In older people, medicines are considered appropriate when they have an evidence-based indication, are well-tolerated and cost-effective. However, inappropriate prescribing (IP) is a common and significant healthcare problem in elderly people in Korea as well as in the world. IP in old people is highly prevalent but preventable. Screening for IP is highly desirable, since detection and correction are simple and worthwhile. Until now, Beers' criteria for IP dominate the international literatures, although they have some defects. The 2002 version of Beers' criteriaindependent of diagnosis includes 48 different categories of either single medications or multiple medications of a similar class identified as IP, and the 2002 version of Beers' criteria-considering diagnosis contains 19 different categories containing possible drug-disease interaction. Successful approaches to optimizing prescribing have been either educational or administrative. More research specially focused on the IP in the elderly is needed.
Aged ; Delivery of Health Care ; Humans ; Inappropriate Prescribing ; Korea ; Mass Screening

BACKGROUND: If two or more doctors prescribe for one patient, each doctor must be careful to minimize the number of drugs and the frequency of admistration, and also be careful to avoid duplicating drugs. The purpose of this study is to evaluate the appropriateness of prescription for the patient who visits two or more doctors. METHODS: In a tertiary hospital, outpatients who received prescriptions simultaneously from two or more doctors were selected, and the number of drugs, the frequency of admistration and duplication of drugs were evaluated. RESULTS: The number of eligible patients was 887. The number of drugs was 5.2 for patients who visited 2 doctors, and 8.1 for patients who visited 3 doctors. 13% of patients who visited 2 doctors received more than 8 drugs, and 32.6% of patients who visited 3 doctors received more than 10 drugs. The frequency of administration per day was 3.7 for patients who visited 2 doctors, and 5.0 for patients who visited 3 doctors. 12% of patients who visited 2 doctors had to take drug more than 6 times a day and 9.3% of patients who visited 3 doctors had to take drug more than 8 times a day. 9.2% of total patients received duplicated drugs. The duplication of drugs was more frequent among patients who visited 2 doctors than who visited 3 doctors. CONCLUSIONS: For the patients who visited two or more doctors, the number of drugs and frequency of admistration was inappropriate and duplication of drugs was found, therefore the doctors should make more efforts to avoid inappropriate prescription.
Drug Prescriptions* ; Humans ; Inappropriate Prescribing ; Outpatients ; Prescriptions ; Tertiary Care Centers

BACKGROUND: The American Geriatric Society released the 2012 updated version of the Beers criteria with intentions to improve care of older adults by reducing their exposure to potentially inappropriate medications (PIMs). However, there have been no reports on the prevalence of PIMs prescriptions according to the 2012 version of Beers criteria in South Korea. METHODS: This is a retrospective study using medical records and code analysis of each PIM to survey the prevalence of PIMs prescriptions and common PIMs used for elderly patients. Locating the PIMs was carried out in all outpatients who visited Asan Medical Center from May 2012 to April 2013. Selection of PIMs was based on the 2012 updated version of the Beers criteria. RESULTS: A total of 652,192 outpatients older than 65 years visited our medical center during the study period and were analyzed. Among them, 33,810 (5.19%) received at least one PIM and 125,498 cases of PIM prescriptions were written. The percentage of the patients who received at least two kinds of PIMs concurrently was 33.14%. Common PIMs were tramadol (24.15%), clonazepam(11.51%), ibuprofen (10.02%), megesterol (9.80%), and amitriptyline (9.51%). CONCLUSION: Our study investigated the prevalence of PIMs prescription for Korean elderly outpatients in a single tertiary medical center. Compared to previous reports using the older version of the Beers criteria, our study showed a change in the priority of common PIMs.
Adult ; Aged ; Amitriptyline ; Beer ; Humans ; Ibuprofen ; Inappropriate Prescribing ; Intention ; Medical Records ; Outpatients ; Polypharmacy ; Prescriptions ; Prevalence ; Republic of Korea ; Retrospective Studies ; Tramadol

