OBJECTIVE: Written information could be helpful for senior population to adhere to complex medication therapies, but must be well prepared and empirically assessed to achieve such end. We purposed to develop a drug information leaflet for senior citizens by applying 'performance-based user-testing.' METHODS: We employed a user-testing, a mixed method to figure difficulties out with patients' leaflets from the user perspective. The cycle made of test and revision can be repeated as necessary. We recruited senior citizens with age of 65 or above who were taking antihypertensive medications at the point of participating and excluded the elderly who suffered illiteracy. We firstly rectified a drug information leaflet of antihypertensive medications for the general public distributed by the Korean authority based on focus group interviews (9 participants). The revised leaflets were tested four times with 8~12 participants in each round (40 seniors in total). We targeted to develop a leaflet which more than 80% of participants understood 10 key information. Main outcomes measures were to be able to find information and be able to understand information. This study was approved by the Yeungnam University Research Ethics Committee. RESULTS: Focus group interviews identified difficulties with small font of words, professional language, long information, and a poor structure. The leaflet was revised and in the first round questionnaire found problems with 4/10 information points; interviews disclosed all but one (normal blood pressure range) were ill-understood. The second round questionnaire and interview found fewer problems but the comprehensiveness of participants was still poor in several points. For the third and fourth rounds we revised the leaflets in the individual-targeted manner. Finally, the fourth round showed all key information found and understood by at least 80% of participants except one question about drug name. CONCLUSION: The drug leaflets need to be developed in a personalized mode for the seniors. There was a limit for Korean seniors to understand nonproprietary name of their drugs because they used to producers' trade names which the Korean health system predominantly works with.
Aged ; Antihypertensive Agents* ; Blood Pressure ; Ethics Committees, Research ; Focus Groups ; Health Literacy ; Humans ; Literacy ; Methods

OBJECTIVE: This study aimed to explore the readability and comprehensibility of the drug information on a patient leaflet for the senior by employing performance-based user-testing. METHODS: We included 36 elderly (65 years old or older) as the senior group (intervention group) and 36 adults (40~59 years old) as the adult group (control). We developed a questionnaire to test if participants could access to drug information. After completing a questionnaire, the participant was interviewed about their understanding over the patient leaflet. We performed t-test, χ2-test or Fisher's exact test to examine differences between two groups in primary outcomes. RESULTS: The senior were less likely able to find information (78%) than the adult (91%); they were much less likely able to understand information (42%) than the adult (69%). While we found differences between the ability of finding and understanding drug information in both groups, the senior group had greater difficulties in understanding all kinds of drug information. They had significant difficulties to remember information after reading the patient leaflet and frequently failed to find proper information even though they were allowed to access freely to the leaflet during interviewing. CONCLUSION: To secure safe and effective use of drugs for the senior, it is necessary to develop drug leaflets for the senior.
Adult ; Aged* ; Comprehension ; Health Literacy ; Humans

BACKGROUND: Generic medications are approved on the basis of bioequivalence with brand medications in healthy volunteers rather than the target population, there remains a substantial uncertainty regarding their clinical effectiveness and safety. The object of this paper is to compare the clinical equivalence of generic statin drugs in patients. METHODS: Literature published before September 2016, which is indexed in PubMed, EMBASE, RISS, comparing generic to brand products in statins. Outcomes included blood lipid level, proportion of days covered (adherence), hospitalization and mortality. RESULTS: 511 citations were screened, of which 11 studies met eligibility criteria (6 randomized clinical trials, 5 observational studies). Generic atorvastatin was clinical equivalent with brand drugs in blood lipid level (3 RCTs) and generic simvastatin was also clinical equivalent with brand drugs (2 RCTs). 2 of 3 studies reported no significant difference in proportion of days covered except 1 study which reported generic statin significantly enhance proportion of days covered (p<0.001). Hospitalization was no significant difference in all studies (p>0.05). 1 study reported that all cause of mortality was significantly low in generic drugs (p<0.0001). CONCLUSION: Published data on comparing clinical efficacy of generic and brand statins were insufficient in both quantity and quality. This systematic review suggests that additional studies on clinical equivalence and safety of generic medications in patients would be needed.
Atorvastatin Calcium ; Drugs, Generic ; Health Services Needs and Demand ; Healthy Volunteers ; Hospitalization ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors* ; Mortality ; Simvastatin ; Therapeutic Equivalency ; Treatment Outcome ; Uncertainty

