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Abstract We assessed the effect of continuity of care (COC) on the frequency of hospitalization for Ambulatory care-sensitive conditions (ACSCs) to estimate the impact of COC and hearing disability relative to the controls. This retrospective cohort study used claim data of Korean National Health Insurance Service – National Sample Cohort 2.0 DB. We used propensity score matching to determine a control group for the hearing disability group by age, sex, and the Charlson Comorbidity Index. The hearing-impaired group included 720 participants, and the non-disabled control group, consisting of individuals without any form of disability, had 1,423 individuals. We used the frequency of hospitalization for ACSCs during one-year follow-up as the dependent variable for Poisson regression. We measured COC with the Bice–Boxerman Continuity of Care Index (COCI); higher COCI values represent better continuity of care, with COCI values ranging from 0 to 1. Poisson regression showed that disability status modifies the effect of COCI on the incidence of hospitalization. COCI = 1 reduced hospitalizations in people with hearing disabilities (adjusted Incidence Rate Ratio [aIRR]: 0.30, 95% CI: 0.20–0.44) but was not statistically significant for controls. In the COCI = 1 group, the effect of disability was not significant(aIRR: 1.10, 95% CI: 0.83–1.44). Compared to people without disabilities, enhanced COC for people with hearing disabilities was more effective in preventing hospitalizations for ACSCs.

Abstract Background This study analyzed the relationship between protective health behaviors and polypharmacy in individuals aged 65 years and older. Methods We used data from a nationwide survey (KNHANES) from 2012 to 2016 in conjunction with the health insurance claims databases. A total of 3297 adults aged 65 or older were included in the study. Polypharmacy was defined as more than 30 prescription days in 6 months with five or more different drugs. Health-related behaviors (BMI, smoking, drinking, regular walking, and living alone) were extracted for 6 months before measuring polypharmacy. We used multivariable logistic regression on polypharmacy for each protective health behavior, as well as a composite score of protective health behavior. Subgroup analysis was also conducted by age and sex. Results Among protective health behaviors, BMI

BackgroundInsomnia is a prevalent disorder that impacts quality of life and leads to significant economic costs. Treatment includes both non-medication and pharmacological interventions, with international guidelines recommending cognitive behavioral therapy for insomnia (CBT-I) as the first-line treatment.ObjectiveTo describe current insomnia treatment practices in South Korea, focusing on pharmacological and non-medication treatments, and to identify gaps in guideline implementation.MethodsThis cohort study used data from the Korea National Health Insurance Service-National Sample Cohort (NHIS-NSC) from 2002 to 2019 and identified 18,003 patients newly diagnosed with insomnia between 2015 and 2019. This study analyzed treatment patterns and utilization rates.ResultsOf the 18,003 patients, 16,181 (89.9%) received pharmacological treatment, resulting in 35,638 prescriptions. Zolpidem (60%) and benzodiazepines (30-40%) were the most prescribed medications. Most patients were treated in clinics, with consistent dosages and increasing treatment lengths. Psychotherapy claims rose from 3.20% in 2015 to 9.14% in 2019, particularly in general hospitals (22.06% to 48.37%), but remained low in clinics (1.26% to 2.08%).ConclusionPharmacological treatments dominate insomnia management in South Korea, with CBT-I being underutilized. Future efforts should focus on integrating non-pharmacological treatment into routine practice and exploring treatment risks and effectiveness based on patient demographics.