BACKGROUND: Prescribing potentially harmful drugs and omitting essential drugs to older patients is a common problem because they take so many medications. In this study, our goal was to identify potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) using Screening Tool of Older Persons' potentially inappropriate Prescriptions (STOPP) and Screening Tool to Alert doctors to the Right Treatment (START) criteria to improve proper prescription and reduce improper prescription. METHODS: Enrolled in this study were 117 patients older than 65 years old who were hospitalized at Inha University Hospital in Incheon due to pneumonia from January 2012 to March 2012. Patient data, including medical histories, current diagnoses, current medications, and biochemical data were recorded from electronic records. STOPP and START were applied to their clinical datasheets. RESULTS: STOPP criteria identified 24 patients who had 29 PIMs. Most potential inappropriate prescribing was of cardiovascular medications, followed by drugs whose primary effect is on the urogenital system and gastrointestinal system. START criteria identified 31 patients who had 46 PPOs. The cardiovascular system drugs comprised most of the PPOs. No PPOs were identified under the central nervous system criteria. CONCLUSION: Given the current Korean medical system conditions and considering the many clinically important situations when prescribing drugs, STOPP/START criteria are not absolute criteria to prevent improper prescription, but sagacious usage of these standards can help physicians to prescribe properly in clinical practice.
Cardiovascular System ; Central Nervous System ; Drugs, Essential ; Electronics ; Electrons ; Humans ; Inappropriate Prescribing ; Mass Screening ; Pneumonia ; Prescriptions ; Urogenital System

BACKGROUND: The elderly population is rapidly growing in numbers in Korea. According to the high prevalence of chronic disease in older persons, the issue of polypharmacy becomes one of the main problems in geriatric care. In this study, we tried to investigate the current status of inappropriate multiple drug prescriptions in older patients who were admitted to general hospital. METHODS: From July 1st 2010 to July 31th 2010, a total of 163 patients of 65 years of age or over who were admitted to one general hospital were investigated. Subjects were examined with a structured questionnaire survey. They were reviewed with medical records, and all medications taken by patients were analyzed. Inappropriate prescriptions were evaluated by Beers criteria and drug-drug interactions guidelines. RESULTS: Among the 163 participants, 146 patients took daily medication in the previous week, and the average numbers of pills taken by these patients were 7.95. 24 cases (16.4%) of inappropriate prescriptions were identified by Beers criteria, and 19 cases (13.0%) manifested a potential risk for drug-drug interaction. A total 7 cases (4.8%) of overlapping prescription of similar efficacy were also identified. Also, the risk of inappropriate prescription increased, when older patients visited 2 or more physicians (p<0.01). CONCLUSION: A considerable number of cases of prescriptions probable to cause adverse events in older patients were identified, which suggests physicians need to be thoughtful and alert for the harmful effects of polypharmacy, and the necessity of a well-structured drug monitoring system for older persons. A dedicated personal physician system for older patients should also be considered, to reduce inappropriate prescriptions.
Aged ; Beer ; Chronic Disease ; Drug Interactions ; Drug Monitoring ; Drug Prescriptions ; Hospitals, General ; Humans ; Inappropriate Prescribing ; Korea ; Medical Records ; Polypharmacy ; Prescriptions ; Prevalence ; Surveys and Questionnaires

