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Kim DS, Je NK, Park J, Lee S. Effect of nationwide concurrent drug utilization review program on drug-drug interactions and related health outcome. Int J Qual Health Care 2021; 33:6353545. [PMID: 34402911 DOI: 10.1093/intqhc/mzab118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND A computerized drug utilization review (DUR) program has provided physicians and pharmacists with alerts on drug-drug interactions (DDIs), drug-age precautions and therapeutic duplication in Korea since 2010. OBJECTIVE The purpose of this study was to evaluate the impact of the DUR program on health outcomes associated with DDIs. METHODS An uncontrolled before-after study was performed to investigate the impact of the nationwide DUR program on DDIs and related health outcomes. The study population consisted of people who used two types of DDI pairs before DUR implementation (from January 2009 to December 2010) and post-DUR implementation (from January 2012 to December 2013); (i) benzodiazepines with concurrent use of metabolic enzyme inhibitors and (ii) QTc (heart-rate corrected QT interval) prolongation agents. The main outcome measures were all-cause and cause-specific hospitalization admissions or emergency department (ED) visits. RESULTS This study included 107 874 people who used benzodiazepines with enzyme inhibitors and 8489 who received co-medication of QTc prolongation agents. For patients receiving a combination of benzodiazepines and enzyme inhibitors, both all-cause hospitalization and cause-specific hospitalization decreased after DUR implementation, from 43.2% to 41.7% and from 4.6% to 4.5% (adjusted odds ratio [OR] = 0.96; 95% confidence interval (CI), 0.93-0.98; OR = 0.89, 95% CI = 0.84-0.99, respectively). For patients receiving co-medication of QTc prolongation agents, all-cause hospitalization (54.2%) was lower than before (54.9%) (OR = 0.87, 95% CI = 0.79-0.96), but no significant change was found for cause-specific hospitalization and ED visits. CONCLUSION Implementation of a DUR program may reduce the adverse health outcomes posed by DDIs in patients on combination of benzodiazepines and enzyme inhibitors potentially QTc-prolongation agents.
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Affiliation(s)
- Dong-Sook Kim
- Department of Research, Health Insurance Review and Assessment Service, HyeoksinRo 60, Wonju 26465, South Korea
| | - Nam Kyung Je
- College of Pharmacy, Pusan National University, Pusandaehakro 63Gil 2, Busan 14624, South Korea
| | - Juhee Park
- Department of Research, Health Insurance Review and Assessment Service, HyeoksinRo 60, Wonju 26465, South Korea
| | - Sukhyang Lee
- College of Pharmacy, Ajou University, WorldcupRo 206, Suwon 16499, South Korea
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Kim S, Kim E, Suh HS. Cost-Effectiveness of an Opioid Abuse-Prevention Program Using the Narcotics Information Management System in South Korea. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:174-181. [PMID: 33518023 DOI: 10.1016/j.jval.2020.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 12/01/2020] [Accepted: 12/08/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of an opioid abuse-prevention program embedded in the Narcotics Information Management System ("the Network System to Prevent Doctor-Shopping for Narcotics") in South Korea. METHODS Using a Markov model with a 1-year cycle length and 30-year time horizon, we estimated the incremental cost-utility ratio (ICUR) of implementing an opioid abuse-prevention program in patients prescribed outpatient opioids from a Korean healthcare payer's perspective. The model has 6 health states: no opioid use, therapeutic opioid use, opioid abuse, overdose, overdose death, and all-cause death. Patient characteristics, healthcare costs, and transition probabilities were estimated from national population-based data and published literature. Age- and sex-specific utilities of the general Korean population were used for the no-use state, whereas the other health-state utilities were obtained from published studies. Costs (in 2019 US dollars) included the expenses of the program, opioids, and overdoses. An annual 5% discount rate was applied to the costs and quality-adjusted life-years (QALYs). Parameter uncertainties were explored via deterministic and probabilistic sensitivity analyses. RESULTS The program was associated with 2.27 fewer overdoses per 100 000 person-years, with an ICUR of $227/QALY. The ICURs were generally robust to parameter changes, although the program's effect on abuse reduction was the most influential parameter. Probabilistic sensitivity analysis showed that the program reached a 100% probability of cost-effectiveness at a willingness-to-pay threshold of $900/QALY. CONCLUSIONS The opioid abuse-prevention program appears to be cost-effective in South Korea. Mandatory use of the program should be considered to maximize clinical and economic benefits of the program.