Background: There is limited research into the clinical implications of the coronavirus disease 2019 (COVID-19) pandemic for non-COVID-19 pneumonia in older adults, as well as their quality of care or outcomes. This study aims to assess the process and outcome quality of care for hospitalized older adult patients with pneumonia before and after the pandemic. Methods: A retrospective cohort of older adult patients (age ≥ 65) hospitalized for non–COVID pneumonia were recruited from five Korean hospitals (January 20, 2019, to January 19, 2021). The quality of care before and after the COVID-19 pandemic was evaluated. Results: A total of 7356 hospitalization episodes of older adult pneumonia were identified, and 978 cases (552 pre-pandemic and 426 during the pandemic) were analyzed. The pneumonia severity score was higher during the pandemic, and the waiting time from the emergency room to admission was also longer. Furthermore, the pneumonia mortality rate during the pandemic was higher than that in the pre-pandemic period (in-hospital mortality: 10.1% vs. 18.1%; 90-day mortality: 11.6% vs. 22.3%). A significantly higher mortality risk was observed during the pandemic than in the period prior (adjusted odds ratio: 1.74, 95% confidence interval: 1.14–2.63). Conclusions: While the quality of care for hospitalized pneumonia has been maintained during the pandemic, there has been an increase in mortality rates. Further investigations are needed to understand the underlying causes of this increase.

Abstract As the importance of utilizing real‐world data (RWD)/real‐world evidence (RWE) for supporting regulatory scientific decision‐making continues to grow, experiences and inputs from experts become crucial for developing a systematic and practice‐oriented plan for the use of fit‐for‐purpose RWD/RWE. This study aimed to survey relevant experts from government agencies, industries, and academia to identify prerequisites for the drug life cycle in Korea. The questionnaire comprised the following: (A) the definition and categories of RWD/RWE, (B) the suitability and feasibility of using RWD/RWE at each authorization stage by the types of RWD, and (C) the challenges and solutions for the use of RWD/RWE. A total of 46 respondents completed the online survey, with 89.1% of them having prior experience with RWD/RWE usage. A majority of respondents agreed that RWD can be obtained from various sources. Among these sources, the registry was the most suitable source. It is suitable to compensate for the limitations of randomized control trials and ensure quality in data collection. Though there was consensus among the respondents for the use of RWD/RWE in post‐marketing surveillance, the use of such data in new drug application (NDA) was disagreeable. Respondents considered it necessary to write a protocol in advance for RWD collection and RWE generation, for all RWD types. In conclusion, this study examined the perceptions of experts for RWD/RWE use at each approval stage of drugs. The results suggest that guidelines for the fit‐for‐purpose use of RWD/RWE should be developed via careful deliberation among experts in the future.

Abstract Background People with hearing impairment have many problems with healthcare use, which is associated with health literacy. Research on health literacy is less focused on people with hearing impairments. This research aimed to explore the levels of health literacy in people with hearing impairment, find the barriers to health literacy, and summarize methods for improving health literacy. Methods A systematic review was conducted using three databases (PubMed, Cochrane, and Embase) to search the relevant articles and analyze them. The studies were selected using pre-defined inclusion/exclusion criteria in two steps: first, selection by examining the title and abstract; and second, after reading the study in full. The Risk of Bias Assessment Tool for Nonrandomized Studies (RoBANS) was used to assess the quality of the articles. Results Twenty-nine studies were synthesized qualitatively. Individuals with hearing impairment were found to have lower health literacy, when compared to those without impairment, which can lead to a higher medical cost. Most of the people with hearing impairment faced barriers to obtaining health-related information and found it difficult to communicate with healthcare providers. To improve their health literacy, it is essential to explore new ways of accessing health information and improving the relationship between patients and healthcare providers. Conclusions Our findings show that people with hearing impairment have lower health literacy than those without. This suggests that developing new technology and policies for people with hearing impairment is necessary not to mention promoting provision of information via sign language. Trial registration OSF: https://doi.org/10.17605/OSF.IO/V6UGW . PROSPERO ID: CRD42023395556.

