OBJECTIVE: Patients with acute coronary syndrome (ACS) are typically managed with dual antiplatelet therapy of acetylsalicylic acid (aspirin) and P2Y12 receptor inhibitor. In this study, we discussed current and previous antiplatelet therapy guidelines and compared with guidelines of the USA (ACC/AHA), Europe (ESC) and Korea (KSC). METHOD: This study investigated from ACC/AHA Joint Guidelines (the USA), ESC Clinical Practice Guidelines (Europe) and Korea Society of Interventional Cardiology (Korea) web site, respectively. RESULTS: It is significant that difference between the current and the previous guidelines was integration of terminology from clopidogrel to P2Y12 receptor inhibitors since prasugrel and ticagrelor, new antiplatelet drugs, has been added. The other difference was all three guidelines has differences in dose of aspirin. The most notable difference was class of recommendation (COR) in P2Y12 receptor inhibitors. ACC/AHA and Korean guidelines recommend clopidogrel, prasugrel, and ticagrelor with COR IB; whereas, ESC recommend prasugrel and ticagrelor with IB which is higher than clopidogrel with IC. CONCLUSION: This research addresses important movement to revise the Korean existing guideline recommendations. New Korean antiplatelet therapy guideline should be avoiding obvious differences in ACC/AHA and ESC guidelines and harmonizing international guidelines.
Acute Coronary Syndrome* ; Aspirin ; Cardiology ; Europe* ; Humans ; Joints ; Korea* ; Prasugrel Hydrochloride

BACKGROUND: Singapore has the stable healthcare system with utilizing pharmacist manpower in proper positions by demand of populations' health among Asian countries. OBJECTIVE: This study aims to systematically review (1) the pharmacists' role and (2) the pharmacy education system of Singapore in comparison with Korea. METHOD: We searched for information about academic, medical and governmental institutions related to professional pharmacists' practice in Singapore by primarily using database such as DBpia, KISS, Google Scholar and ProQuest and the official website of the Singapore Ministry of Health. We contacted and arranged the visit schedules with National University of Singapore, National Health Group's polyclinics, Agency for Integrated Care, National University Hospital, and community chain pharmacies. During onsite visits, we interviewed pharmacists working in each institution and obtained additional documents and materials relevant to this manuscript work. RESULTS: To become a registered pharmacist in Singapore, the pharmacy curriculum requires four full-time academic years and six additional months allotted for pre-registration training. Pharm.D. course is offered for pharmacy graduate students with additional two full-time years of study. Team teaching and inter professional education program seem the most significant method in pharmacy education. Pharmacists working at hospitals, polyclinics, and community pharmacies in Singapore take broader roles and offer more cognitive services such as smoking cessation program and medication reconciliation. Especially, pharmacists in Agency for Integrated Care fill the role of primary care providers for the continuing care of the community through the governmental support toward the patients-centered integrated care. CONCLUSION: Singaporean pharmacists take significant and active roles in collaboration with other healthcare providers. Efforts such as interprofessional pharmacy education and governmental endorsement of the systematic and interactive care between pharmacists and other medical providers in Singapore are needed to be urgently applied to Korea healthcare system for the promotion of population health.
Appointments and Schedules ; Asian Continental Ancestry Group ; Cooperative Behavior ; Curriculum ; Delivery of Health Care* ; Education, Pharmacy* ; Education, Professional ; Health Personnel ; Humans ; Korea ; Medication Reconciliation ; Pharmacies ; Pharmacists ; Pharmacy* ; Primary Health Care ; Singapore ; Smoking Cessation

