Strategy for establishing an effective Korean drug utilization review system

Drug utilization review (DUR) system has been defined as "structured, ongoing initiatives that interpret patterns of drug use in relation to predetermined criteria, and attempt to prevent or minimize inappropriate prescribing." This paper introduces the concept, purpose, and effective application of OUR in Korea. OUR can be classified as retrospective OUR, prospective OUR, and concurrent OUR based on the time direction of applying OUR. OUR can also be classified as quantitative DUR defined by retrospective OUR using databases including previously prescribed medicines, and qualitative DUR defined by OUR reflecting patient`s clinical condition. We described the history of developing OUR in the United States and the Europe. Finally current status of DUR in Korea is described and the strategy of future settlement of DUR system in Korea is suggested.KIM DS, 2010, HIRA POLICY TREND, V4, P14PARK JY, 2010, HIRA POLICY TREND, V4, P23*INT SOC PHARM, 2010, EUR DRUG UT RES GROUCHOI BC, 2009, HIRA POLICY TREND, V3, P11SHIN KS, 2009, HIRA POLICY TREND, V3, P22PARK BJ, 2008, J PHARMACOEPIDEMIOL, V1, P13Yeom JH, 2005, ANN PHARMACOTHER, V39, P1918, DOI 10.1345/aph.1E674HENNESSY S, 2005, PHARMACOEPIDEM DR S, P833PARK BJ, 1999, KOREAN J CLIN PHARM, V7, P3ERWIN WG, 1991, CLIN PHARMACOL THER, V50, P596

부산지역 의원급 외래 노인 골관절염환자의 비스테로이드성 소염제 사용양상평가

학위논문(석사)--서울대학교 대학원 :의학과 예방의학전공,2004.Maste

The association between antidepressant use and deaths from road traffic accidents: a case-crossover study

Purpose: Antidepressants are some of the most commonly used psychiatric medications, but little information is available about the effects of antidepressant treatment on the risk of traffic accidents across classes of antidepressants or associated with each substance individually. To investigate the relationship between exposure to antidepressants and risk of fatality in road traffic accidents. Methods: We used a Korean national road traffic authority database linked with a national health insurance database between January 1, 2010 and December 31, 2014 and applied a case-crossover design. The study subjects were drivers in South Korea who died from traffic accidents and who had prescriptions for antidepressants within 1 year prior to the date of the accident. We compared the status of prescription for antidepressants with the hazard period and four matched control periods using conditional logistic regression, adjusting for other drug use. The trends of antidepressant utilization were described in terms of the number of prescriptions. A case–case-time-control design was applied to drugs with an increasing trend in use and a significant case-crossover odds ratio (OR). Results: A total of 1250 antidepressant-using drivers were included, and an increased risk was observed during the 30-day hazard period (adjusted OR 1.30; 95% CI 1.03–1.63). Selective serotonin reuptake inhibitors (SSRIs) and serotonin–norepinephrine reuptake inhibitors (SNRIs) showed significant risks, but tricyclic antidepressants did not. However, the associations of all antidepressants, SSRIs, SNRIs, escitalopram, and duloxetine did not remain significant after adjusting for trends in utilization. Paroxetine and milnacipran were associated with increased risks, with no obvious increase in their utilization, but the possibility of confounding by indication could have affected the results for milnacipran. Conclusion: Considering the trends of antidepressant prescription and utilization, the use of paroxetine increased the risk of fatal traffic accidents. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature

AGE, SEX, AND TIME-SPECIFIC TRENDS IN SURGICAL APPROACHES FOR RHEGMATOGENOUS RETINAL DETACHMENT: A Nationwide, Population-Based Study Using the National Claim Registry

PURPOSE:: To investigate the primary surgical approach for rhegmatogenous retinal detachment (RRD) according to age group, sex, and year in Korea. METHODS:: We retrospectively identified patients from the national claims database who underwent primary surgery for RRD from 2007 to 2011 using the diagnostic code and surgical codes for RRD. Patients were categorized into three groups according to surgical treatment; scleral buckling, vitrectomy, and combined operation. We analyzed the frequency and proportion of primary surgical approach for RRD according to age group, sex, and year. RESULTS:: Of 24,928 RRD patients, 11,372 (45.6%) patients underwent scleral buckling, 10,583 (42.5%) patients underwent vitrectomy, and 2,973 (11.9%) underwent a combined operation. Regression analysis showed that relative proportion of surgical approach had linear relationship with age; the percentage of patients undergoing vitrectomy increased by an average of 7.55% every 10 years (P < 0.001). This age-related trend was observed for both sexes. Scleral buckling tended to be preferred in younger patients (<45 years) and vitrectomy in older patients (≥45 years). Men tended to undergo vitrectomy significantly more than women in patients aged 15 years to 34 years. There was no consistent trend over time in the primary surgical approach during the study period. CONCLUSION:: Age and sex of RRD patients influence the selection of primary surgical approaches. Young patients tend to undergo scleral buckling, whereas older patients tend to receive vitrectomy. Among young patients, men are more likely to undergo vitrectomy than women. No discernible trend over time was observed in the surgical approach over the 5-year study period. © 2017 by Ophthalmic Communications Society, Inc

