Therapeutic duplicate prescribing in Korean ambulatory care settings using the National Health Insurance claim data
- 277 Downloads
Background Duplicate prescribing is known to occur across health systems and is one of the most frequent drug related problems. Therapeutic duplication (TD) increases the risk of adverse drug reactions without additional therapeutic benefits. Objectives This study aimed to develop TD criteria concerning four drug categories which are acid-related disorder drugs, antimicrobials, antihypertensives, and lipid modifying drugs and to estimate the prevalence of therapeutic duplicate prescribing at the ambulatory care settings in Korea. Methods TD criteria were developed using the WHO anatomical therapeutic chemical classification and modified with an expert consensus panel using the Delphi method. The prevalence of TD including ingredient duplication (ID) of four drug categories was examined using National Health Insurance claim database including 15 million patients during one month in 2009 (December). TD was defined as prescribing medications within the same category in the developed TD criteria list. Results The numbers of patients who received acid-related disorder drugs, antimicrobials, antihypertensives, and lipid-modifying drugs in the study period were 10,049,292, 7,584,131, 4,349,945, and 1,425,292 respectively. In the field of acid-related disorder drugs prescribed, there were 0.3 % IDs and 2.5 % TDs within a prescription issued by one prescriber. There were 8.4 % IDs and 14.5 % TDs between prescriptions issued at different ambulatory visits. In the field of antimicrobial medicines, there were 0.1 % IDs and 2.6 % TDs within a prescription, while there were 5.0 % IDs and 7.6 % TDs between different prescriptions. Amongst the antihypertensives prescribed, there were 0.4 % IDs and 1.9 % TDs within a prescription, while there were 9.9 % IDs and 11.5 % TDs between prescriptions. Lastly, looking at lipid-modifying drugs prescribed, there were 0.3 % IDs and 0.5 % TDs within one prescription, while there were 8.9 % IDs and 9.4 % TDs between prescriptions. Conclusion The prevalence of duplicate prescribing was substantial in the ambulatory care setting which is to be improved using the TD criteria developed from this study in the national drug utilization review system in Korea.
KeywordsAmbulatory care Korea National Health Insurance claim data Therapeutic duplication
The authors acknowledge the participation of physicians and pharmacists in the Delphi method to modify the TD criteria.
This study was supported by a grant of the Korea Healthcare R&D Project, the Ministry of Health & Welfare, Republic of Korea (Grant No. HI13C0723).
Conflicts of interest
- 1.Omnibus Budget Reconciliation Act of 1990. P.L.101–508.Google Scholar
- 5.HIRA. Korean DUR Guideline. Seoul: HIRA; 2010. G000DE1-2013-91.Google Scholar
- 6.Kim DS, Kang HY, Jeon HL, Park CM, Park JH, Je NK. The study on DUR program evaluation methods. Seoul: HIRA; 2012. G000k31-2014-44.Google Scholar
- 7.Lee SO, Bae SJ, Kang H, Kim SK, Kim YJ. The study on Inappropriate drugs use analysis. Seoul: HIRA; 2012. 2012-06|.Google Scholar
- 8.WHO. Anatomical therapeutic chemical (ATC) classification. Oslo: WHO Collaborating Centre for Drug Statistics Methodology; 2011.Google Scholar
- 9.HIRA. Korean Health Insurance Reimbursement Criteria for Pharmacy Benefit. Seoul: HIRA; 2013. G000J67-2013-76.Google Scholar
- 13.Third Report of the National Cholesterol Education Program. (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III) final report. Circulation. 2002;106(25):3143–421.Google Scholar
- 14.Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: a pathophysiologic approach. 9th ed. New York: McGraw-Hil; 2014.Google Scholar
- 15.Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: a pathophysiologic approach. 8th ed. New York: McGraw-Hil; 2011.Google Scholar
- 16.Ko HK, Lee SH. Use of gastrointestinal drugs in patients without digestive symptoms. Korean J Clin Pharm. 2000;10(2):57–61.Google Scholar
- 17.NICE. Management of dyspepsia in adults in primary care. National Institute for Clinical Excellence; 2004. ISBN-10: 0-9540161-7-3.Google Scholar
- 18.Chui MA, Rupp MT. Evaluation of online prospective DUR program in community pharmacy practice. J Manag Care Pharm. 2000;6:27–32.Google Scholar