OBJECTIVE: Clinical practice guidelines (CPGs) are systematically developed statements aimed at helping optimal care of the patient in a given clinical circumstance. Because of the increasing evidence that active implementation of CPGs improve health outcomes, there is a growing awareness of the importance of guideline development and dissemination. The objective of this study was to investigate the status of CPG development and availability of the CPGs in Korea. METHOD: We searched in the Web sites of 180 organizations to identify CPGs which were developed and/or published in Korea until 1 July 2014. The data of titles, published year, publisher, distributer, and accessibility at the internet web of all CPGs were collected and analyzed. RESULTS: A total of 172 CPGs were developed and 80% had been released since 2009. Most (51.2%) were developed for management of 4 diseases: 28 for digestive system disease; 27 for infectious disease; 18 for endocrine and metabolic diseases; and 15 for neoplasms. Of the 172 CPGs, 150 CPGs were publicly available. Among the 150 CPGs, 78.7% (118/150) were developed by only one organization. CONCLUSION: To ensure the production of high-quality CPGs, it is necessary to collaborate with other relevant professional societies in guideline development process. In addition, stronger efforts on wider dissemination of CPGs must be employed at the country levels to promote implementation of CPGs in clinical settings.
Communicable Diseases ; Digestive System Diseases ; Evidence-Based Medicine ; Humans ; Internet ; Korea* ; Metabolic Diseases

OBJECTIVE: This experiment is to study how elderly group and their various lifestyles interact with health functional foods, according to their selection behavior. Different lifestyles will be observed closely, as well as how different health conditions and consumer involvements will affect critical decision making in selecting health functional foods. METHOD: Theories and discoveries from original advanced research were compared parallel to the new study. RESULTS: First, cluster analysis and exploratory analysis were performed amongst different elder lifestyles. Lifestyle exploratory analysis was used for healthy, unique, leisure, and economical-style elders. Cluster analysis was used for material trend oriented, health oriented, complacent oriented-style elders. Health Functional Foods' selection trait Exploratory Factor Analysis showed that product's originality (function, uniqueness, specialty, compatibility, distributor, expiration date), quality (amount, daily dose, visual representation, accessibility, portability, natural ingredients), and popularity (product container, brand image, taste and smell, advertised product, domestic or import, well-known function) were the three main causes. Secondly, the amount of benefits for the elderly group health lifestyle were affected by 'Interest in health', 'Notability of the health functional food', and 'Functionality approved mark'. Specifically, the importance of, 'Interest in health', 'Notability of health functional food', and 'Functionality approved mark' were noticeably high within health oriented elders. Lastly, after examining the data from elder lifestyle's relationship with health functional food selection trait, all three different results showed equal importance. If you closely examine material trend oriented elderly group, selection trait showed distinctively high regards in 'Fundamental Attribute', 'Typical Attribute', and 'Cognitive Attribute'. Health oriented elders showed their distinctively high regards in 'Natural Attribute', and less consideration in 'Typical Attribute' and 'Cognitive Attribute'. Complacent oriented-style elderly group showed less focus on 'Fundamental Attribute', and even less in 'Typical Attribute', and 'Cognitive Attribute'. Health oriented elderly group concluded with above data from the fact that they showed most importance and involvement in health beneficial products that are scientifically proven. Material trend oriented elderly group showed balanced traits in their concluded data, showing that they prefer function, safety, as well as the brand image and their reputation. Also, they consider the products' outer elements, such as design and product name, in order to sense inner functions. CONCLUSION: So, Silver Business corporations must develop products to fulfill the market demands, and strategize marketing plans to better target the correct audience.
Aged* ; Commerce ; Consumer Participation ; Decision Making ; Functional Food* ; Humans ; Leisure Activities ; Life Style* ; Marketing ; Silver ; Smell

OBJECTIVES: To suggest direction for improving policies by understanding current management of narcotics or psychotropic drugs and analyzing their distributions and usage. METHOD: We conducted a comparison analysis between health insurance claims and the amount supplied to health care institutions for narcotics or psychotropic drugs through health insurance claims data and drug distribution supply data from 2010 to 2012 collected from Korea Pharmaceutical Information Service Center (KPIS). Furthermore, we carried out literature investigation and online search to comprehend the current management of narcotics drugs in Korea. RESULTS: The amount supplied to medical institutions for all drugs in 2012 was 19.4 trillion won, which increased from 19.5 trillion in 2011 by 0.54%. For narcotic drugs, the amount supplied was 318.4 billion won in 2011 and increased to 335.1 billion won by 5.3% in 2012, which exceeded the rate of increase for the amount supplied for all drugs. The proportion of amount claimed in the total amount supplied to medical institutions for all drugs was 60.5% in 2012, whereas the proportion of amount claimed for narcotic drugs was 55.6%, which showed that narcotic drugs were used relatively less within health insurance. Furthermore, management of the current domestic distribution supply data focuses on manufacturing and medical institution supply stages. CONCLUSION: Hereafter, the management of narcotics or psychotropic drugs needs to be improved by reinforcing active monitoring in optimal prescription and usage in patients by collecting and analyzing information on drug usage of patients.
Delivery of Health Care ; Humans ; Information Services ; Insurance, Health ; Korea ; Narcotics* ; Prescriptions ; Psychotropic Drugs

