Advertisement

International Journal of Clinical Pharmacy

, Volume 37, Issue 1, pp 76–85 | Cite as

Therapeutic duplicate prescribing in Korean ambulatory care settings using the National Health Insurance claim data

  • Dong-Sook Kim
  • Nam Kyung Je
  • Grace Juyun Kim
  • Hena Kang
  • Yoon Jin Kim
  • Sukhyang LeeEmail author
Research Article

Abstract

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.

Keywords

Ambulatory care Korea National Health Insurance claim data Therapeutic duplication 

Notes

Acknowledgments

The authors acknowledge the participation of physicians and pharmacists in the Delphi method to modify the TD criteria.

Funding

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

None.

Reference

  1. 1.
    Omnibus Budget Reconciliation Act of 1990. P.L.101–508.Google Scholar
  2. 2.
    Fulda TR, Lyles A, Pugh MC, Christensen DB. Current status of prospective drug utilization review. J Manag Care Pharm. 2004;10(5):433–41.PubMedGoogle Scholar
  3. 3.
    Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54(10):1516–23.PubMedCrossRefGoogle Scholar
  4. 4.
    Hanlon JT, Schmader KE, Semla TP. Update of studies on drug-related problems in older adults. J Am Geriatr Soc. 2013;61(8):1365–8.PubMedCrossRefGoogle Scholar
  5. 5.
    HIRA. Korean DUR Guideline. Seoul: HIRA; 2010. G000DE1-2013-91.Google Scholar
  6. 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. 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. 8.
    WHO. Anatomical therapeutic chemical (ATC) classification. Oslo: WHO Collaborating Centre for Drug Statistics Methodology; 2011.Google Scholar
  9. 9.
    HIRA. Korean Health Insurance Reimbursement Criteria for Pharmacy Benefit. Seoul: HIRA; 2013. G000J67-2013-76.Google Scholar
  10. 10.
    Haag S, Andrews JM, Katelaris PH, Gapasin J, Galmiche JP, Hunt R, et al. Management of reflux symptoms with over-the-counter proton pump inhibitors: issues and proposed guidelines. Digestion. 2009;80(4):226–34.PubMedCrossRefGoogle Scholar
  11. 11.
    Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA. 2003;289(19):2560–72.PubMedCrossRefGoogle Scholar
  12. 12.
    Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the national cholesterol education program adult treatment panel III guidelines. Arterioscler Thromb Vasc Biol. 2004;24(8):e149–61.PubMedCrossRefGoogle Scholar
  13. 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. 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. 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. 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. 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. 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
  19. 19.
    Meredith S, Feldman PH, Frey D, Hall K, Arnold K, Brown NJ, et al. Possible medication errors in home healthcare patients. J Am Geriatr Soc. 2001;49(6):719–24.PubMedCrossRefGoogle Scholar
  20. 20.
    Paulino EI, Bouvy ML, Gastelurrutia MA, Guerreiro M, Buurma H. Drug related problems identified by European community pharmacists in patients discharged from hospital. Pharm World Sci. 2004;26(6):353–60.PubMedGoogle Scholar
  21. 21.
    Leemans L, Veroeveren L, Bulens J, Hendrickx C, Keyenberg W, Niesten F, et al. Frequency and trends of interventions of prescriptions in flemish community pharmacies. Pharm World Sci. 2003;25(2):65–9.PubMedCrossRefGoogle Scholar
  22. 22.
    Azoulay L, Zargarzadeh A, Salahshouri Z, Oraichi D, Berard A. Inappropriate medication prescribing in community-dwelling elderly people living in Iran. Eur J Clin Pharmacol. 2005;61(12):913–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Cecilia DP, Chan S, Stephen CE, Klein JD. Antimicrobial prescription errors in hospitalized Children: role of antimicrobial stewardship program in detection and intervention. Clin Pediatr. 2009;48(5):505–12.CrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2014

Authors and Affiliations

  • Dong-Sook Kim
    • 1
  • Nam Kyung Je
    • 2
  • Grace Juyun Kim
    • 3
  • Hena Kang
    • 1
  • Yoon Jin Kim
    • 1
  • Sukhyang Lee
    • 4
    Email author
  1. 1.Research Team, Health Insurance Review and Assessment ServiceSeoulKorea
  2. 2.College of PharmacyPusan National UniversityBusanKorea
  3. 3.Department of Biomedical Science, College of MedicineSeoul National UniversitySeoulKorea
  4. 4.College of PharmacyAjou UniversitySuwonKorea

Personalised recommendations