Impact of the Outpatient Prescription Incentive Program on Reduction of Pharmaceutical Costs of Clinics in South Korea / 보건행정학회지

BACKGROUND: South Korea has experienced problems with excessive pharmaceutical expenditures. In 2010, the South Korean government introduced an outpatient prescription incentive program to effectively manage pharmaceutical expenditures. Therefore, we examined the relationship between the outpatient prescription incentive program and pharmaceutical expenditures. METHODS: We used data from the Korean National Health Insurance claims database, which included medical claims filed for 22,732 clinics from 2011–2014 to evaluate associated pharmaceutical expenditures. We performed multiple regression analysis and Poisson regression analysis using generalized estimating equation models to examine the associations between outpatient prescription incentives and the outcome variables. RESULTS: The data used in this study consisted of 123,392 cases from 22,372 clinics (average 5.4 periods follow-up). Clinics that had received outpatient prescription incentives in the last period had better cost saving and Outpatient Prescribing Costliness Index (OPCI) (received: proportion of cost saving, β=6.8179; p-value <0.0001; OPCI, β=−0.0227; p-value <0.0001; reference=non-received). Moreover, these clinics had higher risk in the provision of outpatient prescription incentive (relative risk, 2.772; 95% confidence interval, 2.720 to 2.824). The associations were higher in clinics that had separate prescribing and dispensing programs, or had professional staff. CONCLUSION: The introduction of an outpatient prescription incentive program for clinics effectively managed problems with rapid increases of pharmaceutical expenditures in South Korea. However, the pharmaceutical expenditures still increased in spite of the positive impact of the outpatient prescription incentive program. Therefore, healthcare professionals and health policy makers should develop more effective alternatives (i.e., for clinics without separate prescribing and dispensing programs) based on our results.

Impact of the Outpatient Prescription Incentive Program on Reduction of Pharmaceutical Costs of Clinics in South Korea / 보건행정학회지

BACKGROUND: South Korea has experienced problems with excessive pharmaceutical expenditures. In 2010, the South Korean government introduced an outpatient prescription incentive program to effectively manage pharmaceutical expenditures. Therefore, we examined the relationship between the outpatient prescription incentive program and pharmaceutical expenditures. METHODS: We used data from the Korean National Health Insurance claims database, which included medical claims filed for 22,732 clinics from 2011–2014 to evaluate associated pharmaceutical expenditures. We performed multiple regression analysis and Poisson regression analysis using generalized estimating equation models to examine the associations between outpatient prescription incentives and the outcome variables. RESULTS: The data used in this study consisted of 123,392 cases from 22,372 clinics (average 5.4 periods follow-up). Clinics that had received outpatient prescription incentives in the last period had better cost saving and Outpatient Prescribing Costliness Index (OPCI) (received: proportion of cost saving, β=6.8179; p-value <0.0001; OPCI, β=−0.0227; p-value <0.0001; reference=non-received). Moreover, these clinics had higher risk in the provision of outpatient prescription incentive (relative risk, 2.772; 95% confidence interval, 2.720 to 2.824). The associations were higher in clinics that had separate prescribing and dispensing programs, or had professional staff. CONCLUSION: The introduction of an outpatient prescription incentive program for clinics effectively managed problems with rapid increases of pharmaceutical expenditures in South Korea. However, the pharmaceutical expenditures still increased in spite of the positive impact of the outpatient prescription incentive program. Therefore, healthcare professionals and health policy makers should develop more effective alternatives (i.e., for clinics without separate prescribing and dispensing programs) based on our results.

