본 연구에서는 2012년 4월부터 2013년 1월 15일까지 아주대학교 의료원을 내원한 환자처방 중 DDIs의 예외사유 코드번호로 입력된 총 7,772건과, 외래, 입원, 응급 등 총 환자들 중 예외사유내용에 입력된 총 89,686건을 대상으로 분석하였다. 예외사유내용 중 외래환자 건수는 총 20,183건, 입원환자는 41,861건, 응급 등 기타는 27,642건이었다. 본 연구에서 예외사유코드의 분석 에 사용된 7,772건은 모두 외래환자로 제한하였다.
또한, 외래환자들 중 중복 예외사유 내용으로 입력한 20,183건을 입력된 내용 과 빈도에 근거하여 13개 그룹으로 분류를 한 후 ATC코드와 ICD코드, 연령 등 을 포함하여 빈도분석과 교차분석을 실시하였다. 또한, 처방의사가 건강보험심 사평가원이 제공하는 중복예외처방사유코드를 사용한 경우와 코드를 사용하지 않고 직접 Free text 형식으로 입력한 모든 건 수 을 3명의 독립적인 연구자가 직접 수작업(manual work)으로 평가하여 새로 분류하고 기존의 코드와 비교 분 석하였다.
분석결과 다음과 같은 주요 결과를 도출하였다.
첫째, 외래, 입원, 응급 전체에 대한 예외사유 내용을 분석한 결과, 외래, 입 원, 응급 등에서 총 89,686건이 시스템 내에 선택항목이 존재하지 않아서, 즉 코드에 입력하지 못하여 자유로운 문장(Free-text)으로 DDIs의 이유를 서술한 것으로 나타났다. 중복예외사유 내용을 분석한 결과, 가장 높은 비율을 차지한 것은 같은 시간대 섭취가 아닌 경우가 31.6% (28,306회)로 나타났으며, 이어서 질병이나 증상을 표기한 것(19,909회)이 22.2%를 차지하는 것으로 나타났고, 염증항목은 열, 부종, 통증, 감염 등의 항목을 포함한 것으로서 총 13.1%
(17,020회)를 차지하는 것으로 나타났다. 전혀 의미가 없는 ‘ㅋㅋㅋ’와 같은 형식으로 표기된 것도 12.0% (10,741회)나 되었으며, 단어나 문장을 서술하였 으나 어떤 의미인지 확인하기가 어려운 불분명한 표기도 0.6%(575회)를 차지하
고 있는 것으로 분석되었다.
그리고 염증과 관련된 경우가 16.0%를 구성하였다. 나머지 항목들은 모두 10%
외사유코드를 적용할 필요가 있음을 확인하였다. 아울러 후향적 DURs의 보다 확장된 결과를 얻을 수 있고 효과적이고 편의적인 DDIs시스템의 구축에 토대가 되고자 한다.
참고문헌
1. Ahn EK, Kam HJ, Park DK, Jung EY, Lee Y, Park RW: Differences among admitting departments in alerts and alert overrides for drug–drug interaction.
Pharmacoepidemiology And Drug Safety
23(4): 390-397, 20142. Ahn EK. Cho SY, Shin D, Jang C, Park RW: Differences of Reasons for Alert Overrides on Contraindicated Co-prescriptions by Admitting Department.
Healthcare Informatics Research
20(4): 280-287, 20143. Chae GH, Cho GW, Nagata R, Park JS, Hong CH, Kang JS: 의약품 안전성 관 리를 위한 연구.
약학회지
57(3): 173-186, 20134. Chui MA, Rupp MT: Evaluation of Online Prospective DUR Programs in Community Pharmacy Practice.
Journal Of Managed Care Pharmacy
6(1):27-34, 2000
5. Cho SC: Developmental Psychopharmacology-Developmental Pharmacokinetic s, Pharmacodynamics And Pharmacogenetis.
Journal of The Korean Academ y of Child And Adolescent Psychiatry
14(2): 157-173, 20036. Choi NK, Park BJ: 한국형 DUR 의 효과적 추진전략.
