Earticle

Background: Along with the increase in the elderly population, concerns about polypharmacy, which can cause medication-related problems, are increasing. This study aimed to find out the association between drug-related factors and readmission in elderly patients within 30 days after discharge. Methods: Data of patients aged ≥65 years who were discharged from the respiratory medicine ward of a tertiary hospital between January and March 2016 were retrospectively obtained. The medication regimen complexity at discharge was calculated using the medication regimen complexity index (MRCI) score, comorbidity status was assessed using the Charlson comorbidity index (CCI), potentially inappropriate medications (PIMs) were evaluated based on the Beer 2019 criteria, and adverse drug events (ADEs) were examined using the ADE reporting system. Multivariable logistic regression analysis was used to evaluate the effect of medication-related problems on hospital readmission after controlling for other variables. Results: Of the 206 patients included, 84 (40.8%) used PIMs, 31 (15%) had ADEs, and 32 (15.5%) were readmitted. The mean age, total medications, MRCI, CCI, and PIMs in the readmission group were significantly higher than those in the non-readmission group. Age significantly decreased the risk of readmission (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.84-0.96) after adjusting for sex, length of hospital stay, and ADEs. The use of PIMs (OR, 2.38; 95% CI, 1.10-5.16) and increased CCI (OR, 1.50; 95% CI, 1.16-1.93) and MRCI (OR, 1.04; 95% CI, 1.01-1.07) were associated with an increased occurrence of readmission. Conclusion: PIMs were associated with a significantly greater risk for readmission than MRCI.

Background: Gastrointestinal (GI) drugs are often co-prescribed with other medications to prevent GI complications. This study aimed to evaluate the prescribing pattern of potentially unnecessary GI drugs in patients with acute cystitis who were prescribed oral antibiotics and investigate the influencing factors affecting this. Methods: We identified female patients ≥20 years with acute cystitis who visited the outpatient clinic and were prescribed oral antibiotics between July and December by analyzing Health Insurance Review and Assessment Service (HIRA)-National Patients Sample (NPS)-2019 data. Patients with no prior history of GI disorders within 180 days prior to acute cystitis, excluding or including the date of diagnosis of acute cystitis, were selected (Group A and B). Multiple logistic regression analysis was performed to estimate the factors affecting the prescription of potentially unnecessary GI drugs. Results: A total of 1,544 in Group A and 552 patients in Group B were included for the final analysis. Potentially unnecessary GI d rugs w ere presc ribed in 1 ,176 p atients in G roup A ( 76.2%) and 231 patients in Group B (41.8%). Third generation cephalosporines and sulfonamides showed the lower odds ratio for prescribing GI drugs than penicillins. Prescribers from Urology clinics showed more than twice odds ratio for the prescription of GI drugs compared to prescribers from internal medicine clinics. Conclusion: The results of this study showed that potentially unnecessary GI drug prescriptions for patients with acute cystitis were high in South Korea. The positive risk factors affecting the prescription of unnecessary GIs were not patient-related factor but healthcare facility and prescriber-related factors.

Background: With the increasing use of narcotic analgesics, the Ministry of Food and Drug Safety has been operating the National Narcotics Information Management System (NIMS) since 2018 in Korea. Some studies are related to the narcotic analgesics use, but the evaluation studies of system, including NIMS users are insufficient. Objective: This study evaluated the NIMS enforcement process through in-depth interviews on the experience of using NIMS of doctors and pharmacists who prescribe or dispense opioid analgesics. Methods: Participants in this study were selected through purposeful sampling as three doctors and two pharmacists in the metropolitan area. The interviews were conducted from August 27 to October 19, 2022. Each interview was analyzed using a phenomenological method. Results: Six components of this study included “Doctors and pharmacists come across drug abusers”, “They respond individually to drug abusers”, “They use NIMS tailored to the needs of system managers”, “They are concerned about the role of NIMS in practice settings”, “They face challenges against drug abusers” and “They find a way to utilize the system to deal with drug abusers.” The interviews confirmed that doctors and pharmacists used NIMS little in their work, and they only reported data. Therefore, it might be difficult for doctors and pharmacists to take measures for the safe use of narcotic analgesics. Conclusion: It is likely that adding data-feedback and medication-check function can reduce the abuse of narcotic analgesics. In the future, further studies on the evaluation of the empirical results of NIMS and review of systems in other countries will be required.

