Earticle

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: Bipolar disorder displays a spectrum of manifestations, including manic, hypomanic, depressive, mixed, psychotic, and atypical episodes, contributing to its chronic nature and association with heightened suicide risk. Creating effective pharmacotherapy guidelines is crucial for managing bipolar disorder and reducing its prevalence. Treatment algorithms grounded in science have improved symptom management, but variations in recommended medications arise from research differences, healthcare policies, and cultural nuances globally. Methods: This study compares Korea’s bipolar disorder treatment algorithm with guidelines from the UK, Australia, and an international association. The aim is to uncover disparities in key recommended medications and their underlying factors. Differences in CYP450 genotypes affecting drug metabolism contribute to distinct recommended medications. Variances also stem from diverse guideline development approaches—expert consensus versus metaanalysis results—forming the primary differences between Korea and other countries. Results: Discrepancies remain in international guidelines relying on meta-analyses due to timing and utilized studies. Drug approval speeds further impact medication selection. However, limited high-quality research results are the main cause of guideline variations, hampering consistent treatment conclusions. Conclusion: Korea’s unique Delphi-based treatment algorithm stands out. To improve evidence-based recommendations, large-scale studies assessing bipolar disorder treatments for the Korean population are necessary. This foundation will ensure future recommendations are rooted in scientific evidence.

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: Medication’s benefits and harms require careful management. Laws mandate pharmacists to provide essential medication details since inadequate counseling may pose risks. This study explores public expectations for pharmacist-provided side effect information to enhance safety. Methods: A self-developed questionnaire was created for participant to self-report, refined through pilot surveys with experts and laypersons. Nineteen items were categorized into four sections, using closed-ended questions. Adults over 20, having obtained prescription medications within the past year, were surveyed via convenience sampling. Data analysis employed descriptive statistics and T-tests using IBM SPSS Statistics 21 and Microsoft Excel. Results: The study involved 189 participants, with a slightly higher proportion of females (59.3%) than males (40.7%), predominantly in their 20s (45.0%) and college graduates (57.1%). Health professionals represented 76.2% of respondents. Over half visited pharmacies at least 5 times yearly for prescriptions. Indirect experience with side effects was more common (30.2%) than direct experience (17.5%). Most (82.0%) showed interest in media-reported side effect events. Satisfaction with pharmacist-provided side effect explanations was low (59.7%), but importance was high (98.9%). Preferences favored combined verbal and written explanations (65.1%), with a majority desiring explanations for common but less serious side effects (82.5%). Healthcare professionals found explanations significantly more sufficient than non-professionals did. Older individuals, those living with elderly, and frequent pharmacy visitors attributed greater importance to pharmacist-provided explanations. Conclusion: Koreans view pharmacist-provided medication side effect explanations as vital but find current services lacking. Enhancements in content and delivery methods are needed in pharmacy counseling to meet public expectations.

Background: At the end of the‘Waste Drug Disposal Project’, collection and disposal of waste drugs remain a social issue. Objective: This study aimed to provide suggestions to improve the drug waste management system in Korea by comparing domestic and overseas relevant programs. Methods: This is a comparative study between South Korea, Australia, Canada, France, and the US. These overseas countries were selected because they have been operating waste drug management programs continuously to date. Comparison was conducted by a pre-determined analysis frame including legal regulation, enforcement program and its performance. Results: All selected countries except Australia had legal regulations on drug wastes. The US had the largest variety of drug waste disposal methods. Canada had recommended that pharmacies actively participate in drug waste withdrawal programs. France had the largest variety of methods to promote relevant programs, including window sticker, SNS, and app, as well as the highest level of awareness and participation. Australia had the lowest level of awareness and participation in pharmaceutical waste management programs. Pharmaceutical companies took responsibility of paying for these programs in the selected overseas countries. Conclusion: Further efforts should be made to establish a clear guideline including the role of pharmaceutical companies, and to develop various methods for the public to be aware of appropriate ways of disposing drug wastes in Korea.