J Korean Med Assoc
53(12):1130-1138, 2010
7. Enna SJ, Goodman: Gilman's The Pharmacological Basis of Therapeutics Edited by Joel G. Hardman, Lee E. Limbird, Perry B. Molinoff, and Raymond W. Ruddon. McGraw-Hill, New York. 1996. xxi+ 1905 pp. 21× 26 cm. ISBN 0-07-026266-7.
Journal Of Medicinal Chemistry
40(16): 2657-2658, 19978. Federal Risk Management Framework,
U.S. FDA, Editor,
19379. Fisher CR: Hospital and Medicare financial performance under.
Health Care Financing Review 13(3):1,
199210. Fulda TR, Collins T, Kuhle J, Devereaux DS, Zuckerman IH: Medicaid drug utilization review annual reports for federal fiscal year 1999: looking back to move forward.
Journal of the American Pharmacists Association
44(1):69-74, 2003
11. Fung M, Thornton A, Mybeck K, Wu JH, Hornbuckle K, Muniz E:
Evaluation of the characteristics of safety withdrawal of prescription drugs from worldwide pharmaceutical markets-1960 to 1999.
Drug Information Journal
35(1): 293-317, 200112. Ghoreishi KT, In Encyclopedia of Toxicology (Third Edition), P. Wexler, Editor.
Academic Press Oxford
, 201413. Grizzle AJ, Mahmood MH, Ko Y, Murphy JE, Armstrong EP, Skrepnek GH, Malone DC: Reasons provided by prescribers when overriding drug-drug interaction alerts.
The American Journal Of Managed Care
13(10): 573-578, 200714. Hansten PD, Horn JR: Drug interactions. analysis and management.
Wolters Kluwer Health,
200715. History of International Society for Pharmacoepidemiology. [cited 2015 20th April];Available from:https://www.pharmacoepi.org/about/history.cfm.
16. History of Korean Society for Pharmacoepidemiology and Risk Management. [cited 2015 20th April].
17. History of Pharmaceutical Medicine. [cited 2015 20th April]; Available from:
http://www.drugstudy.md/resource9.html.
18. Honigman B, Light P, Pulling RM, Bates DW: A computerized method for identifying incidents associated with adverse drug events in outpatients.
International Journal Of Medical Informatics
61(1): 21-32, 200119. International Classification of Diseases (ICD).[cited 2015 3rd.May];Available f rom: http://www.who.int/classifications/icd/en/, 2015
20. Jeong HS: Impact of the reform for separation between prescribing and dis pensing of drugs upon financial situation of the National Health Insurance.
Health Policy And Management
16(2): 117-134, 200621. Jha AK, Kuperman GJ, Teich JM, Leape L, Shea B, Rittenberg E, Bates DW:
Identifying adverse drug events.
Journal Of The American Medical Informatics Association
5(3): 305-314, 199822. Krähenbühl-Melcher A, Schlienger R, Lampert M, Haschke M, Drewe J, Krähenbühl S: Drug-related problems in hospitals.
Drug Safety
30(5):379-407, 2007
23. Kohn LT, Corrigan J, Donaldson MS: To err is human. Washington, D.C.
National Academy Press,
200024. Lake CR, Gallant S, Masson E, Miller P: Adverse drug effects attributed to
phenylpropanolamine: a review of 142 case reports.
The American Journal Of Medicine
89(2): 195-208, 199025. Lee JH: 위해관리와 REMS 의 소개.
J Korean Med Assoc
55(9): 852-860, 201226. Lee KS, Choi JW, Baek YJ, Kim KR: The status of agricultural diseases, injuries and accidents among the England, the USA, the France, the Japan, and the Korea.
