• 약학회지
• /
• 제51권5호
• /
• pp.327-335
• /
• 2007

This study was to evaluate economic impact of a comprehensive pharmaceutical care intervention provided by community pharmacists on drug-related morbidity and mortality in the elderly population, in a societal perspective. Clinical outcomes of pharmaceutical care included compliance increase, inappropriate medication discontinuation, and subsequent drug-related morbidity and mortality reduction. Economic outcomes included cost savings from direct medical costs reduction such as medication and healthcare resource utilization. Input costs for pharmaceutical care included pharmacist time and computerized prescription review supporting program costs. Model parameters of outcomes were derived from published literatures, and costs were from literatures and health insurance statistical data in Korea. Annual costs and benefits were estimated in the year 2005. Current usual care and standardized pharmaceutical care required 0.3 and 2.0 hours per year respectively, for elderly outpatient using average 4.4 prescription drugs per visit and average annual frequency of 17.8 pharmacy visits. Comprehensive pharmaceutical care provided to overall elderly outpatients at community pharmacies would have cost of \74,994 mil. and benefit of \357,002 mil. per year. Benefit:cost ratio was 4.8:1 and net benefit was \282,008 mil/year. It was corresponded to net benefit of \73,816/year for individual elderly patient. In addition, pharmaceutical care was estimated to reduce 1,531 drug-related deaths/year. Conclusively this study, a first attempt in Korea to evaluate an economic value of pharmaceutical care at community pharmacies, proved that it was a cost-effective intervention having significant economic benefit.

• 한국임상약학회지
• /
• 제26권2호
• /
• pp.107-114
• /
• 2016

Background: Depression is the leading cause of lowering the quality of life of cancer patients and lung cancer is the most likely to cause depression. It is necessary to find out depression-related factors in lung cancer patients. Methods: The study was a retrospective cohort study using medical records, and was a non-equivalent comparison group design. It involved patients diagnosed of lung cancer at the Konkuk University Medical Center from January to December 2012. Between antidepressants prescription group and non prescription group, socio-demographic factors, clinical factors, treatment-related factors and other factors were analyzed statistically. Results: Antidepressant prescription group consisted of 23 people and non-prescription group of 206 people. Prescription rate of quetiapine was the highest 47.8% (11/23), followed by escitalopram (43.5%, 10/23), amitryptyline and trazodone (30.4%, 7/23). The prescription group was prescribed with an average of 1.9 antidepressants. Antidepressants were prescribed after average of 248 days from lung cancer diagnosis and prescription period per patient was average 177.5 days. According to the result of univariate logistic regression analysis between 2 groups, factors such as number of outpatient visit, number of admission, days of hospitalization, sleep disorder, and comorbidity were found to be statistically significant (p < 0.05). However, According multivariate logistic regression analysis showed that number of admission, days of hospitalization and sleep disorder were statistically significant (p < 0.05) excluding comorbidity. Conclusion: About 10% of lung cancer patients had received a prescription for antidepressants after lung cancer diagnosis. A sleep disorder, number of hospitalization and length of stay were identified as factors influencing the prescribing antidepressants.

• 턱관절균형의학회지
• /
• 제5권sup호
• /
• pp.1-5
• /
• 2015

Objectives: The aim of this study was to review main symptoms of outpatient in Lee young Jun clinics who developed the functional cerebrospinal therapy and to investigate the therapeutic effects on one time application of functional cerebrospinal therapy (FCST). Methods: Patients who visited at least twice at an oriental medical clinic and treated with FCST were included. They were asked to write 216 numeric rating scale (NRS)-based questionnaire about degree of various symptoms at each visit. Prevalence and degree decrease of all reported symptoms were analyzed. Results: Total of 744 outpatients were included. There were fourteen symptoms of which more than half of all patients commonly complained. All symptoms were significantly reduced after one administration of FCST. About four to seven percent of patients reported at least five-point reduction on NRS in each symptom after FCST. Conclusions: FCST might have potential immediate effect on not only TMJ related symptoms, but also diverse kinds of pain, psychological symptoms, and fatigue-related symptoms.