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: The over-prescription of acid-suppressive therapy for the provision of stress ulcer prophylaxis (SUP) in hospitalized patients has been identified in a proceeding study. OBJECTIVE: This study was conducted to evaluate clinicians' beliefs, knowledge and other factors that influence the over-prescribing of SUP in low-risk, non-intensive care unit (non-ICU) patients. METHOD: A cross-sectional survey consisting of multiple-choice queries and close-ended questions was distributed to healthcare personnel at a major teaching hospital in Korea. RESULTS: More than half of total respondents reported that they would continue SUP following patients discharge from the ICU (77.8%, 43.5%, and 39.7% in the physician, pharmacist, and nurse groups, respectively). Over 55% of physicians would also initiate non-ICU patients on SUP upon hospital admission, and 42.6% of physicians would even continue prophylaxis post hospital discharge. The mean knowledge score regarding SUP indications and side effects was higher in pharmacists compared to physicians and nurses (12.44, 7.40, and 7.28, respectively; p<0.001). High-prescribing behavior was associated with a prescriber's belief that SUP is effective for preventing bleeding (odds ratio 7.40; 95% confidence interval 1.57 to 31.94; p=0.012). Low knowledge score and computerized order set also showed statistically significant association with the overutilization of SUP.
Cross-Sectional Studies ; Surveys and Questionnaires ; Delivery of Health Care* ; Hemorrhage ; Hospitals, Teaching ; Humans ; Korea ; Pharmacists ; Ulcer*

OBJECTIVES: The present study assessed the prevalence of the potentially inappropriate medication (PIM) use in Korean elderly patients with Parkinson's disease. In addition, this study examined risk factors that affect PIM use. METHOD: A retrospective, observational study was conducted using Korean National Health Insurance claims database of 2009. PIM use in Parkinson's disease patients aged 65 years or older was examined based on 2012 Beers Criteria. Multivariable logistic regression was conducted to identify risk factors for PIM use. RESULTS: Among 5,277 elderly patients with Parkinson's disease, 88.9% of patients used PIM(s) at least once. The average number of PIM items used per patient was 4.2. PIM use ratio, the proportion of total amount of PIMs to all medications per patient, was 12.6%. Frequently used PIM therapeutic classes were benzodiazepines (32.7%), first-generation antihistamines (19.2%), and prokinetics (17.5%). Individual PIMs most commonly used included chlorpheniramine (11.4%), levosulpiride (10.9%), diazepam (9.0%), and alprazolam (7.6%). Women (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.11-1.16), medical aid (OR 1.18, 95% CI 1.15-1.21), and long-term facilities (OR 2.43, 95% CI 2.22-2.65) were shown to be risk factors associated with PIM use. Of particular, wide variation in PIM use was associated with the types of healthcare facility. CONCLUSION: The PIM prevalence was very high in elderly Parkinson's disease patients. Nationally effective and systematic efforts to identify and prevent PIM use should be made to ensure patient safety and to improve quality of care in the elderly.
Aged* ; Alprazolam ; Beer ; Benzodiazepines ; Chlorpheniramine ; Delivery of Health Care ; Diazepam ; Female ; Histamine Antagonists ; Humans ; Logistic Models ; National Health Programs ; Observational Study ; Parkinson Disease* ; Patient Safety ; Prevalence ; Retrospective Studies ; Risk Factors