Prevalence of extraintestinal manifestations in Korean inflammatory bowel disease patients

Background The prevalence of inflammatory bowel disease (IBD) in South Korea is increasing. Although extraintestinal manifestations (EIMs) are an important factor in the clinical outcomes of IBD patients, EIMs have not yet been investigated in Korea. Thus, we conducted a cross-sectional study to assess the prevalence of EIMs in Korean IBD patients. Methods The 2014 claims data from the National Health Insurance System (NHIS) of Korea were used. IBD patients were identified by codes for Crohn disease (CD) and ulcerative colitis (UC) in the NHIS registration system for rare or intractable diseases. International Classification of Diseases, Tenth Edition codes were used to identify EIM cases. To estimate the prevalence of EIMs in the general population of Korea, we used national sample data. Standardized prevalence ratios (SPRs) were calculated to compare the prevalence rates of EIMs among IBD patients to those among the general population of Korea. Results A total of 13,925 CD patients and 29,356 UC patients were identified. CD and UC patients were different in terms of demographics and utilization of medication. Among the 17 EIMs investigated, pyoderma gangrenosum, osteomalacia, Sweet syndrome, and scleritis were observed in very few patients. The SPRs were greater than 1 for all EIMs. Aphthous stomatitis, rheumatoid arthritis, and osteoporosis were highly prevalent in both CD and UC patients, but the SPRs of the EIMs were not high. Conclusion The study confirmed that EIMs are more prevalent among IBD patients than among the general population of Korea. The prevalence of EIMs in IBD patients suggests the need for greater attention and effort in clinical practice. © 2018 Yang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Impact of Malaria in Pregnancy on Risk of Malaria in Young Children: Systematic Review and Meta-Analyses

Background. Our objective was to quantify the risk of acquiring malaria among progeny of women with malaria during pregnancy. Methods. We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Library for eligible prospective studies. The primary predictor was malaria during pregnancy defined as placental malaria, parasitemia, clinical malaria, or pregnancy-associated malaria. Primary outcomes were parasitemia or clinically defined malaria of young children. We performed meta-analyses to pool adjusted risk estimates using a random-effects model. Results. Nineteen of 2053 eligible studies met inclusion criteria for the systemic review. Eleven of these studies were quantitative and were included in the meta-analyses. The pooled adjusted odds ratio (aOR) or adjusted hazard ratio (aHR) of malaria during pregnancy for detection of parasitemia in young children were 1.94 (95% confidence interval [CI], 0.93-4.07; P = .08) and 1.46 (95% CI, 1.07-2.00; P < .001), respectively. The pooled aOR or aHR for clinically defined malaria in young children were 2.82 (95% CI, 1.82-4.38; P < .001) and 1.31 (95% CI, 0.96-1.79; P = .09), respectively. Conclusions. Our results confirmed that malaria during pregnancy significantly increased the overall risk of malaria in young children via indeterminate mechanisms and emphasize the urgent need to implement safe and highly effective strategies to prevent malaria during pregnancy

Hepatitis virus infection and age-related cataract

This study was performed to investigate the relationships of hepatitis B (HBV) and hepatitis C virus (HCV) infection to age-related cataract, and to assess whether liver damage mediates the hepatitis-cataract association. This study analyzed data in the Korea National Health and Nutrition Examination Survey 2010-2012 on 10,037 participants aged ≥40 years. We performed mediation analysis to address the contribution of serum markers of liver damage, high aspartate (AST, >49.9 IU/L) and alanine aminotransferase (ALT, >56.1 IU/L), to the relationships of HBV and HCV infection to cataract. Odds ratios (ORs) for nuclear and any cataract with HBV infection were 1.09 [95% confidence interval (95CI) = 1.02-1.16] and 1.07 (95CI = 1.00-1.14), respectively, compared to HBV uninfection; ORs with HCV infection were 1.35 (95CI = 1.18-1.55) and 1.40 (95CI = 1.12-1.76), respectively. High AST completely mediated the HBV infection-any cataract association. The significant relationships of HCV infection with nuclear and any cataract were formed only by their direct effects, not by mediation effects of high AST or ALT. HBV and HCV infection was significantly associated with nuclear and any cataract. High AST significantly mediates the effects of HBV infections on any cataract outcome, but the associations of HCV infection with nuclear and any cataract were not mediated by high AST or ALT. © 2017 The Author(s)

(A)Novel pharmacovigilance index for detecting signals of adverse drug reaction using health insurance claims database