Background: The number of people with HIV/AIDS has consistently increased in Korea since the first case of HIV/AIDS infection was reported in 1985. The depressive symptoms of patients with HIV/AIDS may lead to medication non-adherence. This study sought to investigate the cross-sectional and longitudinal association between depression and antiretroviral treatment adherence in the Korean HIV/AIDS population. Methods: We included participants of the Korea HIV/AIDS cohort study between 2009 and 2017. All information was collected at the enrollment and every annual visit, including sociodemographic characteristics, health-related behaviors, HIV/AIDS infection-related factors, depression score, and frequency of skipped medication. We performed a cross-sectional analysis of 601 participants registered between 2009 and 2017. Longitudinal data were evaluated by panel regression analysis in 515 patients who registered from 2009 to 2013. Results: In cross-sectional analysis, the HIV/AIDS patients with depressive symptoms were more likely to be non-adherent (adjusted OR = 0.52, 95 % CI 0.34, 0.79, p = 0.002). Medication adherence was significantly associated with a health-related lifestyle; the adjusted odds ratio of the non-smoking and non-drinking group was 1.75 (95 % CI 1.05, 2.90, p = 0.031). The longitudinal panel regression model revealed a significant negative impact of depression on medication adherence (adjusted OR = 0.50, 95 % CI 0.30, 0.84, p = 0.009). Non-smoking and non-drinking participants were 2.31 times more likely to adhere to antiretroviral treatment (95 % CI 1.29, 4.15, p = 0.005). Conclusions: Our finding of depression and lifestyle modifications being significant contributors underscore the importance of proactive interventions to optimize the treatment outcomes of PLWH.

Background Policy-makers have proposed and implemented various cost-containment policies for drug prices and quantities to regulate rising pharmaceutical spending. Our study focused on a major change in pricing policy and several incentive schemes for curbing pharmaceutical expenditure growth during the 2010s in Korea. Methods We constructed the longitudinal dataset from 2008-2017 for 12 904 clinics to track the prescriber behavior before and after the implemented policies. Applying an interrupted time series model, we analyzed changes in trends in overall monthly drug expenditure and antibiotic drug expenditure per prescription for outpatient claims diagnosed with three major diseases before and after the policies’ implementation. Results Significant price reductions and incentives for more efficient drug prescriptions resulted in an immediate decrease in monthly drug expenditures in clinics. However, we found attenuated effects over the long run. The topspending clinics showed the highest rate of increase in drug costs. Conclusion Future policy interventions can maximize their effects by targeting high-spending providers.

Abstract Background Opportunities for paid employment provide meaningful ways for those with disabilities to participate in society and achieve financial independence. Although the onset age of disabilities can alter individuals’ attitudes toward accepting their disabilities and their desire for work, the lack of data limits relevant empirical research. The purpose of this study is to examine the effect of the onset age on employment, job security (permanent vs. temporary), and wage level among visually impaired adults in South Korea. Methods We used three years of the National Survey on Persons with Disabilities data, 2011, 2014, and 2017, and included 583 participants in this study. We used a logistic regression model for the employment status and a multinomial logistic regression model for job security. We analyzed log monthly wage by a multivariate linear regression model, which subdivided the age groups, with 20–49 years old denoting prime-aged (n = 245) and 50–64 years old denoting late-middle-aged (n = 338). For each age group, we conducted a sub-analysis by sex. Results For prime-aged adults, the employment probability decreased as the age of visual impartment onset increased, and women in particular experienced a lower employment rate for both permanent and temporary jobs when their disability onset age was above 25. However, among permanent employees, monthly wages were higher if the onset age was 25 + compared to when the onset age was 0–5 years old. In late middle-aged adults, adult onset disabilities were associated with higher odds of employment and higher wages for temporary jobs, implying these individuals worked unskilled or manual jobs. Conclusions In prime-aged adults, higher monthly wages among permanent employees showed that they were more likely to continue their original work, whereas in late-middle-aged adults, adult-onset disabilities were associated with a higher employment rate and higher wages for temporary jobs, suggesting the need for further investigation into job quality. These findings indicate a need for differentiated policy approaches considering the onset age of visual impairment to improve labor market outcomes throughout individuals’ lifespans.