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Affiliation(s)
- Siin Kim
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Eunji Kim
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Hae Sun Suh
- College of Pharmacy, Pusan National University, Busan, South Korea.
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Kim Y, Paik M, Khan C, Kim YJ, Kim E. Real-world safety evaluation of musculoskeletal adverse events associated with Korean pediatric fluoroquinolone use: a nationwide longitudinal retrospective cohort study. Sci Rep 2019; 9:20156. [PMID: 31882917 PMCID: PMC6934562 DOI: 10.1038/s41598-019-56815-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022] Open
Abstract
Though the pediatric use of fluoroquinolones (FQs) is limited for musculoskeletal safety concerns, the clinical usefulness still exists. This study examined the association between FQs and musculoskeletal adverse events (AEs) as well as the possible risk factors associated with the pediatric FQs uses. This population-based, longitudinal, retrospective study was conducted using Korean National Sample Cohort database originating between 2002 and 2015. An FQ-treated pediatric cohort (<18 years old) was compared to a control treated with amoxicillin. Propensity score matching (PSM) and a Cox proportional hazard model was used to estimate the hazard ratio (HR) for a diagnosis of musculoskeletal AEs within 60 days of the first prescription. Among one million participants, total of 15,706 and 147,840 children were eligible for the FQ and amoxicillin cohorts, respectively. The PSM cohorts showed a slightly increased risk of musculoskeletal AEs after FQ treatment (HR, 1.19; 95% confidence interval, 1.01–1.40; p = 0.042). This association was stronger in males, older patients, and some FQs users. This study indicates that pediatric FQ use is associated with a risk of musculoskeletal AEs and that FQ use should be carefully monitored in groups with certain risk factors. Well-designed pragmatic trials could be expected to clarify these issues.
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Affiliation(s)
- Yoonhye Kim
- Clinical Data Analysis, Evidence based clinical research Lab., Departments of Health Science & Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Minwoo Paik
- Clinical Data Analysis, Evidence based clinical research Lab., Departments of Health Science & Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Chanjoo Khan
- Department of Pharmaceutical Industry, Chung-Ang University, Seoul, 06974, Republic of Korea
| | - Yae-Jean Kim
- Department of Paediatrics, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, 06351, Republic of Korea
| | - EunYoung Kim
- Clinical Data Analysis, Evidence based clinical research Lab., Departments of Health Science & Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, 06974, Republic of Korea. .,Department of Pharmaceutical Industry, Chung-Ang University, Seoul, 06974, Republic of Korea.
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Toward safer prescribing: evaluation of a prospective drug utilization review system on inappropriate prescriptions, prescribing patterns, and adverse drug events and related health expenditure in South Korea. Public Health 2018; 163:128-136. [PMID: 30145461 DOI: 10.1016/j.puhe.2018.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 04/05/2018] [Accepted: 06/01/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study aimed to evaluate the effect of the prospective drug utilization review (DUR) system introduced in Korea in December 2010 as a real-time method to improve patient safety, in terms of changes in prescribing practices, adverse drug events (ADEs), and ADE-related healthcare expenditure, using non-steroidal anti-inflammatory drugs (NSAIDs) and their common ADEs as a guide. STUDY DESIGN We used an interrupted time-series study design using generalized estimating equations to evaluate changes in prescription rate and ADE-related healthcare expenditure. Cox regression analysis was used to evaluate the probability of NSAID-associated ADEs. METHODS A total of 154,585 outpatients with musculoskeletal or connective tissue disorders, without pre-existing gastric bleeding or ulcers were included in this study. The primary outcome was the level and trend change in prescription rate, drug-drug interactions, coprescribed gastro-protective drugs, and defined daily dose (DDD) of NSAIDs. The secondary outcome was the probability of ADEs and changes in ADE-related healthcare expenditure. RESULTS There was a significant trend change after introducing the DUR system in terms of drug-drug interactions (-3.6%) and coprescribed gastro-protective drugs (+0.6%). The mean DDD of NSAIDs increased by 0.2. The probability of ADEs decreased overall (-1.7%) and in the high-risk group (age ≥65 years; -9.6%); however, only the latter was significant. There was no significant trend or level change in ADE-related health expenditure. CONCLUSIONS The introduction of the DUR system was associated with more efficient prescribing, including a reduction in drug-drug interactions and an increase in the use of gastro-protective drugs. The system had a positive effect on patient outcome but was not associated with reduced ADE-related costs. Further studies are needed to evaluate the long-term effects of the DUR system in Korea.
