한국과 영국의 건강불평등 국가 데이터베이스 비교: 중독 물질 오남용 관련 정신건강 및 호흡기 질환을 중심으로

이인향,Lee, Iyn-Hyang 한국임상약학회 2021 한국임상약학회지 Vol.31 No.3

Objective: Taking action on health inequalities starts with the production of information laying out the problems of inequalities, but Korean society has no national database to view related data at a glance. This study aimed to compare Korean national database with the Public Health Profile (PHP), a health inequality database of the UK. Methods: Data were collected from the websites of government and relevant organizations in the both countries between March and August 2020, which was updated in August 2021. Two themes including Co-occurring substance misuse and mental health issues in mental health and INteractive Health Atlas of Lung conditions in England were selected for comparison in terms of data accessibility, data usability and data visualization. Results: The British PHP is being served on a web-based platform, Fingertips. The data collected at the regional level were presented on 31 health inequality themes. The data are displayed at a level that can be compared between comparable communities, and visualized into various tables and figures. Comparable Korean data were scattered in several themes and websites, and mostly provided as a 17 administrative region base, which was too vast to make a meaningful comparisons. Conclusion: The findings proposed several considerations which could be useful for establishing a database of health inequality in the Korean society.

국내 의약품정보에 대한 소비자의 시각 및 활용도

이인향,계승희,이숙향 한국임상약학회 2013 한국임상약학회지 Vol.23 No.4

노령 보훈의료지원 인구의 외래 처방의약품 사용경향과 적정성

이인향,제남경,황예령 대한약학회 2019 약학회지 Vol.63 No.3

This study aimed to analyze national claims data of elderly veterans to generate scientific evidence over thetrends and appropriateness of their drug utilization in outpatient setting. National claims data of elderly veterans during2014-2015 were provided by the Health Insurance Review & Assessment (HIRA). We selected two comparable groupsthrough random sampling and matching the data between elderly veterans and National Health Insurance (NHI) or MedicalAid (MAID) patients. We made comparisons among groups in drug use and costs using multivariate gamma regressionmodels, and in two inappropriate prescribing indicators using multivariate logistic regression models. Given the sameenvironment, elderly veteran patients, in comparison to NHI patients, visited medical institution less with 0.82 times, had1.83 times more drug use, and paid 1.22 times more drug costs (p<0.05). In comparison to elderly MAID patients, elderlyveteran patients visited medical institution less with 0.94 times, had 1.24 times more drug use, and paid 1.04 times moredrug costs (p<0.05). Elderly veteran patients were exposed to the risk of potentially inappropriate medications (PIM)prescribed 1.3 times more than comparison groups (OR=1.26 in those compared to NHI patients, or 1.28 in thosecompared to MAID patients, p<0.0001), and to the risk of therapeutic duplication 1.6 times more than comparison groups(OR=1.62 in those compared to NHI patients, or 1.56 in those compared to MAID patients, p<0.0001). There were greaterworries in drug use behaviors of elderly veteran patients over inefficient and potentially unsafe drug utilization.

OECD 회원국에서 COVID-19 팬더믹 위기시대 지역약사의 확장된 역할에 대한주제범위 문헌고찰

이인향,제남경 한국임상약학회 2022 한국임상약학회지 Vol.32 No.4

Objective: Community pharmacists are frontline health care providers, but have been considered as underutilized professionals on adaily basis. The purpose of this scoping review was to identify information about the impact of the COVID-19 pandemic oncommunity pharmacy services and to evaluate new services that could be applicable. Methods: We searched MEDLINE andEMBASE for studies published up to January 10, 2020. Search terms consisted of keywords relevant to this review, including“COVID-19”, “community pharmacy”, and “community pharmacist”. This review targeted studies of pharmacist services providedby community pharmacies in OECD member countries during the COVID-19 pandemic period. Results: Twenty-seven studieswere included in this review. Changes in community pharmacist services due to the COVID-19 pandemic were broadly classifiedinto four categories. First, as the face-to-face services became challenging, various non-face-to-face services were being tried. Second, community pharmacists directly participated in the services to prevent the spread of COVID-19. Third, communitypharmacists made efforts to support continuity of care for patients who experienced difficulties due to the reduced professional careas health and medical resources are concentrated in response to COVID-19. Fourth, community pharmacist services were emerging,targeting patients suffering from greater health inequality during the pandemic. Patients expressed high demand and satisfaction forthe service of the community pharmacist, and pharmacists reported self-efficacy and professional pride. Conclusion: This studydemonstrated that in the era of the COVID-19 pandemic, various community pharmacist services have been tried and receivedpositive evaluations from patients in several OECD countries.

