당뇨병 진료 적정성 평가에 따른 관련 지표의 변화: 2010-2015년 건강보험심사평가원 자료를 이용하여
Changes in Indicators after Assessment of Diabetes Mellitus Adequacy Evaluation: Korean Health Insurance Review and Assessment Service Data 2010-2015
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
연구배경: 건강보험심사평가원은 2010년부터 당뇨병 진료 적정성 평가 사업을 시행하고 있다. 본 연구는 적정성 평가 사업 이후 제2형 당뇨병 환자의 진료 적정성을 평가하고향후 사업의 방향을 수립하는 데 도움을 주고자 시행하였다. 방법: 건강보험심사평가원의 자료를 이용하여, 2010년부터 2015년까지 적정성 평가 횟수에 따른 적정성 평가 시행률, 검사항목 비율 및 당뇨병 약제 처방률 등을 조사하였다. 자료는 카이제곱 및 로지스틱 회귀분석을 시행하였으며, 분산 분석을 통한 경향성을 보고자 하였다. 결과: 당뇨병 검사를 전혀 시행하지 않은 환자들은33.6-39.8%였다. 당화혈색소 검사는 약 7%만 시행하였으며, 혈청지질검사와 동시에 검사한 경우도 36%로 나타났다. 연령이 증가함에 따라 당뇨병 약제 처방일수도 증가하는 추세를 보였다. 적정성검사를 전혀 받지 않았던 환자들의 292일 이상 당뇨병 약제 처방률은 61%였으며, 검사 횟수가 증가할수록 평균 약제 처방률도 증가하였다. 결론: 당뇨병 유병률이 높은 노인에서 당화혈색소를 포함한 당뇨병 적정관리에 필요한 검사율과 평균 약제 처방률을높일 수 있는 대책수립이 필요하다.
Abstract
Background: The Korean Health Insurance Review and Assessment Service has conducted diabetes medical adequacy evaluation projects since 2010. This study aimed to evaluate the medical adequacy of type 2 diabetes mellitus patients after the assessment project and help establish the direction of future projects. Methods: Using data from the Health Insurance Review & Assessment Service (2010-2015), chi-square tests and t-tests were used to analyze the enforcement rate according to a combination of items for appropriate management methods. Logistic regression and linearity test were performed to assess the relationships among the evaluation group, appropriate test items, and prescription rate. Results: We found that 33.6-39.8% of patients did not undergo any diabetes-related tests. Only about 7% of hemoglobin A1c (HbA1c) tests were performed, and 36% of cases were tested simultaneously with serum lipid profile tests. As age increased, the number of days taken to prescribe diabetes medications also increased. The prescription rate of diabetes drugs for 292 days or more was 61% in patients who had not been tested for adequacy, and the average prescription rate increased as the number of tests increased. Conclusions: In older adults with a high prevalence of diabetes, it is necessary to establish a test rate for proper management of diabetes, including HbA1c, and related test items to increase the average prescription rate.
참고문헌 (17)
- "Causes of death" (2018)[URL]
- Zimmet P, "Global and societal implications of the diabetes epidemic", Nature, 414(6865), pp.782~787 (2001)
- Chen L, "The worldwide epidemiology of type 2 diabetes mellitus--present and future perspectives", Nat Rev Endocrinol, 8(3), pp.228~236 (2012)
- Choi YJ, "Prevalence and management of diabetes in Korean adults : Korea National Health and Nutrition Examination Surveys 1998-2005", Diabetes Care, 32(11), pp.2016~2020 (2009)
- 전자영, "Prevalence of Diabetes and Prediabetes according to Fasting Plasma Glucose and HbA1c", Diabetes and Metabolism Journal, 37(5), pp.349~357 (2013), 대한당뇨병학회[DOI]
- "Korean diabetes fact sheet 2015" (2011)[URL]
- The Seventh Korea National health statistics National Health and Nutrition Examination Survey, "Korea Centers for Disease Control and Prevention", KCDC, 1~402 (2018)
- A study to management method of appropriate state of affairs for chronic diseases-production of evaluation index for appropriate management of diabetes mellitus, "Hong JS", Health Insurance Review & Assessment Service, ~ (2009)
- Management method of chronic diseases in private clinics- focus to appropriate assurance for a management cost of chronic diseases, "Jung SH", Health Insurance Review & Assessment Service, ~ (2009)
- A study for appropriate management method of diabetes mellitus, "Kim SR", Health Insurance Review & Assessment Service, ~ (2008)
- "Behavioral Risk Factor Surveillance System (BRFSS) 2010 Survey Data and Documentation" (2010)[URL]
- Shekelle PG, "Quality indicators for the management of diabetes mellitus for vulnerable older person" (2004)
- American Diabetes Association, "Microvascular complications and foot care: standards of medical care in diabetes—2018", Diabetes Care, 41(Suppl 1), pp.S105~S118 (2018)
- Choudhry NK, "Measuring concurrent adherence to multiple related medications", Am J Manag Care, 15(7), pp.457~464 (2009)
- Rozenfeld Y, "Oral antidiabetic medication adherence and glycemic control in managed care", Am J Manag Care, 14(2), pp.71~75 (2008)
- Hussey PS, "Continuity and the costs of care for chronic disease", JAMA Intern Med, 174(5), pp.742~748 (2014)
- Peikes D, "Effects of care coordination on hospitalization, quality of care, and health care expenditures among medicare beneficiaries : 15 randomized trials", JAMA, 301(6), pp.603~618 (2009)