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Lee J, Noh Y, Lee S. Evaluation of preventable adverse drug reactions by implementation of the nationwide network of prospective drug utilization review program in Korea. PLoS One 2018; 13:e0195434. [PMID: 29641617 PMCID: PMC5895028 DOI: 10.1371/journal.pone.0195434] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 03/22/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND A prospective Drug Utilization Review (DUR) program has been implemented in Korea to improve the quality and safety of medication use. OBJECTIVE To evaluate the influence of the DUR program in reducing incidence of preventable adverse drug reactions (pADRs). METHODS This study was performed using administrative data from the Health Insurance Review and Assessment Service (HIRA). The claims data for all adult patients with adverse drug events (ADE)-related diagnoses from 2009 to 2014 were obtained. Incidence rates of first-time and repeat pADRs prior to and after DUR program implementation were evaluated. Quarterly trends in incidence rates of overall ADE, allergic reactions, and ADRs were analyzed. RESULTS Data extraction covering the period from 2009 to 2014 led to the identification of 3,927,662 records. First-time pADR rates decreased gradually after implementation of the DUR program (change in slope: -0.016, p = 0.02). The program had a similar influence on repeat pADR rates (change in slope: -0.006, p≤0.01). The program did not decrease rates of first-time or repeat allergic reactions (change in slope: 0.018, p = 0.07 and 0.003, p = 0.04, respectively). In the cohort aged ≤65 years, first-time pADR rate reduction was significant (28.2% [27.1-29.3] in ≤18 years, and 19.8% [18.1-21.5] in 19-64 years). In contrast, first-time pADR rate was increased by 0.6% [-0.7-1.9] in patients ≥65 years. CONCLUSION Implementation of the prospective DUR program effectively reduced the number of pADRs. In the future, to reduce non-preventable ADRs such as allergic reactions, provision of clinical information including allergy history should be added to the DUR program.
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Affiliation(s)
- Jimin Lee
- College of Pharmacy, Ajou University, Suwon, South Korea
| | - Yoojin Noh
- College of Pharmacy, Ajou University, Suwon, South Korea
| | - Sukhyang Lee
- College of Pharmacy, Ajou University, Suwon, South Korea
- * E-mail:
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Lee SM, Lee SO, Kim DS. Physicians’ and pharmacists’ perceptions on real-time drug utilization review system: a nationwide survey. Int J Qual Health Care 2017; 29:634-641. [DOI: 10.1093/intqhc/mzx085] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 07/03/2017] [Indexed: 11/14/2022] Open
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Hwang SH, Han S, Choi H, Park C, Kim SM, Kim TH. Trends in the prescription of benzodiazepines for the elderly in Korea. BMC Psychiatry 2017; 17:303. [PMID: 28830488 PMCID: PMC5567896 DOI: 10.1186/s12888-017-1467-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This study examined trends in the prescription of benzodiazepines for the elderly (age over 65 years) in Korea, a country with a higher level of spending on pharmaceuticals compared to that in other Organization for Economic Cooperation and Development (OECD) countries, and identified factors related to the inappropriate use of such drugs. METHODS We used the National Health Insurance Claims Data (NHICD) for the period 2009-2013, including all reimbursed drug-prescribing information. Following the OECD's prescribing quality indicators (PQIs), we looked at the prevalence, quantities, durations, and inappropriate (long-term or high-quantity) use of benzodiazepines, some of the most widely prescribed, but