The Korean Journal Of Community Living Science
18(1):189-204, 2007
27. Lyles A, Sleath B, Fulda TR, Collins TM: Ambulatory drug utilization review: opportunities for improved prescription drug use.
Am J Manag Care
7(1): 75-81, 200128. McCarthy M: Palpatory literacy, Chinese therapeutic bodywork (Tui Na) and the remediation of head, neck and shoulder pain.
Journal Of Bodywork And Movement Therapies
7(4): 262-277, 200329. Mitchell WJ, Hamilton PM, Bower AG: Effective Sulfanilamide Dosage: The Value of Quantitative Sulfanilamide Determinations.
California And Western Medicine
52(3): 113-115, 194030. Park BJ, Lee SJ: Background and current status of drug utilization review in the developed countries.
Journal-Korean Society For Clinical Pharmacology And Therapeutics 7(1/2): 3-16, 1999
31. Qureshi ZP, Seoane‐Vazquez E, Rodriguez‐Monguio R, Stevenson KB, Szeinbach SL: Market withdrawal of new molecular entities approved in the United States from 1980 to 2009.
Pharmacoepidemiology And Drug Safety
20(7): 772-777, 2011
32. Rodrigues AD: Drug-Drug Interactions, Second Edition.
CRC Press
, 200833. WHO. Available from: http://www.who-umc.org/.
34. Youn HS: New Nutritional Concepts of Vitamins and Minerals.
Korean Journal Of Pediatrics
48(12): 1295-1309, 200535. Zheng Z: 모바일 헬스케어 애플리케이션 수용에 관한 연구.
한국정책 과학학회보
19(3): 203-236, 201536. 김찬우: 노인장기요양보험제도 실행에서의 한국형 케어매니지먼트 도입에 관한 고 찰.
보건사회연구
33(2): 219-242, 201337. 박윤재 : 해방 후 한약의 변용과 한의학.
한국근현대사연구
(71): 188-211, 201438. 박정규 : 내분비계 장애물질의주요현안과 대응방안.
수시연구보고서
1998(단일호):1-130, 1998
39. 박지영: 병용금기와 의약품 사용평가.
J KOREAN Med Assoc
55: 484-490, 201240. 범희승, 박성희, 최진욱, 김춘배: 임상의사결정지원시스템의 약제부작용 감소 효과에 관한 메타분석.
대한의료정보학회지
8(3): 55-60, 200241. 보건복지부 고시 제 2004-2호. 병용금기 성분, 2004
42. 보건복지부 고시 제 2005-17호. 병용금기 성분, 2005
43. 신순식, 임병묵, 채한, 김성숙, 강희정, 정용석, 이민섭: 기의 의학적 연구.
한국한의
학연구원 연구보고서
, 200044. 유경진, 김재연, 윤소정, 오주연, 곽혜선, 신혜영: 약물-약물 상호작용 screening 프 로그램 시행 후의 처방 분석 II.
병원약사회지
22(4): 339-351, 200545. 이두원: 의사-환자간 커뮤니케이션 행위에 대한 대화분석 연구.
한국언론학보,
45(1):232-265, 2000
46. 이승환, 박찬미, 김영훈, 박선철, 이상규, 배경열, 최진아: 장기지속형 주사제와 경구 투여 약물을 처방받는 조현병 환자들의 재발률, 재입원률, 치료순응도 비교 및 경제 성 분석.
한국보건의료연구원 연구보고서
, 201547. 이윤성, 황상익, 김윤희: 북한이탈주민에 대한 보건의료인 자격인정 방안 마련을 위 한 기초 연구.
대한의사협회 의료정책연구소 연구보고서
, 201148. 이정화: 3차 병원 외래환자 처방의 약물상호작용 평가. 숙명여자대학교 대학원 석사 학위논문, 2006
49. 이석용, 홍경자: 약물 상호 작용의 이해.
