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노인환자의 항정신병 약물 원외처방 내역에 미친 영향 요인 분석

Analysis of Influencing Factors on the Outpatient Prescription of Antipsychotic Drugs in the Elderly Patients

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Background: Most antipsychotic drugs studies have been mainly conducted on side effects, randomized clinical trials, utilization rates, and trends. But there have been few studies on the influencing factors in elderly patients. The purpose of this study was to analyze the influencing factors on the outpatient prescription of antipsychotic drugs in the elderly patients. Methods: Active ingredients of antipsychotic drugs in Korea were selected according to the Korean Pharmaceutical Information Center (KPIC)’s classification. Data source was Korean Health Insurance Review and Assessment Service (HIRA) claims data in 2020 and target patient group was the elderly patient group. We extracted patients who have been prescribed one or more antipsychotic drugs and visited only one medical institution. Data were analyzed using descriptive statistics, chi-square, t-test, negative binomial regression. Results: A number of outpatients were 245,197 and prescriptions were 1,379,092. Most characteristics of patients were 75-85 year’s old, female, health insurance type, no disease (dementia, schizophrenia), atypical drugs, cci score (>2) and characteristics of medical institution were neurology in specialty, rural region, general hospitals. Results of regression showed that patient’s characteristics and medical center characteristics had significant effect on the outpatient prescription of antipsychotic drugs in the elderly patients. Conclusion: This study suggests that national policy of antipsychotic drugs in the elderly patients, with the consideration of the patients’ and medical institutions’ characteristics, is needed.

Abstract

Background: Most antipsychotic drugs studies have been mainly conducted on side effects, randomized clinical trials, utilization rates, and trends. But there have been few studies on the influencing factors in elderly patients. The purpose of this study was to analyze the influencing factors on the outpatient prescription of antipsychotic drugs in the elderly patients. Methods: Active ingredients of antipsychotic drugs in Korea were selected according to the Korean Pharmaceutical Information Center (KPIC)’s classification. Data source was Korean Health Insurance Review and Assessment Service (HIRA) claims data in 2020 and target patient group was the elderly patient group. We extracted patients who have been prescribed one or more antipsychotic drugs and visited only one medical institution. Data were analyzed using descriptive statistics, chi-square, t-test, negative binomial regression. Results: A number of outpatients were 245,197 and prescriptions were 1,379,092. Most characteristics of patients were 75-85 year’s old, female, health insurance type, no disease (dementia, schizophrenia), atypical drugs, cci score (>2) and characteristics of medical institution were neurology in specialty, rural region, general hospitals. Results of regression showed that patient’s characteristics and medical center characteristics had significant effect on the outpatient prescription of antipsychotic drugs in the elderly patients. Conclusion: This study suggests that national policy of antipsychotic drugs in the elderly patients, with the consideration of the patients’ and medical institutions’ characteristics, is needed.

참고문헌 (50)