potentially inappropriate, drugs for the elderly. We also performed multivariate logistic regression analyses to identify factors related to the inappropriate use of these drugs. RESULTS The annual prevalence of benzodiazepine prescribing for elderly subjects decreased slightly over time but remained high (37.9% in 2009 and 35.1% in 2013). There were also small decreases in the inappropriate long-term use of benzodiazepines over the five years, with a 0.6 decrease in the Defined Daily Dose and a 4.1 per 1,000 decreases in elderly user-days. The proportion of subjects using long-acting benzodiazepines also fell from 263.6 to 220.4 per 1,000 elderly patients. The regression analyses found that the inappropriate long-term use of benzodiazepines in the elderly was significantly related to the patients visiting several institutions and physicians prescribing more than 30 days' worth of medication. CONCLUSIONS The prevalence of prescribing potentially inappropriate drugs, such as benzodiazepines, remains high in Korea. Policy efforts, such as a periodic assessment of prescribing, restricting prescribing days, and more practical guidelines, are needed to improve the quality of prescribing.
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Affiliation(s)
- Soo-Hee Hwang
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Seungjin Han
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Hyojung Choi
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Choonseon Park
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Sun Min Kim
- 0000 0004 0647 5429grid.467842.bHealth Insurance Review and Assessment Service (HIRA), Wonju, Republic of Korea
| | - Tae Hyun Kim
- Department of Hospital Administration, Graduate School of Public Health, Institute of Health Services Research, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, 03711, Seoul, Republic of Korea.
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Song I, Shin HN, Shin JY. Decrease in use of contraindicated drugs with automated alerts in children. Pediatr Int 2017; 59:720-726. [PMID: 28177180 DOI: 10.1111/ped.13258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 12/05/2016] [Accepted: 02/03/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study evaluated changes in the use of contraindicated drugs in the pediatric population, via automated alerts through the nationwide drug utilization review. METHODS We conducted an interrupted time series analysis using the nationwide health insurance database. Study drugs consisted of a total of 72 drugs in 22 classes that were designated as age contraindicated between January 2007 and December 2011. The subjects consisted of the patients in Korea who had been prescribed with any of the study drugs at least once. Changes in the use of age-contraindicated drugs after the regulatory action were estimated as relative and absolute reductions with 95% CI. Regression analysis was carried out based on the monthly number of users prior to the announcement of age-contraindicated drugs on 3 December 2009 to estimate the predicted values, and these were then compared with the observed values after the announcement. RESULTS A total of 2 541 888 patients were prescribed age-contraindicated drugs at least once. The percentage of age-contraindicated drug users was 2.10% of the total users (n = 3 309 566) during the period prior to the 2009 regulatory action, but it decreased to 0.30% (n = 542 529) after the action. Overall, there was an 85.71% relative reduction (95% CI: 71.53-102.72) in the percentage of age-contraindicated drug users. The projected monthly number of users of age-contraindicated drugs showed a gradual downward trend. CONCLUSION Decreases in contraindicated drugs have accelerated after a regulatory action with automated alerts.