신일상사
: 1-135, 200350. 전하림, 전하림, 박주희, 김동숙, 최병철: 의약품 사용평가 (DUR) 사업의 미국 47 개 주 Medicaid 자료비교 및 정책적 함의 고찰.
보건사회연구
34(3): 192-221, 201451. 정석관, 유태웅: 의료기관의 위험관리 교육 방안.
생명윤리정책연구
4(1) : 1-26, 201052. 조진환: 종합병원 외래환자의 처방전에 기초한 약물 상호작용 검토. 중앙대학교 의약 식품대학원 석사학위논문, 2005
53. 재한, 이수진, 장정희, 신상우: 한의과대학 학부생을 대상으로 한 영문 의학논문 교 육의 효과 고찰.
대한한의학회지
28(1): 2007부 록 부록 1. ATC
Class of drug 1 Class of drug 2 N %
Antithrombotic agents Antithrombotic agents 568 7.308
Antiepileptics Antiepileptics 549 7.064
Antidepressants Antidepressants 408 5.250
Drugs for peptic ulcer and
gastro-oesophageal reflux disease (gord)
Drugs for peptic ulcer and
Blood glucose lowering drugs,
excl. insulins 380 4.889
Lipid modifying agents, plain Lipid modifying agents, plain 367 4.722
Anxiolytics Anxiolytics 354 4.555
Angiotensin ii antagonists, plain Angiotensin ii antagonists, plain 350 4.503 Thyroid preparations Thyroid preparations 277 3.564 Selective calcium channel blockers with
mainly vascular effects
Selective calcium channel blockers with mainly vascular effects
234 3.011
Opioids Opioids 212 2.728
Beta blocking agents Beta blocking agents 211 2.715 Antihistamines for systemic use Antihistamines for systemic use 198 2.548 Other drugs for acid related disorders Other drugs for acid related
disorders 165 2.123
Antiinflammatory and antirheumatic products, non-steroids
Hypnotics and sedatives Hypnotics and sedatives 124 1.595
Calcium Calcium 122 1.570
Antimalarials Antimalarials 111 1.428
Vasodilators used in cardiac diseases Vasodilators used in cardiac
diseases 95 1.222
Intestinal antiinflammatory agents Intestinal antiinflammatory
agents 94 1.209
Anti-dementia drugs Anti-dementia drugs 88 1.132
Drugs used in benign prostatic hypertrophy
Drugs used in benign prostatic
hypertrophy 82 1.055
Dopaminergic agents Dopaminergic agents 78 1.004
Peripheral vasodilators Peripheral vasodilators 67 0.862 Drugs for functional gastrointestinal
disorders
Drugs for functional
gastrointestinal disorders 65 0.836 Other systemic drugs for obstructive
airway diseases
Other systemic drugs for
obstructive airway diseases 65 0.836 Vitamin b12 and folic acid Vitamin b12 and folic acid 64 0.823 Supplement 1. Frequency of ATC Codes in 7,772 Outpatient Cases with Therapeutic Duplication
Class of drug 1 Class of drug 2 N % Other alimentary tract and metabolism
products
Other alimentary tract and
metabolism products 60 0.772 Other dermatological preparations Other dermatological
preparations 60 0.772
Antacids Antacids 59 0.759
Selective calcium channel blockers with direct cardiac effects
Selective calcium channel blockers with direct cardiac effects
59 0.759 Corticosteroids, plain Corticosteroids, plain 57 0.733 Muscle relaxants, centrally acting agents Muscle relaxants, centrally
acting agents 53 0.682
Low-ceiling diuretics, thiazides Low-ceiling diuretics, thiazides 51 0.656 Ace inhibitors, plain Ace inhibitors, plain 50 0.643
Propulsives Propulsives 47 0.605
Immunosuppressants Immunosuppressants 46 0.592
Expectorants, excl. combinations with cough suppressants
Expectorants, excl. combinations
with cough suppressants 43 0.553 High-ceiling diuretics High-ceiling diuretics 42 0.540 Other analgesics and antipyretics Other analgesics and antipyretics 40 0.515
Parasympathomimetics Parasympathomimetics 40 0.515
Hormone antagonists and related agents Hormone antagonists and related
agents 39 0.502
Other antineoplastic agents Other antineoplastic agents 39 0.502 Antidiarrheal microorganisms Antidiarrheal microorganisms 36 0.463
Immunosuppressants 36 0.463
Anesthetics, general Anesthetics, general 35 0.450
Iron preparations Iron preparations 35 0.450
Vitamin b-complex, incl. combinations Vitamin b-complex, incl.