Background d‐Dimer level is a marker of hypercoagulability, which is associated with thrombus formation and resolution. We investigated the value of d‐dimer levels in predicting outcomes of acute ischemic stroke in patients who underwent endovascular treatment (EVT). Methods We analyzed data of patients who underwent only EVT from the SECRET (Selection Criteria in Endovascular Thrombectomy and Thrombolytic Therapy) registry. d‐Dimer levels were routinely measured in 10 of 15 participating hospitals. Patients were grouped into tertiles (tertile 1, tertile 2, and tertile 3) according to d‐dimer levels (lowest, moderate, and highest, respectively). We compared serial scores on the National Institutes of Health Stroke Scale at baseline, on day 1 of hospitalization, and at discharge; functional outcome 3 months after EVT; and rate of mortality within 6 months after EVT. Results In the 170 patients, the median d‐dimer level was 477 ng/mL (interquartile range, 249–988 ng/mL). In tertile 3, the National Institutes of Health Stroke Scale score was higher at discharge than on day 1 of hospitalization. Poor outcome 3 months after EVT (modified Rankin Scale score, ≥3) was more common with high d‐dimer levels (26.3% of tertile 1, 57.1% of tertile 2, and 76.4% of tertile 3; P

Abstract Single-tablet regimens (STRs) should be considered for patients with HIV/AIDS to increase medication compliance and improve clinical outcomes. This study compared variations in the prescription trends between STRs and multiple-tablet regimens (MTRs) for treatment-naïve patients with HIV/AIDS after the approval of the new STRs, a proxy indicator for improvement in medication adherence. The medical and pharmacy claim data were retrospectively obtained from the Health Insurance Review and Assessment service, which contains basic information on the patients’ sociodemographic characteristics and treatment information for the entire Korean population. From 2013 to 2018, a total of 6737 patients with HIV/AIDS were included. Most patients were men (92.8%, n = 6251) and insured through the National Health Insurance (95.1%, n = 6410). The mean number of pills in their antiretroviral treatment regimens decreased from 2.8 ± 1.2 in 2013 to 1.2 ± 1.0 in 2018. After the first STR (EVG/c/TDF/FTC) was approved in 2014, prescription transitions from MTR to STR were observed among more than 38% of patients. In 2018, most treatment-naïve patients were prescribed STRs (91.2%). There was a time lag for STR prescription trends in non-metropolitan hospitals compared with those in metropolitan cities. Our data provide a valuable perspective for evaluating ART regimen prescription patterns on a national scale.

ObjectiveWe assessed the collateral impact of the COVID−19 pandemic on healthcare service use among people with disabilities.MethodsWe utilized the COVID−19 database from the Korean National Health Insurance Service claims from 2015 until June 2020. We included 5,850 people with disabilities and matched 5,850 without disabilities among those who were neither tested nor diagnosed with COVID−19. We used a quasi–experimental setting with a COVID−19 outbreak as an external event in a difference–difference estimation with matching controls.ResultsParticipants with disabilities recorded a larger decrease in the number of claims for total services (2.1 claims per 5 months) upon the COVID−19 pandemic's onset compared to those without disabilities (1.6 claims), and the difference–in–difference estimates were statistically significant (0.46 claims). The decline was driven by outpatient and emergency visits. The extent of the decline was large for the severe disability group overall. By disability type, those with a physical disability showed a statistically significant decline in the number of claims.ConclusionThe COVID−19 pandemic has had a collateral impact on people with disabilities' use of healthcare services. Continued assessment is needed regarding whether the collateral impact has been sustained or is following a different path.

Abstract Influenza is an important public health concern. We propose a new real-time influenza-like illness (ILI) surveillance system that utilizes a nationwide prospective drug utilization monitoring in Korea. We defined ILI-related claims as outpatient claims that contain both antipyretic and antitussive agents and calculated the weekly rate of ILI-related claims, which was compared to weekly ILI rates from clinical sentinel surveillance data during 2014–2018. We performed a cross-correlation analysis using Pearson’s correlation, time-series analysis to explore actual correlations after removing any dubious correlations due to underlying non-stationarity in both data sets. We used the moving epidemic method (MEM) to estimate an absolute threshold to designate potential influenza epidemics for the weeks with incidence rates above the threshold. We observed a strong correlation between the two surveillance systems each season. The absolute thresholds for the 4-years were 84.64 and 86.19 cases per 1000claims for claims data and 12.27 and 16.82 per 1000 patients for sentinel data. The epidemic patterns were more similar in the 2016–2017 and 2017–2018 seasons than the 2014–2015 and 2015–2016 seasons. ILI claims data can be loaded to a drug utilization review system in Korea to make an influenza surveillance system.