There are serious problems concerning the inadequate prescription of antibiotics and overuse of injections in primary care. However, the determinants of prescription patterns in Korea are not well-documented. To examine the area characteristics affecting the prescription of antibiotics and injections in primary care practices in the treatment of respiratory tract infections (RTIs), a nationwide cross-sectional study was performed in all 250 administrative districts of Korea. The outcome was modeled as a binary variable: over-prescription or not compared with the nation-wide average. Over-prescription of antibiotics was associated with the ratio of specialists to general physicians and over-prescription in previous years in the area (adjusted odds ratio [aOR], 4.8; 95% confidence interval [CI] 1.5-14.8; and aOR, 12.0; 95% CI 5.5-25.9, respectively). Over-use of injections was associated with younger population, urban living and the number of hospital beds in the area (aOR, 0.2; 95% CI 0.1-0.4; aOR, 0.3; 95% CI 0.1-0.8; and aOR, 0.4, 95% CI 0.2-0.9; respectively). There were differences in the prescribing patterns in different districts; prescription patterns were affected more by supply factors than by demand factors. Highly competitive medical environment associated with supply factors is a significant determinant of prescription patterns in Korea.
Anti-Bacterial Agents/*therapeutic use ; Cross-Sectional Studies ; Female ; Hospitals ; Humans ; Inappropriate Prescribing ; Male ; Odds Ratio ; *Physician's Practice Patterns ; Primary Health Care ; Respiratory Tract Infections/drug therapy

Drug utilization review (DUR) is one of the approaches to improve quality of health care and reduce its costs. DUR programs have been defined as "structured, ongoing initiatives that interpret patterns of drug use in relation to predetermined criteria, attempting to prevent or to minimize inappropriate prescribing while maximizing the effectiveness of drug therapy to save costs." There have been a limited number of papers to evaluate the economic consequences of DUR programs, and they provide no definite evidence regarding the cost saving or costeffectiveness of the programs. A possible explanation for this would be that DUR might not be awarded a high priority, resulting in reduced opportunities for financing to DUR including development of a good program and its evaluation study. However, despite these problems, in Korea simple descriptive studies of drug utilization and the development of effective intervention strategies must start and continue in order to optimize drug therapy and to save costs in health care. Pharmacoeconomic studies are employed to measure drug efficiencies, through comparison of the costs and effects of alternative therapies. Theses studies can uncover the economics repercussions of inappropriate prescribing and quantify the cost effectiveness of various DUR interventions. The use of DUR in conjunction with pharmacoeconomic analysis will result in more costeffective and rational utilization of medicines. Both methods could be used in a complementary fashion. In conclusion, DUR processes will lead to the better utilization of drugs, based on improved economic and social performance.
Awards and Prizes ; Complementary Therapies ; Cost Savings ; Cost-Benefit Analysis ; Delivery of Health Care ; Drug Therapy ; Drug Utilization Review* ; Drug Utilization* ; Economics, Pharmaceutical ; Inappropriate Prescribing ; Korea ; Quality of Health Care

OBJECTIVE: The objectives of this study were 1) to evaluate the pattern of prescription for arthritis patients by pharmacists and the side effects caused by it before the introduction of the new medical system of "the separation of prescribing and dispensing drugs", and 2) to analyze the proportion of arthritis patients who were persuaded to purchase anti-arthritis medication by pharmacists and the pattern of purchase after the introduction of the system. METHODS: Before August 2000, 55 patients with arthritis who had a definitive history of taking anti-arthritis medication prescribed by pharmacists were evaluated by review of their medical records in terms of the sorts, dose, duration and the side effects of the medication. From March to December of 2001, patients visiting outpatient rheumatology clinic of the same institute was given a questionnaire regarding the purchase of anti-arthritis medicine recommended by pharmacists. RESULTS: The mean duration of treatment with the medication prescribed by pharmacists was 6.43 years. NSAIDs were prescribed in 89.1% and more than 2 NSAIDs were prescribed in 69.4% of them. Corticosteroids were prescribed in 72.7%, and 60% of these were long-acting ones. 15 cases of diabetes mellitus, 8 cases of vertebral compression fracture, 20 cases of iatrogenic Cushing syndrome, and 2 cases of death from sepsis were identified. After the new system, 17.4% of outpatients reported that they purchased anti-arthritis medication recommended by pharmacists. CONCLUSION: The extent of inappropriate prescription by pharmacists before the new system was profound and serious. Patients were found to be not free from the risk of exposing themselves to unnecessary and possibly harmful medication recommended by pharmacists even after the new system.
Adrenal Cortex Hormones ; Anti-Inflammatory Agents, Non-Steroidal ; Arthritis* ; Cushing Syndrome ; Diabetes Mellitus ; Fractures, Compression ; Humans ; Inappropriate Prescribing ; Korea* ; Medical Records ; Outpatients ; Pharmacists* ; Prescriptions* ; Surveys and Questionnaires ; Rheumatology ; Sepsis