combinations 33 0.425
Vitamin a and d, incl. combinations of the two
Vitamin a and d, incl.
combinations of the two 32 0.412 Antigout preparations Antigout preparations 31 0.399 Antithyroid preparations Antithyroid preparations 29 0.373 Psychostimulants, agents used for adhd
and nootropics
Psychostimulants, agents used
for adhd and nootropics 29 0.373 Anticholinergic agents Anticholinergic agents 27 0.347
Urologicals Urologicals 26 0.335
Other cardiac preparations Other cardiac preparations 24 0.309
Bile therapy Bile therapy 23 0.296
All other therapeutic products All other therapeutic products 22 0.283 Other drugs for disorders of the
musculo-skeletal system
Other drugs for disorders of the
musculo-skeletal system 21 0.270 Capillary stabilizing agents Capillary stabilizing agents 20 0.257 Antiemetics and antinauseants Antiemetics and antinauseants 19 0.244 Specific antirheumatic agents Specific antirheumatic agents 19 0.244 Stomatological preparations Stomatological preparations 18 0.232 Other beta-lactam antibacterials Other beta-lactam antibacterials 17 0.219 Adrenergics, inhalants Adrenergics, inhalants 15 0.193 Direct acting antivirals Direct acting antivirals 15 0.193
Class of drug 1 Class of drug 2 N % Drugs for treatment of tuberculosis Drugs for treatment of
tuberculosis 15 0.193
Lipid modifying agents, combinations Lipid modifying agents,
combinations 15 0.193
Cough suppressants, excl. combinations with expectorants
Cough suppressants, excl.
combinations with expectorants 14 0.180 Drugs for constipation Drugs for constipation 14 0.180
Estrogens Estrogens 14 0.180
Liver therapy, lipotropics Liver therapy, lipotropics 14 0.180 Multivitamins, combinations Multivitamins, combinations 14 0.180 Antiinflammatory/antirheumatic agents in
combination
Antiinflammatory/antirheumatic
agents in combination 13 0.167 Antimetabolites
Antiinflammatory and antirheumatic products, non-steroids
12 0.154 Digestives, incl. enzymes Digestives, incl. enzymes 12 0.154 Low-ceiling diuretics, excl. thiazides Low-ceiling diuretics, excl.