근거중심 의약품 정책 결정; 극복하기 어려운 과제인가? 한국 전문가의 생생한 의견

이인향 한국임상약학회 2013 한국임상약학회지 Vol.23 No.3

의약품의 허가외사용 정보제공과 동의에 대한 일반인 인식

이인향,계승희,제남경,이숙향 한국임상약학회 2014 한국임상약학회지 Vol.24 No.4

Objective: This study aims to explore the perception of off-label use of medications and the provision of informed consentsfrom the general public’s perspective. Methods: The study subjects (n=291) were recruited from 7 cities in Koreathrough a convenience sampling method. The self-administered questionnaire with 13 items was issued and collected. The study subjects who have had a pharmaceutical job were excluded. Results: The total of 231 respondents wasincluded. Only 23% of respondents were familiar with the concept of off-label use of medications. Eighty five percentof respondents (n=196) stated that the prescribers should explain the off-label use of a medication to their patients. Thepreferred method for delivering the message was the oral explanation (n=122, 53%), followed by oral explanation plusa pamphlet (n=94, 41%). The safety issue is the most concerned aspect regarding the off-label drug use, also effectivenessand insurance coverage. The majority of respondents (n=217, 94%) agreed that the prescriber should get a consentfrom patients before prescribing medications for off-label use. They preferred written consent to oral consent (140vs. 77). Conclusion: This study demonstrated general publics are infrequently aware of off-label use of medications. Itis important to raise public awareness of the off-label use of medications and to openly discuss its pros and cons forsafe and effective drug therapy.

의약품 허가외사용 관리 체계 발전 방안

이인향,서미경,이영숙,계승희,김현아,이숙향 대한약학회 2014 약학회지 Vol.58 No.2

This study aimed to develop a regulation system for off-label drug use to secure the safe use of marketed drugs. We searched governmental documents for national and global regulating systems of off-label drug uses and a body of academic literature to explore current regulating trends. We included European Union, United Kingdom, United States of America, Australia and Japan, and critically reviewed the regulation of off-label drug use in four issues, which were a reg-ulatory structure, safety control before and after off-label use, and information management. The findings of the present investigation called for several measures in off-label drug uses: enhancing prescribers’ self-regulation, providing up-to-date information to prescribers for evidence-based practice and to patients for their informed consent, making evidence with sci-entific rigor, building an official registering process for off-label use in good quality and extending the role of pharmaceutical industry in pharmacovigilance. At last, we proposed a new system so as to regulate and evaluate off-label drug uses both at national and institutional level. In the new system, we suggested a clear-cut definition for clinical evidence that applicants would submit. We newly introduced an official ‘Off-Label Drug Use Report’ to evaluate the safety and clinical efficacy of a given off-label drug use. In addition, we developed an algorism of the regulation of off-label drug use within an institution to help set up the culture of evidence-based practices in off-label drug uses.