Abstract The eligibility of reperfusion therapy has been expanded to increase the number of patients. However, it remains unclear the reperfusion therapy will be beneficial in stroke patients with various comorbidities. We developed a reperfusion comorbidity index for predicting 6-month mortality in patients with acute stroke receiving reperfusion therapy. The 19 comorbidities included in the Charlson comorbidity index were adopted and modified. We developed a statistical model and it was validated using data from a prospective cohort. Among 1026 patients in the retrospective nationwide reperfusion therapy registry, 845 (82.3%) had at least one comorbidity. As the number of comorbidities increased, the likelihood of mortality within 6 months also increased (p

Abstract This study analyzed the impact of visual impairment on socioeconomic and physical health status and its heterogeneity by severity of visual impairment. We used nationally representative cohort data based on Korean national health insurance claims (2002–2013), which were extracted for 11,030 persons (2206 visually impaired, 8824 control). This was restructured as monthly data for each person (person-month). Multivariate and ordered logistic regressions were conducted, and the pre-impairment status between the visually impaired and non-visually impaired people was adjusted by difference-in-difference (DiD) estimation. Focusing on medical aid (a public healthcare service assistance program for people who cannot afford health insurance premiums), the DiD estimate showed that the likelihood of receiving aid was higher among visually impaired compared with non-impaired people. Mildly and severely visually impaired people were more likely to be medical aid recipients than their counterparts. The severely visually impaired group was more likely to be unemployed. The visually impaired group were less likely to have no comorbidity. Our findings show that the socioeconomic and physical health status of visually impaired people is more likely to deteriorate than that of their non-visually impaired counterparts following onset of impairment.

Abstract Background The dose response relationship of nine-year cumulative anticholinergic exposure and dementia onset was investigated using the Korean version anticholinergic burden scale (KABS) in comparison with the Anticholinergic Cognitive Burden Scale (ACB). We also examined the effect of weak anticholinergics in the prediction of dementia. Methods A retrospective case-control study was conducted comprising 86,576 patients after 1:2 propensity score matching using the longitudinal national claims database. For cumulative anticholinergic burden estimation, average daily anticholinergic burden score during the 9 years prior to dementia onset was calculated using KABS and ACB and categorized as minimal,

Abstract Background We evaluated the effect of statin use on new-onset type 2 diabetes among individuals without atherosclerotic cardiovascular disease (ASCVD) using nationally representative South Korean claims data (2002–2013, N = 1,016,820). Methods A total of 13,698 patients (statin users 5273, non-statin users 5273) aged 40–74 years, newly diagnosed with dyslipidemia but without any history of diabetes or ASCVD, were selected in 2005. We followed up the final sample until 2013 and evaluated the cumulative incidence of type 2 diabetes. We used extended Cox regression models to estimate the time-varying adjusted hazard ratios of statin use on new-onset type 2 diabetes. We performed further analyses based on the cumulative defined daily dose of statin received per year to evaluate the degree of risk compared to non-statin users. Results Over the mean follow-up period of 7.1 years, 3034 patients developed type 2 diabetes; the number of statin users exceeded that of non-users, demonstrating that statin use significantly increased the risk of new-onset type 2 diabetes. The risk of new-onset type 2 diabetes differed among statin users according to cDDD per year (adjusted HR = 1.31 [95% CI 1.18–1.46] for less than 30 cDDD per year; 1.58 [1.43–1.75] for 30–120 cDDD per year; 1.83 [1.62–2.08] for 120–180 cDDD per year; and 2.83 [2.51–3.19] for more than 180 cDDD per year). The diabetogenic effect of pitavastatin was not statistically significant, but the risk was the largest for atorvastatin. Long-term exposure (≥ 5 years) to statins was associated with a statistically significant increase in the risk of new onset type 2 diabetes in all statin subtypes explored, with the highest magnitude for simvastatin (HR = 1.916, 95% CI 1.647–2.228) followed by atorvastatin (HR = 1.830, 95% CI 1.487–2.252). Conclusions Statin use was significantly associated with an increased risk of new-onset type 2 diabetes. We also found a dose–response relationship in terms of statin use duration and dose maintenance. Periodic screening and monitoring for incident type 2 diabetes may be warranted in long-term statin users.