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Affiliation(s)
- Inmyung Song
- Division of Risk Assessment and International Cooperation, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Han Na Shin
- Korea Health Insurance Review and Assessment Service, Review and Assessment Research Institute, Gangwon, Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, Korea
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Pediatric fluoroquinolone prescription in South Korea before and after a regulatory intervention: A nationwide study, 2007-2015. PLoS One 2017; 12:e0176420. [PMID: 28520738 PMCID: PMC5435163 DOI: 10.1371/journal.pone.0176420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/10/2017] [Indexed: 11/19/2022] Open
Abstract
Objective To investigate the impact of national implementation of age restriction on fluoroquinolone prescription in children and adolescents. Methods Data collected from the database of Health Insurance Review and Assessment Service in South Korea, a national health insurance system to analyze fluoroquinolone prescribing practice in children and adolescents younger than 18 years, between 2007 and 2015. The age restriction was implemented in December 2009. The annual prescription rate of FQ per 100,000 person-years was calculated and an autoregressive model was used to predict the prescription pattern if an intervention had not occurred. Results A total of 505,859 children received systemic fluoroquinolone during the study period—297,054 ciprofloxacin, and 208,805 levofloxacin. After implementation of the drug utilization review program, the annual prescription rate for ciprofloxacin declined by 97.5% (from 840 to 21 per 100,000 person-years, P < 0.001), and for levofloxacin by 96.4% (from 598 to 11 per 100,000 person-years, P < 0.001). The decline was more dramatic in the outpatient setting than in the inpatient setting for both drugs. Conclusion The dramatic and sustained decline in prescription number and change in prescription pattern after the regulatory action suggests that the implementation under drug utilization review program was successful in controlling excessive and inappropriate use of fluoroquinolones in children, possibly guiding towards more judicious and selective prescription behavior.
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Kim JA, Yoon S, Kim LY, Kim DS. Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data. J Korean Med Sci 2017; 32:718-728. [PMID: 28378543 PMCID: PMC5383602 DOI: 10.3346/jkms.2017.32.5.718] [Citation(s) in RCA: 455] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/28/2017] [Indexed: 11/20/2022] Open
Abstract
Health Insurance and Review Assessment (HIRA) in South Korea, also called National Health Insurance (NHI) data, is a repository of claims data collected in the process of reimbursing healthcare providers. Under the universal coverage system, having fee-for-services covering all citizens in South Korea, HIRA contains comprehensive and rich information pertaining to healthcare services such as treatments, pharmaceuticals, procedures, and diagnoses for almost 50 million beneficiaries. This corpus of HIRA data, which constitutes a large repository of data in the healthcare sector, has enormous potential to create value in several ways: enhancing the efficiency of the healthcare delivery system without compromising quality of care; adding supporting evidence for a given intervention; and providing the information needed to prevent (or monitor) adverse events. In order to actualize this potential, HIRA data need to actively be utilized for research. Thus understanding this data would greatly enhance this potential. We introduce HIRA data as an important source for health research and provide guidelines for researchers who are currently utilizing HIRA, or interested in doing so, to answer their research questions. We present the characteristics and structure of HIRA data. We discuss strengths and limitations that should be considered in conducting research with HIRA data and suggest strategies for optimal utilization of HIRA data by reviewing published research using HIRA data.
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Affiliation(s)
- Jee Ae Kim
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Seokjun Yoon
- Department of Preventive Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Log Young Kim
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Dong Sook Kim
- Pharmaceutical Policy Research Team, Health Insurance Review & Assessment Service, Wonju, Korea.
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Kang HA, Lee SM, Park C, Kim DS. Prevalence and predictors of non-steroidal anti-inflammatory drug/analgesic therapeutic duplication in the South Korean ambulatory care setting. Eur J Clin Pharmacol 2015; 72:109-16. [DOI: 10.1007/s00228-015-1958-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 09/22/2015] [Indexed: 11/30/2022]
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Cho I, Lee JH, Choi SK, Choi JW, Hwang H, Bates DW. Acceptability and feasibility of the Leapfrog computerized physician order entry evaluation tool for hospitals outside the United States. Int J Med Inform 2015; 84:694-701. [PMID: 26049311 DOI: 10.1016/j.ijmedinf.2015.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 05/16/2015] [Accepted: 05/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Computerized physician order entry (CPOE) with clinical decision support is expected to deliver many benefits in terms of patient safety. The Leapfrog tool was developed to allow hospitals to assess their medication-safety related decision support. To explore the approach's generalizability, we examined its acceptability and feasibility through an evaluation using this tool in four Korean hospital systems. METHODS Four hospitals with locally developed CPOE systems participated, and a cross-sectional study design was used with the approval of the Leapfrog Group and the institutional review board at each hospital site. The hospitals were tertiary and academic institutions with long experience of advanced CPOE. From January 21 to 28, 2014, web-based tests were conducted at each site following the given instructions, and the results were self-reported. We measured each system's response rate, category completion rate, and time to complete the evaluation. Additionally, we compared the evaluation results of the four systems with scores from five US systems, as was reported in another study. RESULTS The four systems underwent the tests, and the overall category completion rates ranged from 67.9% to 75.5%. The times to finish the tests were tolerable and within the allowed test timeframe. One system did not pass the deception analysis, which checks for false positives, due to a conflict with another type of alert checking for the presence of a medical diagnosis for documentation purposes. The other three systems scored at the completed the evaluation stage, with scores ranging from 21.6% to 36.5%. Of the nine error categories, Drug-Allergy was an area of strength for all systems, whereas the categories of Therapeutic duplication, Drug-Labs, and Drug-Age were areas of weakness for all. In comparison with the US systems, gaps were identified, and further improvement is needed. CONCLUSIONS The acceptability of the CPOE evaluation tool was moderate, but the feasibility was sufficient to operate the test outside the US, and the results revealed many opportunities for improvement in the Korean systems, as was the case when this application was introduced in the US.