• 한국병원경영학회지
• /
• 제11권1호
• /
• pp.54-90
• /
• 2006

Medical clinics are core institutes that cover the primary medical care in Korea. Financial viability of the clinics is essential for them to conduct their roles and functions, and can be improved by increasing their operating profitability. On this ground, this study aimed at finding important factors that affect the operating profitability, and thereby at suggesting strategic alternatives that can contribute to the improvement of the profitability. Operating margin was set as a dependent variable, and such factors as general management conditions, number of visits, medical revenue, marketing activities, input resources, medical cost as independent variables. Nineteen hypotheses related to the variables were established and tested using data collected from 138 sample clinics for the year 2003. The results of the study are as follows : Firstly, such variables as percent ratio of the depreciation plus rent costs to total administration costs, type of clinical department manifested whether medical, surgical, or quasi-surgical, percent ratio of the interior facility investment to total fixed assets, and total number of outpatient visit are important factors that affect, positively or negatively, the medical profitability of the clinics. Secondly, following measures are needed to be established and implemented to improve the medical profitability. (1) Administration costs share 53.2% of the total medical costs, and depreciation plus rent costs 16.3% of the total administration costs. This implies that such measures as reinforcement of marketing activities, establishment of the cooperative utilizing system of the facility and equipment, or group practice are needed to increase cost-effectiveness. (2) Occupancy rate of the clinics with inpatient bed is as low as 45.5%, causing high fixed costs and low medical profitability. For its improvement, the resource input structure should be reorganized. Thirdly, in the future, a study that can increase sample representativeness of the study and explanation power of the variables should be performed for each type of clinical department to find more specific determinant factors and to contribute to the improvement of the medical profitability of the clinics.

• 한국콘텐츠학회논문지
• /
• 제20권3호
• /
• pp.92-105
• /
• 2020

이 연구에서는 실손형 민간의료보험 가입의 영향요인과 실손형 민간의료보험이 외래 및 입원 의료이용에 미치는 영향에서 성별 차이를 파악하고자 하였다. 한국의료패널의 2010년부터 2016년까지 조사 자료를 패널자료로 구성하여 로짓모형과 회귀모형으로 분석하였다. 실손형 민간의료보험의 가입에서 남성은 여성보다 가입확률이 낮았고, 여성의 경우 미충족 의료 여부, 주관적 건강상태에 따라 가입확률의 차이가 있었고, 남성의 경우 결혼상태, 거주지에 따라 차이가 있었다. 실손형 민간의료보험은 여성군에서 외래 방문 당 진료비에 영향을 미치지 않았으나 남성군에서는 외래 방문 당 진료비를 증가시키는 것으로 분석되었다. 또한, 여성군에서 실손형 민간의료보험이 입원 당 진료비를 유의하게 증가시켰으나 남성군의 입원 당 진료비에는 영향을 주지 않았다. 실손형 민간의료보험의 가입과 실손형 민간의료보험이 의료이용에 미치는 영향에서 성별 차이가 있음을 확인하였으며, 이는 실손형 민간의료보험 관련 연구와 제도 운용에서 성별 차이를 고려할 필요가 있음을 시사한다.

• 가정∙방문간호학회지
• /
• 제24권2호
• /
• pp.210-220
• /
• 2017

Purpose: The study aimed to describe the utilization of home healthcare in patients using home mechanical ventilator(HMV) Method: A descriptive cross-sectional design was used in this study. A Questionnaires were sent to nation wide home healthcare agencies to assess their utilization status of home healthcare. A convenience sample of 158 patients data was reviewed. Result: A total of 88(55.7%) men with the mean age of 51.94(${\pm}19.52$) years were included in the study. Approximately 55.1% of patients at the outpatient department were referred to the home healthcare services after discharge. The underlying diseases were as follows : 129 amyotrophic lateral sclerosis and 27 muscular dystrophies. A total of 155 patients have invasive HMV. Efficient home healthcare nursing activities provided by a highly skilled home healthcare advanced practice nurses(HHCAPN) were tracheotomy and gastrostomy tube management and urinary catheterization. The average frequency of home visit for one patient was 2.52times per month. The duration of home healthcare utilization with >1 year was 82.9%. HHCAPNs have limited knowledge and skill for HMV. Conclusion: The government support is required to provide sufficient home healthcare services to the patients discharged with HMV. HHCAPNs should be properly educated on the effective HMV care.

• 한국병원경영학회지
• /
• 제22권4호
• /
• pp.61-73
• /
• 2017

In the Health Insurance System of South Korea, patients must pay high out-of-pocket expenditures for the medical service by uninsured medical benefits. So, the government implemented a policy to relieve the burdens of patients by lowering the uninsured selective-medical treatment costs in August, 2014. This study investigate the policy effects of selective-medical treatment(SMT) on the medical service's usage and cost with severe lung cancer patients. The patients are selected in one university hospital(with 1,000 beds), between one year before and after policy implementation. The study find that the usages of outpatient(visit number) and inpatient (length of stay) are not changed by statistically significant. It means that there are no effect in medical service behavior between before and after the policy. In medical expenses, outpatients decreased in their out-of-pocket payments by policy, but total medical expenses and insured medical benefits is not changed, because of the increased another medical insurance fees. For inpatient, although the SMT costs are statistically significant decrease, the total out-of-pocket payments and insured medical expenses are not changed statistically significant. Those findings show that the political decision making about SMT made lowing the selective-medical expenses, but total insured cost and patient's out-of pocket money were not changed by the new increased medical insurance fees. It means that the policy about SMT gave no particular benefit for patients. So, it need another benefit plans to lower the medical expenses of severe lung cancer patients with a high medical service usage and much total medical expense.