Objective: There is a growing interest in the safe use of medications in pregnant and breastfeeding women. Therefore, the purpose of this study is to find ways to improve education about safe medication use by investigating the status of medication use of pregnant and breastfeeding women, and by evaluating their knowledge, attitudes, and practices toward safe medication use. Methods: In this study, a self-report questionnaire was conducted on pregnant or breastfeeding women in Seoul and Gyeonggi Province. The questionnaire consisted of the following four sections; 1) sociodemographic characteristics of participants, 2) experience of medication use, 3) experience of being educated on safe medication use, and 4) knowledge, attitudes, and practices about medication use during pregnancy/breastfeeding. Results: A total of 203 participants were included in the analysis. Of these, 38.4% reported to take prescription medications during pregnancy and breastfeeding. Regarding education on safe medication use, nearly 90% of the participants answered that they were not educated or were unsure whether they had it. In the knowledge-attitude-practice evaluation on safe medication use, the knowledge level was the highest (mean, 4.45), followed by the attitude level (mean, 3.58) and the practice level (mean, 3.33). The preferred education method of the participants was online education using a computer or mobile phone application, etc. Conclusions: This study suggests that there is a need for systematic and effective education that can link knowledge of safe medication use with attitudes and practices in pregnant and breastfeeding women.

Background and Objective: With the advancement of cancer treatments and increased life expectancy, managing breakthrough cancer pain (BTcP) is essential to improve the quality of life for cancer patients. This study aimed to compare the major rapid onset opioids in Korea based on their characteristics and costs to determine the best option for each patient. Methods: Based on sales information from IQVIA-MIDAS, sublingual fentanyl tablet (SLF), fentanyl buccal tablet (FBT), and oral transmucosal fentanyl citrate (OTFC) were selected as the top three drugs for the treatment of BTcP in Korea, considering them the most comparable drugs. The cost and cost-pain relief ratio of the drugs for short-term (1 month) and long-term (1 year) treatment were compared and the ease of administration based on various factors, including pharmacokinetics, onset of action, and administration procedures were evaluated. Results: SLF was evaluated as the best overall in terms of rapid onset of action, ease of administration, and drug cost and also had the highest market share. SLF had the lowest cost pain relief ratio for both the initial and supplemental treatment for the 1- month pain intensity difference 15 (PID15) ratio. However, for the 1-month PID30 ratio, SLF was not superior to OTFC or FBT. The longer the breakthrough cancer pain duration, the more cost-effective the other rapid onset opioids. Conclusion: The rapid onset opioids that fit the patient’s breakthrough cancer pain pattern have the best cost-effectiveness.

Background: Mobile applications (apps) on dietary supplements can increase consumers’ access to information. However, it can lead to indiscriminate use of dietary supplements. This study aims to systematically review dietary supplement apps released in English and Korean and evaluate the quality of those apps. Methods: Through the app stores, apps on dietary supplements were systemically searched and examined. Two independent evaluators evaluated the apps and presented a mean score using the Mobile App Rating Scale (MARS). The correlation between MARS scores, user and evaluator ratings, and the number of secondary features of the apps were analyzed. Results: Of the 2,772 dietary supplement apps identified, 17 apps were included according to the selection criteria. The mean MARS score was 3.28 (standard deviation: 0.29) out of 5. Apps had higher scores in aesthetics and functionality dimensions, while engagement and information dimensions had lower scores. There was a positive correlation between the number of app downloads and information among MARS dimensions. The subjective evaluation also correlated with the information dimension. There was a positive correlation between the secondary features of the apps and MARS total score as well as the engagement dimension. Conclusion: The dietary supplement apps need to be managed at a higher level of quality to provide safe and reliable information to consumers. Especially, quality on information and engagement dimensions can be improved. Involvement of healthcare professionals in the app development, management with adequate referencing of information, and use of secondary features for enhanced user engagement can be helpful.

Objective: Adherence is an important component in the treatment of various diseases, and poor adherence to antidepressants in patients with major depressive disorder is common. Non-adherence can be more prevalent in elderly patients with multiple morbidity and polypharmacy, resulting in negative treatment outcomes. The purpose of this study was to analyze adherence to antidepressants in Korean elderly patients with major depressive disorder. Method: A retrospective study was conducted using the Korean National Health Insurance claims database, and the subjects of this study were patients aged 65 or older who received at least one prescription of antidepressant monotherapy for the treatment of major depressive disorder between January 1, 2020 and June 30, 2020. Adherence was measured using the proportion of days covered at 6 months after the initial antidepressant prescription date. Logistic regression analysis was used to identify factors associated with adherence. Results: A total of 416,766 patients were finally included in the study. Over half of patients were non-adherent (52.67%) to antidepressants. According to the multivariate logistic regression analysis, national health insurance or medical aid, taking selective serotonin reuptake inhibitors or selective norepinephrine reuptake inhibitors, and having comorbidities were significantly associated with greater rates of adherence in the study subjects. The highest adherence rate was observed in patients taking vortioxetine. Conclusion: There was a considerable rate of non-adherence in Korean elderly patients with major depressive disorder. Health care professionals should try to improve adherence in elderly patients with major depressive disorder.