Earticle

Due to the lack of demand-side measures, pharmaceutical cost containment policies have not efficiently achieved cost savings in Korea. Rational use of medicines (RUM) has been partially introduced, yet its impact was minimal to improve prescribing behaviors in a manner of pursuing evidence and cost-effectiveness. Given that irrational prescribing including extravagant prescribing, over-prescribing, under-prescribing, incorrect prescribing, and multiple prescribing, are easily observed, the RUM should be considered and systematized as an alternative to the current flood of new drugs incorporating advanced technology and high cost in order to ensure patient safety and sustainability of the healthcare system in the future.

BACKGROUNDS To find early liver cancer, the ministry of health and welfare has conducted surveillance targeting high-risk patients. In 2017, the incidence rate of liver cancer in surveillance was 0.9%, suggesting that a broad patient group was included in surveillance. In this study, to reduce surveillance patients, a prediction model with zero-falsenegative was developed using a machine learning. METHODS To develop the model, we used 2016 Health Insurance Review & Assessment Service-National Patients Sample utilized to the Common Data Model (CDM). This study targeted patients who did not have a severe condition of liver cancer in surveillance. The number of the target was 13,703 cases. The covariates for the model were identified by a chi-square test conducted on gender, age group, condition between a case and control group. LASSO was performed to develop the model. RESULTS Gender, age group, forty diseases were selected as a covariate. The model has an AUC of 0.745, a negative rate of 4.0%, a specificity of 4.5%, and a PPV of 11.8% with zerofalse- negative. CONCLUSION It might be possible to refine surveillance and save the budget of the National Health Insurance Service, and governments.

BACKGROUND This study was examined to identify the relationship among knowledge, attitude, and compliance with preventive behavior on COVID-19 by students of a Pharmacy College. OBJECTIVE The purpose of this study is to determine the knowledge level, attitude, and risk perception of the students of the pharmacy college regarding the prevention of COVID-19 infection, and to understand how these factors affect the performance of preventive actions. METHODS A structured survey was used. Survey questionnaire included knowledge (6 items), attitude (8 items), and risk awarness (1 item), and preventive action performance (10 items) of pharmacy students. RESULTS 92 out of 143 students of Pharmacy College, Inje University participated, and the response rate was 62.3%. The performance of preventive actions against COVID-19 showed that the higher the knowledge level of COVID-19, the more important the attitude toward the COVID-19 code of conduct, and the higher the perception of the risk of being infected with COVID-19. Among them, prevention behavior performance was found to have a higher correlation with knowledge order. CONCLUSION When creating an educational program for pharmaceutical students on COVID-19, it is judged that it would be good to organize activities that not only transmit knowledge about COVID-19, but also instill the importance of rules of conduct and raise risk perception.

OBJECTIVES To investigate government programs or policies that aim to manage and monitor drug use in patients in foreign countries. METHODS We conducted a literature review by searching electronic documents through domestic literature databases, various search engines, and official websites of public organizations or government-related agencies in charge of programs or policies. The contents of investigation included the purpose of the program, how to operate, eligible patients or drug class, action by physicians or pharmacists, and rewards for participation. RESULTS We identified national or regional programs for rational and safe use of drug in patients in 6 countries. The UK implemented ‘Medical Use Review’ and ‘New Medicine Service’ as a pharmacist’s service and ‘High Risk Drug Monitoring’ as a general practitioner’s service. In Ontario, Canada, ‘MedsCheck’ programs encourage pharmacists to manage drug therapy of patients. ‘Long-Term Condition service’ in New Zealand consisted of pharmacist’s services for patients who received prescriptions for multiple long-term conditions and had adherence issues. The US has the ‘Medication Therapy Management’ program that includes a review of prescription history, evaluation of drug therapy, and patient counseling. CONCLUSION Various programs for drug use management were being operated in accordance with the public health system of each country. A comprehensive program for appropriate and safe drug use in patients is also needed in Korea.

OBJECTIVE To investigate association between the use of sedative-hypnotics and fractures in the Korean elderly population. METHODS We used 2016 Health Insurance Review and Assessment Service-the Adult Patient Sample (HIRA-APS) data, which was extracted from 20% of the elderly patients over 65 years old. We excluded individuals diagnosed with fractures, osteoporosis, or car accidents during a wash-out period (i.e., January - March). Then, patients with at least one claim record with prescribed sedative-hypnotics from April through December were defined as those treated with sedative-hypnotics. If there was at least one claim record with a diagnosis of fracture during the same time period, then we defined a fracture incidence. RESULTS A multivariate logistic regression analysis result showed that the elderly prescribed with sedative-hypnotics had a significantly higher risk of fractures by 1.337 times (adjusted odds ratio (aOR)=1.337, 95% confidence interval (CI): 1.316-1.358). Also, the risk of fractures significantly increased as the number of sedative-hypnotics prescribed increased (aOR of taking one sedative-hypnotics vs. none: 1.255 (95% CI: 1.233-1.278), aOR of two sedativehypnotics: 1.464 (95% CI: 1.425-1.504), and aOR of three or more sedative-hypnotics: 1.720 (95% CI: 1.652-1.790). CONCLUSION A significant association between the use of sedative-hypnotics and the risk of fractures and its dose-response relationship among Korean elderly population were confirmed based on a nationally representative data of HIRA-APS. Our results suggest careful use of sedative-hypnotics to treat elderly population. Especially, when it is necessary to prescribe multiple sedative- hypnotics for the elderly, a close monitoring should be accompanied to prevent fractures.

In the United States, the Risk Evaluation and Mitigation Strategy (REMS) has been implemented since 2007, and generic products of original drugs under REMS are also subject to REMS. South Korea has adopted a Risk Management Plan (RMP) to ensure drug safety throughout the drug’s product cycle in 2015. This paper reviews the current status of a Shared System (SS) REMS in the United States and the SS REMS of isotretinoin (iPLEDGE program) to understand its implications for Korea's RMP system. In the United States, generic manufacturers can either individually implement REMS or collaborate with original manufacturers. SS REMS benefits the shareholders by reducing the work burden of participating companies, sharing development costs, and maintaining consistency of risk management in clinical settings. The iPLEDGE program is the oldest and most representative SS REMS. It was developed to prevent potential fetal exposure to isotretinoin. A central, systematic risk management website inspects isotretinoin distribution, prescribing, dispensing, and utilization. For example, prescribing isotretinoin is permitted when the results of pregnancy lab tests and contraceptive methods are entered into the website. Since more generic drugs are expected to enter the market in Korea, the SS of RMP can be a systematic approach to maintain a coherent risk mitigation strategy and reduce the operational burden of manufacturers.