Unit Dose Drug Distribution System의 도입을 통한 투약시스템의 질 향상 평가

이인향,이순실,이병구,최원자,홍성선 한국의료QA학회 2001 한국의료질향상학회지 Vol.8 No.1

Background : A study comparing unit dose drug distribution system(UDS) versus traditional drug distribution system(TDS) was conducted in Seoul National University Hospital. The objectives of this study were to identify safer drug distribution system and to measure the efficiency of both systems in utilizing nursing and pharmacist's time. Methods : The study was designed to compare the data on medication errors, nursing time and pharmacists' time before and after implementation of the UDS in the internal medicine and otorhinolaryngology care units. The data on actual medications administered to patients were obtained by a disguised observer during the study period. The data collected were then compared with the physicians' orders to determine the rate of medication errors. In addition, using ten-minute interval work-sampling method nursing and pharmacists' time were measured. Results : About 6% of medications were administered incorrectly in the TDS, in comparison to 1.6% in the UDS. The rate of medication error decreased significantly in the UDS compared with the TDS. Mean times spent on medication-related activities by nurses were 34.1% in the TDS and 28.5% in the UDS. In the internal medicine care unit, nursing time associated with medications decreased significantly after the implementation of the UDS, but the reduction in medication-related nursing time in the otorhinolaryngology care unit was not significant. Pharmacist's medication-related work activities, increased from 2% in the TDS to 20% in the UDS. Pharmacist's time spent on therapy-related activities increased significantly. Conclusion : The rate of medication errors in the UDS decreased significantly compared with the TDS. Time spent on medication-related activities decreased for nurses while it increased for pharmacists. In summary, the UDS was estimated to be safer and to utilize of pharmacists' and nursing time more efficiently than the TDS.

Unit Dose Drug Distribution System의 도입을 통한 투약시스템의 질 향상 평가

이인향,이순실,이병구,최원자,홍성선,Lee, In Hyang,Lee, Soonsil,Lee, Byung Koo,Choi, Won Ja,Hong, Sung Sun 한국의료질향상학회 2001 한국의료질향상학회지 Vol.8 No.2

Background : A study comparing unit dose drug distribution system(UDS) versus traditional drug distribution system(TDS) was conducted in Seoul National University Hospital. The objectives of this study were to identify safer drug distribution system and to measure the efficiency of both systems in utilizing nursing and pharmacist's time. Methods : The study was designed to compare the data on medication errors, nursing time and pharmacists' time before and after implementation of the UDS in the internal medicine and otorhinolaryngology care units. The data on actual medications administered to patients were obtained by a disguised observer during the study period. The data collected were then compared with the physicians' orders to determine the rate of medication errors. In addition, using ten-minute interval work-sampling method nursing and pharmacists' time were measured. Results : About 6% of medications were administered incorrectly in the TDS, in comparison to 1.6% in the UDS. The rate of medication error decreased significantly in the UDS compared with the TDS. Mean times spent on medication-related activities by nurses were 34.1% in the TDS and 28.5% in the UDS. In the internal medicine care unit, nursing time associated with medications decreased significantly after the implementation of the UDS, but the reduction in medication-related nursing time in the otorhinolaryngology care unit was not significant. Pharmacist's medication-related work activities, increased from 2% in the TDS to 20% in the UDS. Pharmacist's time spent on therapy-related activities increased significantly. Conclusion : The rate of medication errors in the UDS decreased significantly compared with the TDS. Time spent on medication-related activities decreased for nurses while it increased for pharmacists. In summary, the UDS was estimated to be safer and to utilize of pharmacists' and nursing time more efficiently than the TDS.

한국 국민건강보험시장에서의 제네릭 의약품 사용 양상과 영향 요인

이인향,박실비아,이의경 대한약학회 2014 약학회지 Vol.58 No.2

This study explores the prescribing pattern of generic drugs and the relationship between socio-demographic factors and the use of generics in South Korea. The analysis was based on claims data of 2011 from Korean National Health Insurance. We examined utilization, costs, and market share of oral preparations by original and generic product. Multiple logistic regression was performed to evaluate the predictive factors of generic use among multi-source medications. Gener-ics accounted for 37~41% of utilization and 34~41% of costs in the insured market of oral preparations. In the generic mar-ket, costly generics made up about 58~61%, 56~66% of volume and value, respectively. Other things being equal, institutional factors affected generic use to the largest degree. The odds of having generics were 6 times higher in clinics, 4 times higher in hospitals, and 1.7 times higher in general hospitals than in teaching hospitals. Those in metropolitan or rural area were more likely to prescribe generics than those in the capital area. While generics were frequently prescribed for off-site pharmacy (OR=1.173), the odds of having generics was 0.88 after weighting the data by units prescribed. This study empirically presented the pattern of generic prescribing, confirming the widely accepted view that costly generics were more likely to be utilized in the Korean market. Up to two thirds of the generic market consisted of costly products.The strongest factors affecting generic use were institutional variables.