  1. Kang YK, "2020 Statistics of Older People", Korean Statistical Information Service, 1~83 (2020)
  2. Kim SM, "National Health Insurance Statistical Yearbook", pp.1~843 (2020), Health Insurance Review & Assessment Service, National Health Insurance Service
  3. Lee YM, "National Mental Health Statistics 2019", National Health Insurance Service National Center for Mental Health, Health Insurance Review & Assessment Service, Korea Institute for Health and Social Affairs, 1~222 (2019)
  4. Park NH, "Health and Welfare Statistical Year Book 2020", pp.1~669 (2020), National Health Insurance Service
  5. "Older Americans 2020 Key Indicators of Well-Being", The Federal Interagency Forum on Aging-Related Statistics, pp.1~161 (2020)
  6. Suffering in silence: age inequality in older people’s mental health care, "Members of executive of Faculty of Old Age Psychiatry, the Royal College of Psychiatrists", The Royal College of Psychiatrists, 1~32 (2018)
  7. "NSW Older People’s Mental Health Services SERVICE PLAN 2017-2027"[URL]
  8. 이중서, "항정신병약물 임상의 역사와 미래", 신경정신의학, 58(1), pp.2~11 (2019), 대한신경정신의학회[DOI]
  9. 오병훈, "노인 정신질환 개요", 대한의사협회지, 53(11), pp.953~957 (2010), 대한의사협회
  10. 원왕연, "노인 정신질환 약물치료", 대한의사협회지, 53(11), pp.972~983 (2010), 대한의사협회
  11. Howland RH, "Prescribing psychotropic medications for elderly patients", J Psychosoc Nurs Ment Health Serv, 47(11), pp.17~20 (2009)
  12. Korean Society for Drug Dynamics and Risk Management, "Drug dynamics", pp.394~401 (2011), Seoul National University Publishing and Cultural Center
  13. Kim DH, "Care points for drug use in elderly patients", The Korean Academy of Family Medicine, 28(11), pp.209~225 (2007)
  14. "DUR implementation on geriatric drug use"[URL]
  15. Centorrino F, "Multiple versus single antipsychotic agents for hospitalized psychiatric patients : case-control study of risks versus benefits", Am J Psychiatry, 161(4), pp.700~706 (2004)
  16. Waddington JL, "Mortality in schizophrenia : Antipsychotic polypharmacy and absence of adjunctive anticholinergics over the course of a 10-year prospective study", Br J Psychiatry, 173(4), pp.325~329 (1998)
  17. "Safety leaflets and card news for elderly people"[URL]
  18. 심인희, "정신건강의학과 입원 환자의 항정신병약물 사용 변화: 일 대학병원에서 1997년, 2003~2004년과 2009~2010년의 비교", 대한정신약물학회지, 23(2), pp.57~64 (2012), 대한정신약물학회[DOI]
  19. 변선정, "정신건강의학과 개방병동 입원 환자의 진단군별 약물 처방 경향 변화 : 경기도 소재 일 대학병원에서의 11년 비교 연구", 생물정신의학, 22(4), pp.195~204 (2015), 대한생물정신의학회
  20. 박성열, "일 대학병원 정신건강의학과 병동에서의 비정형 항정신병제 처방 경향 : 11년 관찰 연구", 대한조현병학회지, 19(2), pp.68~77 (2016), 대한조현병학회
  21. "Antipsychotics in the Elderly"[URL]
  22. Lao KS, "Prescribing trends and indications of antipsychotic medication in Hong Kong from 2004 to 2014:general and vulnerable patient groups", Pharmacoepidemiol Drug Saf, 26(11), pp.1387~1394 (2017)
  23. Ahn SH, "Patterns of prescription of atypical antipsychotics in elderly ambulatory patients with dementia in Korea", Journal of Pharmacoepidemiology and Risk Management, 2, pp.97~104 (2009)
  24. 윤수미, "노인 치매 환자의 항정신병약물 및 항파킨슨약물 처방 현황", 한국임상약학회지, 30(2), pp.81~86 (2020), 한국임상약학회[DOI]
  25. Mark O, "Treatment of young people with antipsychotic medications in the United States", JAMA psychiatry, 72(9), pp.867~874 (2015)
  26. Grace C, "Trends of outpatient prescription drug utilization in US children, 2002–2010", Pediatrics, 130(1), pp.23~31 (2012)
  27. Óskar H, "International trends in antipsychotic use: a study in 16 countries, 2005-2014", Eur Neuropsychopharmacol, 27(10), pp.1064~1076 (2017)
  28. Mikkel H, "Trends in utilization and dosing of antipsychotic drugs in Scandinavia : comparison of 2006 and 2016", Br J Clin Pharmacol, 85(7), pp.1598~1606 (2019)
  29. Helen CK, "Trends in antipsychotic use in dementia 1999-2007", Arch Gen Psychiatry, 68(2), pp.190~197 (2011)
  30. Indrajit B, "Socio demographic profile and utilization pattern of antipsychotic drugs among schizophrenic inpatients : a cross sectional study from western region of Nepal", BMC psychiatry, 13(1), pp.1~10 (2013)
  31. Kim JA, "Introduction and utilization of National HIRA claim data for healthcare research", Obstructive Lung Disease Research Foundation, 2(1), pp.3~9 (2014)
  32. "Korea Pharmaceutical Information Center"[URL]
  33. "Healthcare Quality Statistics as of 2018"[URL]
  34. Kim YJ, "Benzodiazepine prescription patterns for the elderly patients at ambulatory care in Korea", Journal of Pharmacoepidemiology and Risk Management, 1(1), pp.60~67 (2008)
  35. Maust DT, "Antipsychotics, other psychotropics, and the risk of death in patients with dementia:number needed to harm", JAMA psychiatry, 72(5), pp.438~445 (2015)
  36. Ćurković M, "Psychotropic medications in older adults : a review", Psychiatr Danub, 28(1), pp.13~24 (2016)
  37. Kheirbek RE, "Association between antipsychotics and all-cause mortality among community-dwelling older adults", J Gerontol A Biol Sci Med Sci, 74(12), pp.1916~1921 (2019)
  38. 최원정, "급성상기도감염 환자의 항생제 처방에 영향을 주는 요인", 보건행정학회지, 25(4), pp.256~263 (2015), 한국보건행정학회
  39. Methods for the control of measured confounders in outcomes research, "Jang EJ", National evidence-based healthcare collaborating agency, 66~200 (2013)
  40. 김민영, "치과 외래 이용 선택에 있어서 공급자 요인", 대한경영학회지, 28(2), pp.349~364 (2015), 대한경영학회
  41. Gellad WF, "Use of antipsychotics among older residents in VA nursing homes", Med care, 50(11), pp.954~960 (2012)
  42. Rege S, "Atypical antipsychotic prescribing in elderly patients with depression", Res Social Adm Pharm, 14(7), pp.645~652 (2018)
  43. "Major statistics on medical expenses"[URL]
  44. 김선경, "국립법무병원의 조현병 및 조현정동장애 입원환자에 대한 정신약물 치료 경향", 대한법의학회지, 41(4), pp.115~121 (2017), 대한법의학회
  45. Keks NA, "Are atypical antipsychotics advantageous?-the case for", Aust Prescr, 27, pp.146~149 (2004)
  46. Téllez-Lapeira J, "Prevalence of psychotropic medication use and associated factors in the elderly", Eur. J. Psychiat, 30(3), pp.183~194 (2016)
  47. Gerhard T, "Comparative mortality risks of antipsychotic medications in community-dwelling older adults", Br J Psychiatry, pp.20~51 (2014)
  48. "Patient safety-oriented drug evaluation indicators Development Research"[URL]
  49. "Detailed plan to evaluate the adequacy of hospitalization benefits in nursing hospitals"[URL]
  50. 이경희, "치과 외래 치료에서 항생제 처방에 영향을 주는 요인 - 한국 국민건강보험 표본코호트 연구 -", 한국치위생학회지, 19(3), pp.409~419 (2019), 한국치위생학회[DOI]

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