Background: Interprofessional education (IPE) is important for collaboration between professionals in the team-based practices of the healthcare field. Objectives: This study aimed to examine pharmacy students across in Korea on the experience of IPE and the perceptions of the importance of interprofessional collaboration (IPC) and the need of IPE. Methods: A cross-sectional survey using a 20 questionnaire to pharmacy students nationwide was conducted from March to May 2019. Results: A total of 555 students from 32 pharmacy schools participated. They recognized that the importance of close pharmacist-medical doctor collaboration was an average of 5.38 points (out of 6 points), but the current level of pharmacist-to-medical doctor collaboration was an average of 2.51 points (out of 6 points), and the reasons for the insufficient IPC were the lack of an environment encouraging mutual cooperation (79.5%) and the psychological distance to the other professional (35.3%). They perceived the necessity of IPE between pharmacistmedical doctor was 4.95 points (out of 6 points), with the curriculum including how to cooperate with medical doctors (78.2%), communication skills (51.0%), and understanding of medical doctors’ functions (44.5%), etc. Only 52 respondents (9.4%) had experience in IPE. Respondents who recognized the importance of IPC (≥5 points) showed 4.44-fold higher agreement on the need for IPE than those who did not (≤4 points) (OR 4.44, 95% CI 2.56, 7.68). Conclusions: Further attention and discussion to add IPE program in the pharmacy school curriculum is necessary in order to cultivate pharmacists with sufficient professional collaboration capabilities.

Background: There was an important revision of the Korean Clinical Practice Guideline for Stroke (KCPGS) for antithrombotic therapy in patients with acute ischemic stroke in 2022. This review is to provide an updated information in this revision. Methods: The revision history by year after the first announcement was examined for each topic, focusing on antithrombotic therapy during acute phase which was revised in 2022. We compared before and after the revision, and investigated the clinical outcomes presented as evidence. It was also compared with the current U.S. guidelines. Results: The major changes about antiplatelet therapy are a clause stating that dual antiplatelet therapy with clopidogrel and aspirin initiated within 24 hours from the stroke onset and maintained for up to 21-30 days is recommended as an acute treatment, as well as the clause that antithrombotic therapy may be initiated within 24 hours after intravenous thrombolytics and that the use of glycoprotein IIb/IIIa receptor antagonists can be considered in highly selected patients as rescue therapy taking into account of benefit and risk. The change to the use of anticoagulants is that it may be reasonable to start oral anticoagulant between 4 and 14 days after stroke onset for patients with acute ischemic stroke and atrial fibrillation. Conclusions: It will be helpful in improving health outcomes for clinical pharmacists to be aware of the latest information for antithrombotic therapy and to actively use it in pharmaceutical care of stroke patients.

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.

The fourth industrial revolution, with its characteristics of “hyper-connectivity”, “hyper-intelligence” and “automation”, is a hot topic worldwide. It will fundamentally change industry, economy, and business models through technological innovations, such as big data, cloud computing, Internet of Things (IoT), artificial intelligence (AI), and 3D printing. In particular, the development of highly advanced information technology (IT) and AI is expected to replace human roles, thereby changing employment and occupation prospects in the future. Based on this, some predict that the profession of the pharmacist will soon disappear. To counter this, pharmacists’ attention and efforts are required to seek innovative transformations in their functions by responding sensitively and promptly to changes of the fourth industrial revolution. It is also necessary to recognize the new roles of pharmacists and to develop the competencies to perform them. The fourth industrial revolution is an inevitable change of the times. At this time, we should take comprehensive and open perspectives on how the future society will change economically, culturally, and socially, and use it as an opportunity to shape the new future of pharmacists.

Background: Daytime sleepiness, a common phenomenon among adolescents focused on academics, has negative effects on aspects such as growth and overall learning. However, research on various drugs and diseases affecting daytime sleepiness is lacking in the reality. Therefore, this study aims to investigate the factors influencing daytime sleepiness in adolescents with daytime sleepiness. Methods: This study was conducted through a survey of 2,432 middle and high school students, aged 14 to 19. The questionnaire consisted of information on socio-demographic characteristics, overall health status, and sleep patterns. The Pediatric Daytime Sleepiness Scale (PDSS), translated into Korean, was used to assess daytime sleepiness. Daytime sleepiness was measured by calculating the total score for each item of the PDSS, and divided into two groups based on the cutoff value of 19, which was the upper quartile. Results: We analyzed a total of 1,770 students including 799 boys and 971 girls. Students with a PDSS score of 19 or higher made up 33.3% of boys and 66.7% of girls. In multivariate analyses, females, smoking, poor self-reported health level, sleep after 12 am, not feeling refreshed in the morning, headache, muscle pain, and scoliosis increased the risk of daytime sleepiness significantly. The AUROC of PDSS, including significant factors in multivariate analyses, was 0.751 (95% CI 0.725~0.776). Conclusions: Daytime sleepiness in adolescents affects growth, academic performance, and emotional stability. Therefore, it is important to manage medications, diseases, and other factors that affect daytime sleepiness on a social level.