• Archives of Plastic Surgery
• /
• 제37권4호
• /
• pp.465-468
• /
• 2010

Purpose: Soft tissue deformity and skin defect after tumor resection in the periorbital area can cause trouble in the function of eyelid as well as in the aspect of external appearance. Therefore, as cosidering reconstruction in periorbital area, detailed assessment of both functional and aesthetic property are required. thus, the purpose of this study is to examine an appropriate reconstruction through clinical cases. Methods: A 14-year-old girl with congenital giant hairy nevus on right periorbital area was selected. Her first visit to our plastic surgery outpatient clinic was on July 2006. Since then, she has undergone staged removal of lesions and reconstruction by various flap technique such as pedicled island flap, forehead galeal flap, paramedian forehead flap, cheek rotation & advancement flap. Results: In the case of this girl, most lesions were removed and replaced by normal skins. Although there was the difference of skin color after skin graft, such difference was not noticeable and section scar by skin flaps was slight. There was no obvious dysfunction in the eyelids and the girl and her parents were satisfied with results after the surgery. Conclusions: In the reconstruction of soft tissue defect or soft tissue deformity and contracture, it is required to choose appropriate reconstruction method, considering aesthetic and functional aspects depending on aesthetic unit sufficiently.

• Journal of Korean Neurosurgical Society
• /
• 제60권4호
• /
• pp.456-464
• /
• 2017

Objective : Although little is known about its origins, neck pain may be related to several associated anatomical pathologies. We aimed to characterize the incidence and features of chronic neck pain and analyze the relationship between neck pain severity and its affecting factors. Methods : Between March 2012 and July 2013, we studied 216 patients with chronic neck pain. Initially, combined tramadol (37.5 mg) plus acetaminophen (325 mg) was administered orally twice daily (b.i.d.) to all patients over a 2-week period. After two weeks, patients were evaluated for neck pain during an outpatient clinic visit. If the numeric rating scale of the patient had not decreased to 5 or lower, a cervical medial branch block (MBB) was recommended after double-dosed previous medication trial. We classified all patients into two groups (mild vs. severe neck pain group), based on medication efficacy. Logistic regression tests were used to evaluate the factors associated with neck pain severity. Results : A total of 198 patients were included in the analyses, due to follow-up loss in 18 patients. While medication was successful in reducing pain in 68.2% patients with chronic neck pain, the remaining patients required cervical MBB. Lateral cervical curvature, such as a straight or sigmoid type curve, was found to be significantly associated with the severity of neck pain. Conclusion : We managed chronic neck pain with a simple pharmacological management protocol followed by MBB. We should keep in mind that it may be difficult to manage the patient with straight or sigmoid lateral curvature only with oral medication.

• 사상체질의학회지
• /
• 제33권3호
• /
• pp.161-170
• /
• 2021

Introduction Hand eczema is dermatitis that occurs on the hand and fingers. In this case, the patient had chronic hand eczema that had relapsed for 3 years, worsened for 6 months, and did not improve even with standard dermatological treatment. We report significant improvement of the patient with chronic hand eczema, diagnosed with Soeunmin Greater Yin Symptomatology based on Sasang Constitutional Medicine. Methods We prescribed herbal medicine, Sibimigwanjung-tang(十二味寬中湯), and the western medications were continued throughout the treatment period. To evaluate the treatment progression, we observed objective and subjective symptoms and took pictures of the patient's hands. Results At the first time of the outpatient visit, the patient complained of pain, oozing, scaling and severe itching even though she had taken dermatological medication for over 6 months. After 8 weeks of Korean medicine treatment, most symptoms showed improvement, and after about 47 weeks of treatment, the symptoms maintained 90% improvement even after stopping western medications and herbal medications. Conclusion The patient in this case showed a significant improvement of chronic hand eczema and the improvements have been maintained even stopping western medications and herbal medications during follow-up for 15 weeks. In addition, the patient showed improvement and maintenance of general conditions as well as skin-related symptoms. In this case, we can concern the effect of the Sasang Constitutional Medicine focused on treating the patient's general pathology as well as the patient's chief complaint at chronic hand eczema not responding to standard dermatological treatment.