OBJECTIVE: Codeine may result in death or respiratory depression in children, particularly who are rapid metabolizer of CYP2D6, therefore it should be used cautiously among children under 12 years of age. This study was to investigate the prescribing pattern of codeine among children according to the age group, prescribed diagnosis, type of medical service and medical specialties. METHOD: We used Korea Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database. Study subjects included inpatients or outpatients, who were prescribed codeine between January, 1, 2011 and December, 31, 2011. Contraindicated use of codeine was defined as the use of codeine at least one times under aged 12. Age groups were sub-classified according to the <2 years, 2-4 years, 5-8 years, and 9-11 years. Frequently prescribed diagnosis (ICD-10), type of medical service, and medical specialties were also described among codeine users under aged 12. RESULTS: Codeine users were 6,411 inpatients (9,958 prescriptions), and 3,397 outpatients (6,258 prescriptions), respectively. Codeine prescription under 12 years of age were 2.1% (210 prescriptions) among inpatients, and 12.3% (776 prescriptions) among outpatients (p-value<0.05). Outpatient prescriptions of codeine under 12 aged were issued mostly from primary care clinics and frequent diagnosis were unspecified bronchopneumonia (51.6%), and vasomotor rhinitis (23.7%). CONCLUSION: This study found prescribing of codeine under 12 aged is common in outpatient and primary clinics. Nationwide and community-based efforts should be needed to reduce inappropriate prescribing among children.
Bronchopneumonia ; Child* ; Codeine* ; Cytochrome P-450 CYP2D6 ; Diagnosis ; Drug Utilization Review ; Humans ; Inappropriate Prescribing ; Inpatients ; Insurance, Health ; Korea* ; Outpatients ; Prescriptions ; Primary Health Care ; Respiratory Insufficiency ; Rhinitis, Vasomotor

BACKGROUND: Co-administration of two or more antimicrobials with anti-anaerobic activity is not recommended except in certain circumstances. We therefore conducted an intervention to reduce unnecessary double anaerobic coverage (DAC) prescription. MATERIALS AND METHODS: The intervention consisted of education using an institutional intranet and prospective audits and feedback provided through collaboration between a pharmacist and an infectious diseases physician in Seoul National University Bundang Hospital, a tertiary hospital in Seongnam, Republic of Korea, in 2013. The study period was 1 year which contained 6 months of pre-intervention period and 6 months of intervention period. To estimate the overall effect of the intervention, we compared the monthly number of patients receiving unnecessary DAC for more than 3 days and the proportion of patients receiving unnecessary DAC for more than 3 days among all patients receiving DAC. RESULTS: The average monthly number of patients receiving unnecessary DAC for more than 3 days after screening decreased by 73.9% in the intervention period from 26.8 to 7.0. Wilcoxon rank sum test revealed there was a significant statistical difference in the monthly number of patients receiving unnecessary DAC for more than 3 days (P = 0.005). The proportion of patients receiving unnecessary DAC for more than 3 days after screening among all patients identified as receiving necessary or unnecessary DAC also decreased by 67.8% in the intervention period from 42.3% to 13.6% (P < 0.001). CONCLUSION: The multidisciplinary antimicrobial stewardship program with combined methods reduced unnecessary DAC prescription successfully.
Bacteria, Anaerobic ; Communicable Diseases ; Computer Communication Networks ; Cooperative Behavior ; Education ; Gyeonggi-do ; Humans ; Inappropriate Prescribing ; Mass Screening ; Pharmacists ; Prescriptions* ; Republic of Korea ; Seoul ; Tertiary Care Centers