Medical Care Expenditure in Suicides From Non-illness-related Causes / 예방의학회지

OBJECTIVES: Several epidemiological studies on medical care utilization prior to suicide have considered the motivation of suicide, but focused on the influence of physical illnesses. Medical care expenditure in suicide completers with non-illness-related causes has not been investigated. METHODS: Suicides motivated by non-illness-related factors were identified using the investigator's note from the National Police Agency, which was then linked to the Health Insurance Review and Assessment data. We investigated the medical care expenditures of cases one year prior to committing suicide and conducted a case-control study using conditional logistic regression analysis after adjusting for age, gender, area of residence, and socioeconomic status. RESULTS: Among the 4515 suicides motivated by non-illness-related causes, medical care expenditures increased in only the last 3 months prior to suicide in the adolescent group. In the younger group, the proportion of total medical expenditure for external injuries was higher than that in the older groups. Conditional logistic regression analysis showed significant associations with being a suicide completer and having a rural residence, low socioeconomic status, and high medical care expenditure. After stratification into the four age groups, a significant positive association with medical care expenditures and being a suicide completer was found in the adolescent and young adult groups, but no significant results were found in the elderly groups for both men and women. CONCLUSIONS: Younger adults who committed suicide motivated by non-illness-related causes had a higher proportion of external injuries and more medical care expenditures than their controls did. This reinforces the notion that suicide prevention strategies for young people with suicidal risk factors are needed.

Medical Care Utilization During 1 Year Prior to Death in Suicides Motivated by Physical Illnesses / 예방의학회지

OBJECTIVES: Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. METHODS: Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. RESULTS: Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (p<0.001). The number of medical care visits for psychiatric disorders prior to suicide significantly increased only in 40- to 64-year-old men (p=0.002), women <40 years old (p=0.011) and women 40 to 64 years old (p=0.021) after adjustment for residence, socioeconomic status, and morbidity. CONCLUSIONS: Most of the suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

Clinical Features, Disability and Socioeconomic Status of Patients With Muscular Dystrophy in Korea

BACKGROUND: Since 2001, the Ministry of Health and Welfare in Korea has designated muscular dystrophy (MD) to be a rare and intractable disease, and has ensured that patients with this condition obtain support from the National Health Insurance Corporation for their medical expenditure. However, the health-related and socioeconomic status of Korean patients with MD has yet to be established. METHODS: We selected 441 patients with MD who received medical services at 17 neuromuscular centers during 2005. The medical records of selected patients were analyzed, and the subtype of MD was classified by its clinical course and diagnostic tests. A total of 95 patients or their family members participated in this health-related and socioeconomic status survey. RESULTS: Medical record analysis showed similar clinical and diagnostic characteristic data to those published previously in other countries: male predominance, being young at onset, and muscular weakness of the extremities as a predominant symptom in most patients. The diagnostic tests for MD were based on laboratory and electrophysiological studies. The most frequent form of MD among our cohort was Duchenne/Becker muscular dystrophy (42%). Our survey revealed the effect of the patients' profound disability on their activities of daily living. One-half of the patients were dissatisfied with the medical expenditure support service that was made available to them, and most patients suffered from a financial burden. The most important medical services to be developed in the future are expansion of the public health service or development of a rehabilitation hospital. CONCLUSIONS: This is the first multicenter-based epidemiologic study on the health-related and socioeconomic status of patients with MD in Korea. The findings indicate that medical coverage and public health service are currently inadequate and hence should be expanded in the future.

Effect of Sociodemographic Factors, Cancer, Psychiatric Disorder on Suicide: Gender and Age-specific Patterns / 예방의학회지

