic agents, ACE inhibitors (ACE) and cholesterol lowering agents were prescribed to 100%, 93.9%, 46.3%, 19.5%, 89.0% and 61.0% of patients during hospitalization, respectively. The median time taken to perform reperfusion therapy was 62 minutes for thrombolytic therapy, and 185 minutes for percutaneous transluminal coronary angioplasty. Adherence to quality indicators such as aspirin within 24 hours, 13-blockers within 24 hours, aspirin at discharge, li blockers at discharge, ACE at discharge and smoking cessation counseling, was 97.6%, 41.5%, 91.5%, 58.5%, 82.9% and 89.0%, respectively. In hospital mortality rate was 11% (n=9). During a 6-month follow-up, when left ventricular ejection fraction was less than 40%, there was a correlation with recurrent MI and rehospitalization (p=0.029), and for patients with anterior wall MI, there was a high frequency in rehospitalization (p=.020). Except for the use of β-blockers, our results were very dosed to the clinical target. In conclusion, this study implied that compliance to the guidelines would improve clinical outcomes and become a tool for the evaluation and management of the quality of the AM treatment course.