thiazides 12 0.154
Other mineral supplements Other mineral supplements 12 0.154 Vitamin b1, plain and in combination with
Cardiac glycosides Cardiac glycosides 11 0.142
Other vitamin products, combinations Other vitamin products,
combinations 11 0.142
Quinolone antibacterials Quinolone antibacterials 11 0.142
Antimetabolites Antithrombotic agents 10 0.129
Irrigating solutions Irrigating solutions 10 0.129 Belladonna and derivatives, plain Belladonna and derivatives, plain 9 0.116 Cough suppressants and expectorants,
combinations
Cough suppressants and
expectorants, combinations 9 0.116 Nasal decongestants for systemic use Nasal decongestants for
systemic use 9 0.116
Other plain vitamin preparations Other plain vitamin preparations 9 0.116 Potassium-sparing agents Potassium-sparing agents 9 0.116 Antiarrhythmics, class i and iii Antiarrhythmics, class i and iii 8 0.103 Corticosteroids for systemic use, plain Corticosteroids for systemic use,
plain 8 0.103
Posterior pituitary lobe hormones Posterior pituitary lobe
hormones 8 0.103
Other sex hormones and modulators of the genital system
Other sex hormones and
modulators of the genital system 7 0.090 Antiadrenergic agents, peripherally acting Antiadrenergic agents,
peripherally acting 6 0.077 Decongestants and other nasal
preparations for topical use
Decongestants and other nasal
preparations for topical use 6 0.077 Antiglaucoma preparations and miotics Antiglaucoma preparations and
miotics 5 0.064
Antivertigo preparations Antivertigo preparations 5 0.064 Beta-lactam antibacterials, penicillins Beta-lactam antibacterials,
penicillins 5 0.064
Class of drug 1 Class of drug 2 N % Drugs affecting bone structure and
mineralization
Drugs affecting bone structure
and mineralization 5 0.064 Macrolides, lincosamides and
streptogramins
Macrolides, lincosamides and
streptogramins 5 0.064
Anti-acne preparations for topical use Anti-acne preparations for
topical use 4 0.051
Antivaricose therapy Antivaricose therapy 4 0.051
Arteriolar smooth muscle, agents acting on Arteriolar smooth muscle, agents
acting on 4 0.051
Cardiac stimulants excl. cardiac glycosides Cardiac stimulants excl. cardiac
glycosides 4 0.051
Other gynecologicals Other gynecologicals 4 0.051
Antiinflammatory and antirheumatic
products, non-steroids Antithrombotic agents 3 0.039 Antiobesity preparations, excl. diet
products
Antiobesity preparations, excl.
diet products 3 0.039
Potassium Potassium 3 0.039
Androgens Androgens 2 0.026
Antiinflammatory and antirheumatic
products, non-steroids Other antineoplastic agents 2 0.026
Antimetabolites Antimetabolites 2 0.026
Anxiolytics Antimycotics for systemic use 2 0.026 Drugs for functional gastrointestinal
disorders
Drugs for functional
gastrointestinal disorders 2 0.026 Drugs for peptic ulcer and
gastro-oesophageal reflux disease (gord) Direct acting antivirals 2 0.026 Hormonal contraceptives for systemic use Hormonal contraceptives for
systemic use 2 0.026
Ocular vascular disorder agents Ocular vascular disorder agents 2 0.026 Other antineoplastic agents
Antiinflammatory and antirheumatic products, non-steroids
2 0.026 Other dermatological preparations Potassium-sparing agents 2 0.026 Other hematological agents Other hematological agents 2 0.026
Progestogens Progestogens 2 0.026
Urologicals Vasodilators used in cardiac
diseases 2 0.026
Adrenergics for systemic use Adrenergics for systemic use 1 0.013 Antidepressants Decongestants and other nasal
preparations for topical use 1 0.013
Antifibrinolytics Antifibrinolytics 1 0.013
Antimigraine preparations Antimigraine preparations 1 0.013 Antimycotics for systemic use Hypnotics and sedatives 1 0.013 Antimycotics for systemic use Lipid modifying agents, plain 1 0.013 Antispasmodics and anticholinergics in
combination with other drugs
Antispasmodics and
anticholinergics in combination with other drugs
1 0.013
Bacterial vaccines Bacterial vaccines 1 0.013
Other antidiarrheals Other antidiarrheals 1 0.013
Other dermatological preparations 1 0.013
Other nervous system drugs Other nervous system drugs 1 0.013
Class of drug 1 Class of drug 2 N % Other ophthalmologicals Other ophthalmologicals 1 0.013
Potassium-sparing agents Potassium 1 0.013
Progestogens and estrogens in combination
Progestogens and estrogens in
combination 1 0.013
Propulsives Blood glucose lowering drugs,
excl. insulins 1 0.013
Sulfonamides and trimethoprim Sulfonamides and trimethoprim 1 0.013
부록 2. ICD
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %
ICD 질병명 N %