New Alert Override Codes for the Drug Utilization Review System Derived from Outpatient Prescription Data from a Tertiary Teaching Hospital in Korea
2
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Objectives: This paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution. Methods: Data were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons. Results: We identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for “prescription relating to operation” and “emergency situations.” Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: “patient was not taking/will not take the medications involved in the DDI.” Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes. Conclusions: These new codes will facilitate the use of the drug–drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians.
Abstract
Objectives: This paper proposes new alert override reason codes that are improvements on existing Drug Utilization Review (DUR) codes based on an analysis of DUR alert override cases in a tertiary medical institution. Methods: Data were obtained from a tertiary teaching hospital covering the period from April 1, 2012 to January 15, 2013. We analyzed cases in which doctors had used the 11 overlapping prescription codes provided by the Health Insurance Review and Assessment Service (HIRA) or had provided free-text reasons. Results: We identified 27,955 alert override cases. Among these, 7,772 (27.8%) utilized the HIRA codes, and 20,183 (72.2%) utilized free-text reasons. According to the free-text content analysis, 8,646 cases (42.8%) could be classified using the 11 HIRA codes, and 11,537 (57.2%) could not. In the unclassifiable cases, we identified the need for codes for “prescription relating to operation” and “emergency situations.” Two overlapping prescription codes required removal because they were not used. Codes A, C, F, H, I, and J (for drug non-administration cases) explained surrounding situations in too much detail, making differentiation between them difficult. These 6 codes were merged into code J4: “patient was not taking/will not take the medications involved in the DDI.” Of the 11 HIRA codes, 6 were merged into a single code, 2 were removed, and 2 were added, yielding 6 alert override codes. We could codify 23,550 (84.2%) alert override cases using these codes. Conclusions: These new codes will facilitate the use of the drug–drug interactions alert override in the current DUR system. For further study, an appropriate evaluation should be conducted with prescribing clinicians.
참고문헌 (14)
- 최남경, "한국형 DUR의 효과적 추진전략", 대한의사협회지, 53(12), pp.1130~1138 (2010), 대한의사협회
- 최종수, "동시적 의약품 사용평가(cDUR) 시스템 구축 및 적용 사례 연구 : 국내 한 대학병원을 중심으로", 대한산업공학회지, 39(1), pp.20~29 (2013), 대한산업공학회[DOI]
- Strom BL, "Pharmacoepidemiology" (2012), Wiley-Blackwell
- 전하림, "의약품 사용평가(DUR) 사업의 미국 47개주 Medicaid 자료비교 및 정책적 함의 고찰", 보건사회연구, 34(3), pp.192~221 (2014), 한국보건사회연구원
- 김동숙, "의약품 처방·조제지원서비스(Drug Utilization Review)사업이 병용금기 처방률에 미치는 영향", 보건행정학회지, 24(2), pp.120~127 (2014), 한국보건행정학회[DOI]
- Brunton L, "Goodman & Gilman’s the pharmacological basis of therapeutics" (2011), McGraw-Hill
- Rodrigues AD, "Drug-drug interactions" (2008), Informa Healthcare
- Hines LE, "Potentially harmful drug-drug interactions in the elderly: a review", Am J Geriatr Pharmacother, 9(6), pp.364~377 (2011)
- Hansten PD, "Drug interactions analysis and management" (2011), Wolters Kluwers Health
- Grizzle AJ, "Reasons provided by prescribers when overriding drug-drug interaction alerts", Am J Manag Care, 13, pp.573~578 (2007)
- 안은경, "Differences of Reasons for Alert Overrides on Contraindicated Co-prescriptions by Admitting Department", Healthcare Informatics Research, 20(4), pp.280~287 (2014), 대한의료정보학회[DOI]
- Ahearn MD, "General practitioners' perceptions of the pharmaceutical decision-support tools in their prescribing software", Med J Aust, 179(1), pp.34~37 (2003)
- Magnus D, "GPs' views on computerized drug interaction alerts: questionnaire survey", J Clin Pharm Ther, 27(5), pp.377~382 (2002)
- Glassman PA, "Improving recognition of drug interactions: benefits and barriers to using automated drug alerts", Med Care, 40(12), pp.1161~1171 (2002)