BACKGROUND & OBJECT: Ankylosing spondylitis (AS) is a chronic inflammatory disease that causes ankylosis and deformation of axial joints. Since current medicine cannot cure the disease yet, alleviating pain and preventing deformation with medications are the main therapy for patients with AS. The key medications for these purposes include nonsteroidal anti-inflammatory drugs (NSAIDs), and tumor necrosis factor-alpha (TNF-alpha) inhibitors. This study aims to analyze prescribing patterns of AS patients in South Korea. METHOD: National Patients Sample data compiled by the Health Insurance Review and Assessment Service from 2013 was analyzed. Patients with AS were identified with Korean Standard Classification of Diseases code-6, which was M45. The rates of prescription, discontinuation, and switching ingredients were calculated for each medication during 2013. RESULTS: Total number of patients was 655, and most of them were male (n = 514, 78.5%). Of all age groups, the proportion of 30-40 year old patients was the greatest (35.1%). The most utilized drug class was NSAIDs (82.4%). Less than half of patients were prescribed TNF-alpha inhibitors (n = 212, 32.4%). Meloxicam, aceclofenac, and celecoxib were the most frequently prescribed NSAIDs. In case of TNF-alpha inhibitors, adalimumab, etanercept and infliximab were the top three most prescribed drugs. Although not recommended by the current practice guideline, significant proportions of patients were identified using disease modifying anti-rheumatic drugs (DMARDs). CONCLUSION: Considering the current practice guideline and previous studies about the efficacy, the use of DMARDs should be reduced and medical insurance term in South Korea should be re-examined.
Ankylosis ; Anti-Inflammatory Agents, Non-Steroidal ; Antirheumatic Agents ; Classification ; Drug Utilization* ; Humans ; Insurance ; Insurance, Health ; Joints ; Korea ; Male ; Prescriptions ; Spondylitis, Ankylosing* ; Tumor Necrosis Factor-alpha ; Adalimumab ; Celecoxib ; Infliximab ; Etanercept

BACKGROUND: Pharmacy schools newly adopted a 6-year program strengthening clinical knowledge since 2011 in Korea. The clinical training under the guidance of preceptors at hospital sites is a requisite for pharmacy students during the last year of undergraduate course. It has been rarely studied on the hospital pharmacists' perspective regarding being a preceptor or teaching pharmacy students. OBJECTIVES: This study aimed to examine the hospital pharmacists' intention toward student training and to identify the relevant factors among the individual pharmacists' characteristics and working environment within the theoretical frame of the Theory of Planned Behavior (TPB). METHOD: A mail-survey was conducted for pharmacists working in tertiary hospitals in Seoul and Incheon. The survey questionnaire consisting of 131 questions with a 5-likert scale was developed for investigating pharmacists' attitude, subjective norm, perceived behavioral control and the intention to teach pharmacy students as well as other demographic variables. To estimate the construct validity of components, factor analysis was conducted and Cronbach's alpha was calculated to estimate the reliability of the observed variables. Statistical analyses of one-way variance analysis and multiple regression analysis were performed using SPSS 18.0. RESULTS: The survey response rate was 53% (116/210) and the three constructs of attitude (r = .519), subjective norm (r = .233) and perceived control (r = .392) have appropriate correlations with the intention, proving the appropriateness of using the TPB model. Pharmacists working in inpatient (mean = 3.45) and outpatient clinics (mean = 3.34) generally showed positive intention for teaching. The attitude (beta = .432, p < 0.01) and perceived control (beta = .270, p < .01) constructs were significant predictors of the intention. Both age (r = 0.246, p = 0.017) and length of career (r = 0.310, p = 0.002) were positively related with the perceived control. CONCLUSION: Hospital pharmacists showed generally positive intention to provide student training in spite of the concern on their limited perceived behavioral control. Future research to find the actual barriers pharmacists faced in educating students need to be conducted.
Ambulatory Care Facilities ; Education, Pharmacy ; Humans ; Incheon ; Inpatients ; Intention* ; Korea ; Pharmacists* ; Schools, Pharmacy ; Seoul ; Students, Pharmacy ; Tertiary Care Centers