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Affiliation(s)
- Insook Cho
- Nursing Department, Inha University, Incheon, South Korea; The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jae-Ho Lee
- The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - Sun-Keun Choi
- Department of Surgery, Inha University School of Medicine, Incheon, South Korea
| | - Jin-Wook Choi
- Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, South Korea
| | - Hee Hwang
- Center for Medical Informatics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - David W Bates
- The Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Partners Healthcare Systems, Inc., Wellesley, MA, USA
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Cho I, Park H, Choi YJ, Hwang MH, Bates DW. Understanding the nature of medication errors in an ICU with a computerized physician order entry system. PLoS One 2014; 9:e114243. [PMID: 25526059 PMCID: PMC4272266 DOI: 10.1371/journal.pone.0114243] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 11/05/2014] [Indexed: 11/19/2022] Open
Abstract
Objectives We investigated incidence rates to understand the nature of medication errors potentially introduced by utilizing a computerized physician order entry (CPOE) system in the three clinical phases of the medication process: prescription, administration, and documentation. Methods Overt observations and chart reviews were employed at two surgical intensive care units of a 950-bed tertiary teaching hospital. Ten categories of high-risk drugs prescribed over a four-month period were noted and reviewed. Error definition and classifications were adapted from previous studies for use in the present research. Incidences of medication errors in the three phases of the medication process were analyzed. In addition, nurses' responses to prescription errors were also assessed. Results Of the 534 prescriptions issued, 286 (53.6%) included at least one error. The proportion of errors was 19.0% (58) of the 306 drug administrations, of which two-thirds were verbal orders classified as errors due to incorrectly entered prescriptions. Documentation errors occurred in 205 (82.7%) of 248 correctly performed administrations. When tracking incorrectly entered prescriptions, 93% of the errors were intercepted by nurses, but two-thirds of them were recorded as prescribed rather than administered. Conclusion The number of errors occurring at each phase of the medication process was relatively high, despite long experience with a CPOE system. The main causes of administration errors and documentation errors were prescription errors and verbal order processes. To reduce these errors, hospital-level and unit-level efforts toward a better system are needed.
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Affiliation(s)
- Insook Cho
- Department of Nursing, Inha University, Incheon, Republic of Korea
- Harvard Medical School, Boston, MA, United States of America
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States of America
- * E-mail:
| | - Hyeok Park
- Department of Nursing, Inha University Hospital, Incheon, Republic of Korea
| | - Youn Jeong Choi
- Department of Nursing, Inha University, Incheon, Republic of Korea
- Department of Nursing, Inha University Hospital, Incheon, Republic of Korea
| | - Mi Heui Hwang
- Department of Nursing, Inha University, Incheon, Republic of Korea
- Department of Nursing, Inha University Hospital, Incheon, Republic of Korea
| | - David W. Bates
- Harvard Medical School, Boston, MA, United States of America
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, United States of America
- Partners Healthcare Systems, Inc., Wellesley, MA, United States of America
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