BACKGROUND: Some mental illnesses such as depression are known to be one of the risk factors of suicide and proper antidepressant therapy can reduce suicidal behavior. OBJECTIVES: This study aimed to analyze regional variations in antidepressant consumption and adherence, suicide rate, prevalence of suicide related mental disorders, and access to relevant healthcare services. METHODS: Cross-sectional analyses were conducted using National Patients Sample data compiled by the Health Insurance Review and Assessment Service between 2014 and 2016. We included patients who had a diagnosis record of suicide related mental disorders during the study period. Cause of death statistics and National health and medical statistics were used to identify suicide rate and distribution of healthcare service. We conducted visual analyses, chi-squared tests, independent t-tests and correlation analyses to demonstrate regional variations. RESULTS: Between 2014 and 2016, the average prevalence of suicide related mental disorders was 5.4 per cent. Suicide rate and prevalence of suicide related mental disorders were higher in Gangwon, Chungcheong, and Jeolla (p < 0.001), and lower in Seoul (p < 0.001) than the national average. Unexpectedly, regional variations in antidepressant consumption were seen in the limited area including Daejeon, Chungnam and Gyeongnam (p < 0.05). The number of mild patient-centered clinics was associated positively with antidepressant consumption (p < 0.01) and associated negatively with suicide rate (p < 0.01). CONCLUSION: There were some regional variations in prevalence of suicide related mental disorders, antidepressant adherence and suicide rate. The higher level of antidepressant therapy and the lower level of suicide rates were seen in regions with easy access to mild patient-centered clinics.
Antidepressive Agents ; Cause of Death ; Chungcheongnam-do ; Cross-Sectional Studies ; Delivery of Health Care ; Depression ; Diagnosis ; Gangwon-do ; Geographic Information Systems ; Humans ; Insurance, Health ; Mental Disorders ; Prevalence ; Risk Factors ; Seoul ; Spatial Analysis ; Suicide*

OBJECTIVE: This study analyzed the national claims data of veterans to generate scientific evidence of the trends and appropriateness of their drug utilization in an outpatient setting. METHODS: The claims data were provided by the Health Insurance Review & Assessment (HIRA). Through sampling and matching data, we selected two comparable groups; Veterans vs. National Health Insurance (NHI) patients and Veterans vs. Medical Aid (MAID) patients. Drug use and costs were compared between groups by using multivariate gamma regression models to account for the skewed distribution, and therapeutic duplication was analyzed by using multivariate logistic regression models. RESULTS: In equivalent conditions, veteran patients made fewer visits to medical institutions (0.88 vs. 1), had 1.86 times more drug use, and paid 1.4 times more drug costs than NHI patients (p < 0.05); similarly, veteran patients made fewer visits to medical institutions (0.96 vs. 1), had 1.11 times more drug use, and paid 0.95 times less drug costs than MAID patients (p < 0.05). The risk of therapeutic duplication was 1.7 times higher (OR=1.657) in veteran patients than in NHI patients and 1.3 times higher (OR=1.311) than in MAID patients (p < 0.0001). CONCLUSION: Similar patterns of drug use were found in veteran patients and MAID patients. There were greater concerns about the drug use behavior in veteran patients, with longer prescribing days and a higher rate of therapeutic duplication, than in MAID patients. Efforts should be made to measure if any inefficiency exists in veterans' drug use behavior.
Drug Costs ; Drug Utilization ; Humans ; Insurance, Health ; Logistic Models ; National Health Programs ; Outpatients* ; Prescriptions* ; Veterans*

Objectives: This study aimed to identify the opinions of Gyeongsangbuk-do residents on out-of-hours (OOH) pharmacies and to examine the operating experiences of pharmacists who are operating OOH pharmacies in other areas. Methods: Cross-sectional survey was carried out for 1,000 Gyeongbuk residents employing a questionnaire via online or face-to-face, and 82 pharmacists who currently operate OOH pharmacies employing a postal questionnaire. Out of eighty-two, 46 pharmacists replied (response rate 56.1%). Results: As for the necessity of introducing OOH pharmacies in Gyeongsangbuk-do, 84.9% answered more than necessary.86.1% favored the local government support for OOH pharmacies. The necessity of OOH pharmacies was highly evaluated among participants who experienced to be unable to use medicines or services in out of service hours, regardless of their characteristics or health condition. County residents consistently put a positive opinion for the necessity of OOH pharmacies if they have elderly family member(s), while city residents had significant differences across subgroups depending on their conditions (family members, household economics, health status, etc.). Almost all (95.7%) pharmacist participants highly evaluated the necessity of OOH pharmacies and the majority of them (63.0%) felt satisfied. However, 60.9% of participants have ever considered closing their OOH pharmacy business due to private, business management and professional reasons. Conclusion This study made suggestions to address anticipated issues for the Gyeongbuk-style OOH pharmacy model.