OBJECTIVES: We examined the effect of sociodemographic factors, cancer, and psychiatric disorders on suicide by gender and age-specific patterns in South Korea. METHODS: The study is a case-control study. Claim data was obtained from the national health insurance database and national death registration database. The number of people who committed suicide was 11,523, which was matched with a control group consisting of ten times as many people at 115,230 selected from the national health insurance and medical aids beneficiaries. The medical utilization of the case group was one year before death and that of the control group was from July 1,2003 to June 30, 2004. Four variables-address, economic status, presence of a psychiatric disease, and cancer-were used in multiple logistic regression analyses. RESULTS: Living in cities or in rural areas showed a greater risk for suicide than living in a metropolitan city. Low economic status, the presence of a psychiatric disorder, and cancer were also statistically meaningful risk factors for suicide. The three major psychiatric diseases, schizophrenia, alcohol abuse, and bipolar disorder, were meaningful in all age groups, but the scale of the odds ratio differed by the age group. Only the psychiatric disorder variable was meaningful in the adolescent group, whereas a psychiatric disorder and economic status were meaningful for the young adult group, and all variables were meaningful for the middle-aged group. A psychiatric disorder and cancer were meaningful in the elderly group, economic status was meaningful for male subjects, and address was meaningful for female subjects. CONCLSIONS: Factors such as living in city or rural areas, low economic status, the presence of a psychiatric disorder, and cancer were statistically meaningful risk factors in suicide. These factors also differed by age group. Therefore, policymakers should establish policies for suicide prevention that are relevant for each age group.

The Etiologic Fraction of Isocyanate-related Asthma in Isocyanate-exposed Workers / 대한산업의학회지

OBJECTIVES: Isocyanate-induced asthma is the most prevalent occupational asthma in Korea. The main purpose of this study was to estimate the etiologic fraction of isocyanate-related asthma in isocyanateexposed (EFe) workers and to measure the magnitude of preventable occupational asthma. METHODS: Asthma admissions from 2000 to 2005 were analyzed in a cohort containing 10,861 isocyanate-exposed workers and 324,618 isocyanate non-exposed workers who underwent the specialized health examination from January, 2000 to December, 2004. The cohorts of Isocyanate and noise-exposed workers were established using the same data base of Korea Occupational Safety and Health Agency (KOSHA). Asthma admissions were investigated by matching the National Health Insurance Claim Data (NHICD). The standardized rate ratio (SRR) of admission was estimated by Poisson regression method to allow unbiased comparisons across exposure and other variables such as age and sex. The etiologic fraction for the isocyanate-exposed (EFe) workers was calculated using this formula (Efe=SRR-1/SRR). RESULTS: Twenty-eight asthma admissions among the isocyanate-exposed workers and 321 non-exposed workers were observed during 2000~2005. The crude admission rate was 57.2 per 100,000 person-years for the isocyanate-exposed workers and 25.0 for the noise-exposed workers. Compared to the noiseexposed workers, the isocyante-exposed workers had significantly higher asthma admission (SRR=2.80 95%CI=1.89~4.14). The etiologic fraction for the isocyanate-exposed (EFe) workers was 64%. CONCLUSIONS: This study was limited by the restriction to admission cases and the short follow-up periods. Any difference of admission accessibility between the isocyanate-exposed and non-exposed workers will lead to either over- or under-estimation of the biased etiologic fraction for the isocyanateexposed workers. The etiologic fraction for the isocyanate-exposed workers was 64% indicated that 64% of the asthma cases occurred in the isocyanate-exposed workers are preventable through occupational health management.

Anesthetic Management of a Patient with Tuberous Sclerosis Undergoing Bilateral Nephrectomy: A case report / 대한마취과학회지

Tuberous sclerosis is an autosomal dominantly transmitted genetic disorder that has characteristic symptoms triad of mental retardation, convulsion, and facial angiofibroma. Because it is a relatively uncommon disorder, there are few informations about anesthetic management for this disorder. We report a case of tuberous sclerosis that had involved bilateral kidneys. A 14-year old female patient was induced with thiopental sodium, rocuronium bromide and then intubated with an internal diameter 6.5 mm of reinforced tube. Anesthesia was maintained with O2-N2O-isoflurane. Surgery took 3 hours and there were no remarkable changes in vital signs and arterial blood gas analysis.