학위논문(박사)--서울대학교 대학원 :의학과 예방의학전공,2007.Docto

Proton pump inhibitors and risk of Clostridium difficile infection: a multi-country study using sequence symmetry analysis

Objective: To determine the association between incident proton pump inhibitor (PPI) use and Clostridium difficile infections across multiple countries Method: National data covering the total population in Australia and Korea, the Canadian population over 65 years and a 3 million person random sample data set from Taiwan were assessed, as were data from a worker insurance population and a hospital inpatient/outpatient population in Japan. Sequence symmetry analysis was used to assess the association with oral vancomycin dispensing as the outcome of interest. Results: 54,957 patients were included. Positive associations were observed in Australia; adjusted sequence ratio (ASR) 2.48 (95% CI 1.90, 3.12), Korea ASR 2.15 (95% CI 2.11, 2.19), Canada ASR 1.45 (95% CI 1.16, 1.79), Japan hospital dataset ASR 3.21 (95% CI 2.12, 4.55) and Japan worker insurance dataset ASR 5.40 (95% CI 2.73, 8.75). The pooled result was ASR 2.40 (95% CI 1.88, 3.05) and 3.16 (95% CI 1.95, 5.10) when limited to Japan, Korean and Taiwan. Results did not vary by individual PPI. The temporal analysis showed effects within the first two weeks of PPI initiation. Conclusion: Our study confirms the association between PPI initiation and C. difficile infections across countries in the Asia-Pacific region

A Systematic Review of the National Breast Implant Registry for Application in Korea: Can We Predict "Unpredictable" Complications?

Background and Objectives:Since silicone breast implants were introduced to the market several decades ago, the safety of breast implants has remained controversial. Recently, several studies have explored breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) and breast implant illness (BII). Several countries have developed national breast implant registries to improve the safety and quality of breast implant surgery. We performed a systematic review of the current status of national breast implant registries and propose a pilot form of an appropriate breast implant registry model for Korea.Materials and Methods:The systematic review was conducted in accordance with the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) pro forma". PubMed and Google Scholar databases were searched to identify all articles containing information on national breast implant registries. We limited the search to articles written in the English language from 2010 to 2020. Articles were reviewed by two independent authors.Results:A total of 63 articles related to national breast implant registries, registry principles and national breast implant registry annual reports were identified. After reviewing the literature, 25 national breast implant registry-related articles were included in the full-text synthesis. Currently, four countries, The Netherlands, Australia, Sweden, and the UK, have breast implant registries with well-formed sources for big data. Overall, similarities in data points were detected for three categories: implant-related complications, operation details, and device information. However, there were differences for each registry in terms of governance, funding, and capture rate.Conclusion:After reviewing other countries' experiences, tentative datasets for the Korean Breast Implant Registry (K-BIR) were developed. The K-BIR can improve the quality of breast implant surgery in Korea by providing datasets on overall processes and outcome measures with quality indicators and risk adjustment factors. This approach will register characteristics of patients and monitor breast implants, complications, and surgical procedures to improve the outcomes of breast implant surgery in Korea. In addition, it can be used as a track-and-trace system with automated notifications to patients in the event of a product recall or other safety concerns related to a specific type of implant. Background and Objectives:Since silicone breast implants were introduced to the market several decades ago, the safety of breast implants has remained controversial. Recently, several studies have explored breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL) and breast implant illness (BII). Several countries have developed national breast implant registries to improve the safety and quality of breast implant surgery. We performed a systematic review of the current status of national breast implant registries and propose a pilot form of an appropriate breast implant registry model for Korea.Materials and Methods:The systematic review was conducted in accordance with the "preferred reporting items for systematic reviews and meta-analyses (PRISMA) pro forma". PubMed and Google Scholar databases were searched to identify all articles containing information on national breast implant registries. We limited the search to articles written in the English language from 2010 to 2020. Articles were reviewed by two independent authors. Results:A total of 63 articles related to national breast implant registries, registry principles and national breast implant registry annual reports were identified. After reviewing the literature, 25 national breast implant registry-related articles were included in the full-text synthesis. Currently, four countries, The Netherlands, Australia, Sweden, and the UK, have breast implant registries with well-formed sources for big data. Overall, similarities in data points were detected for three categories: implant-related complications, operation details, and device information. However, there were differences for each registry in terms of governance, funding, and capture rate.Conclusion:After reviewing other countries' experiences, tentative datasets for the Korean Breast Implant Registry (K-BIR) were developed. The K-BIR can improve the quality of breast implant surgery in Korea by providing datasets on overall processes and outcome measures with quality indicators and risk adjustment factors. This approach will register characteristics of patients and monitor breast implants, complications, and surgical procedures to improve the outcomes of breast implant surgery in Korea. In addition, it can be used as a track-and-trace system with automated notifications to patients in the event of a product recall or other safety concerns related to a specific type of implant