Objective: This study aimed to explore a veteran patients’ behavior of prescribing drug use and of which influencing factors from the veteran patients’ perspective through qualitative interviews. Methods: We recruited veteran patients through purposive sampling and interviewed 30 veteran patients aged 20 and over who had been taking prescription drugs. We developed and utilized an interview guide consisting of three themes for data collection. We made verbatim transcripts and analyzed data using the framework analysis. Results: Participants were aware that they had large amounts of prescribing medicines and discarded the medicines. They often used improperly by the person himself or his family or acquaintances. The factors that influenced these inefficient prescription drug usage were grouped into ‘factors procuring more drugs than necessary’ and ‘factors being prescribed more drugs than necessary’. Anxiety about downgrading from the upper class to the lower among reward classes for veterans, and suspicion or dissatisfaction with the veteran policy caused the participants to procure more drugs than necessary. Additionally, they received too many medicines due to long-term prescriptions and lack of communication with their doctors, and poor quality of veteran health services. Conclusion To improve the medication use behavior of veteran patients, providing information or introducing interventions for the proper medication use is not enough. Efforts should be made to improve their negative recognition over relevant policies and health care services.

Objective: Taking action on health inequalities starts with the production of information laying out the problems of inequalities, but Korean society has no national database to view related data at a glance. This study aimed to compare Korean national database with the Public Health Profile (PHP), a health inequality database of the UK. Methods: Data were collected from the websites of government and relevant organizations in the both countries between March and August 2020, which was updated in August 2021. Two themes including Co-occurring substance misuse and mental health issues in mental health and INteractive Health Atlas of Lung conditions in England were selected for comparison in terms of data accessibility, data usability and data visualization. Results: The British PHP is being served on a web-based platform, Fingertips. The data collected at the regional level were presented on 31 health inequality themes. The data are displayed at a level that can be compared between comparable communities, and visualized into various tables and figures. Comparable Korean data were scattered in several themes and websites, and mostly provided as a 17 administrative region base, which was too vast to make a meaningful comparisons. Conclusion The findings proposed several considerations which could be useful for establishing a database of health inequality in the Korean society.

Objective: This study aimed to explore a veteran patients’ behavior of prescribing drug use and of which influencing factors from the veteran patients’ perspective through qualitative interviews. Methods: We recruited veteran patients through purposive sampling and interviewed 30 veteran patients aged 20 and over who had been taking prescription drugs. We developed and utilized an interview guide consisting of three themes for data collection. We made verbatim transcripts and analyzed data using the framework analysis. Results: Participants were aware that they had large amounts of prescribing medicines and discarded the medicines. They often used improperly by the person himself or his family or acquaintances. The factors that influenced these inefficient prescription drug usage were grouped into ‘factors procuring more drugs than necessary’ and ‘factors being prescribed more drugs than necessary’. Anxiety about downgrading from the upper class to the lower among reward classes for veterans, and suspicion or dissatisfaction with the veteran policy caused the participants to procure more drugs than necessary. Additionally, they received too many medicines due to long-term prescriptions and lack of communication with their doctors, and poor quality of veteran health services. Conclusion To improve the medication use behavior of veteran patients, providing information or introducing interventions for the proper medication use is not enough. Efforts should be made to improve their negative recognition over relevant policies and health care services.

Objective: Taking action on health inequalities starts with the production of information laying out the problems of inequalities, but Korean society has no national database to view related data at a glance. This study aimed to compare Korean national database with the Public Health Profile (PHP), a health inequality database of the UK. Methods: Data were collected from the websites of government and relevant organizations in the both countries between March and August 2020, which was updated in August 2021. Two themes including Co-occurring substance misuse and mental health issues in mental health and INteractive Health Atlas of Lung conditions in England were selected for comparison in terms of data accessibility, data usability and data visualization. Results: The British PHP is being served on a web-based platform, Fingertips. The data collected at the regional level were presented on 31 health inequality themes. The data are displayed at a level that can be compared between comparable communities, and visualized into various tables and figures. Comparable Korean data were scattered in several themes and websites, and mostly provided as a 17 administrative region base, which was too vast to make a meaningful comparisons. Conclusion The findings proposed several considerations which could be useful for establishing a database of health inequality in the Korean society.