Difference between Cardiovascular Response Blockades by Orolaryngeal and Nasal Lidocaine Sprays during Nasotracheal Intubation under Direct Laryngoscopy / 대한마취과학회지

BACKGROUND: Cardiovascular response elicited by mechanical stimulation of airways varies depends on the site of stimulation. The purpose of this study was to compare cardiovascular pressor responses to direct laryngoscopic nasotracheal intubation, when lidocaine was applied topically as either a nasal spray or an orolaryngeal spray before the induction of anesthesia. METHODS: Forty-six healthy adult patients were randomly allocated to two groups according to the site of the lidocaine spray before the induction of the anesthesia. Group N (nasal spray group, n = 23) received a 10% lidocaine nasal spary using a pump-metered spray (3 times into each nostril), and Group O (orolaryngeal spray group, n = 23) received the same dose and preparation in a sitting position on inspiration. After induction of anesthesia, a nasotracheal tube was inserted through a nostril. Hemodynamic data were recorded in the ward (control), after lidocaine spray, after the induction of anesthesia but before intubation, and immediately and 1min after intubation. RESULTS: Nasotracheal intubation caused a significant increase in heart rate in both groups, but a significant increase in blood pressure occurred in group O only. Rises in systolic, diastolic and mean blood pressure were significantly higher in group O than that in group N immediately and 1 min after nasotracheal intubation. CONCLUSION: Topical lidocaine administered as a nasal spray before the induction of anesthesia was found to be effective at reducing but not abolishing tachycardia response to direct laryngoscopy and nasotracheal intubation.

Awareness, Treatment, Control, and Related Factors of Hypertension in Gwacheon / 예방의학회지

OBJECTIVES: To identify the factors related to awareness, treatment, and control of hypertension in a Gwacheon population. METHODS: This study surveyed 1, 176 Gwacheon residents older than 40 years, and measured blood pressure using a standardized guideline in 1999. The study subjects were 473 adults (175 males, 298 females) with hypertension defined as a systolic blood pressure > or= 140 mmHg, diastolic blood pressure > or= 90 mmHg or reported treatment with antihypertensive medications. Information on awareness, treatment, and control of hypertension, and sociodemographic and health-related factors was collected through person-to-person interviews with a structured questionnaire. RESULTS: Overall, 252 (53.3%) of hypertensive subjects were aware of their condition, of whom as many as 193 (76.6%) were being treated, and 81 (42.0%) had their blood pressure controlled at the recommended level (< 140/90 mmHg). However, of the 473 subjects found to have hypertension, only 40.8% were being treated, and 17.1% were under control. There were no significant differences in the proportions of awareness, treatment, and control of hypertension. In multiple logistic regression models, awareness of hypertension was positively associated with age and family history of hypertension in females. Control of hypertension was also positively associated with having a partner and marital status in females. CONCLUSION: These findings demonstrate that much greater efforts on improving awareness, treatment, and control of hypertension are needed, even in urban community settings, considering related factors such as age, family history, and marital status. However, these factors should be further investigated for their causal relationship.

Dimensions of Consumer Ratings of a Hospital Outpatient Service Quality / 예방의학회지

OBJECTIVES: To examine various dimensions of consumer ratings of health care service with factor analysis and to find which factors influence the overall quality of health care service. METHODS: A cross-sectional study was conducted on outpatients of a general hospital located in Sungnam City. A self-administered questionnaire was used to assess the consumer? ratings of health care service received. The response rate was 92.8% with a total of 537 persons completing the questionnaire. Factor analysis was performed on 34 items evaluating the quality of health care service. Items were grouped into 5 dimensions as a result of factor analysis and the reliability and validity of influence on patient service assessment were evaluated for each dimension. RESULTS: The 5 dimensions were as follows ; 1) physician services, 2) non-physician services, 3) process 4) facilities, and 5) cleanliness. A positive correlation with the quality of health care service was found for the dimensions of non-physician services and process, while no significant correlation was found for the dimensions of physician services, facilities, and cleanliness. CONCLUSIONS: The result of this study may provide basic information for the development of future self-administered questionnaires of consumer ratings and for the evaluation of quality improvement activities in hospital outpatient settings.