Background: A Body Shape Index (ABSI) and the Body Adiposity Index (BAI) are used to quantify body shape for adults. However, only a few studies have been conducted confirming whether ABSI or BAI is a better index for predicating hypertension and pre-hypertension in Chinese children and adolescents. Aim: To estimate scaling exponents for using ABSI with Chinese children and adolescents, comparing body shape indices used for predicting hypertension and pre-hypertension and determine which obesity indices can serve as predictors. Subjects and methods: Data from children and adolescents aged 7–17 years in the 2011 Chinese Health and Nutrition Survey were analysed. Partial correlation analysis and receiver operating characteristics analysis were applied. Results: The area under curve (AUC) values for all the predictors are better for differentiating hypertension than pre-hypertension. Body Mass Index (BMI) gave the largest AUC in both children and adolescents. ABSI and ABSI-(C) (ABSI for Chinese children and adolescents) were unable to differentiate hypertension or pre-hypertension in the population. BAI could only differentiate pre-hypertension in girls aged 7–12 years (AUC = 0.353, p

Previous studies, involving males and females, evaluated the effectiveness of green tea (GT) products in obesity. However, the evidence for its health benefits was lacking when considering females, only. The objective is to examine its effectiveness in the following indicators of obesity: body mass index (BMI), body weight, waist circumference, waist-to-hip ratio, and % body fat upon the intervention of GT products in nondiabetic overweight and obese females. For review and analysis, multiple databases were searched and a total of six studies was found. The results revealed that the treatment group who received GT products underwent statistically significant reductions in BMI, body weight, waist circumference and % body fat. The placebo group experienced decreases in BMI and body weight. Analyses of the differences in post-treatment changes between the groups indicated that, in all five indicators of obesity, there was no significant difference (p > 0.05, all).

Background: The high prevalence of chronic diseases has been an ongoing public concern. The psychological factors, including lack of social support and perceived lack of control, were found to be highly associated with an increased risk of the diseases. In fact, the effect of disease management programs (DMP) in patients diagnosed with chronic diseases were assessed in multiple studies to measure health-related quality of life (HR = QoL), which measured in the EuroQol 5-Dimension Questionnaire (EQ-5D) index score, also known as self-perceived health. Methods: The study was conducted using the Korea National Health and Nutrition Examination Survey (KNHANES) from 2007 to 2012 and through descriptive statistics and multiple linear regression to investigate the association of participation in DMP and the EQ-5D index score. Results: The results revealed that the subjects diagnosed with hypertension were shown to have a lower quality of life to those without the diagnosis ( P .05). Conclusion: Our study has assessed the association of DMP and EQ-5D index score in hypertensive patients only although it is still uncertain the effect of DMP on other chronic diseases therefore, further studies should be conducted to investigate the importance of DMP in Korea for the patients with such diseases in improving their quality of life.

Antiretroviral treatment (ART) adherence is highlighted in management of patients living with human immunodeficiency virus. In South Korea, ART medication research has rarely been conducted due to the low economic burden associated with government-funded treatment. This cross-sectional study aimed to compare the pill burden impact between ART regimen compliance and HIV-RNA viral load suppression. Data were collected from 2008 to 2016 at a general hospital in South Korea. A total of 210 HIV/AIDS treatment-naïve patients were grouped as follows: single-tablet regimen (STR, one tablet/day), mild pill burden (two-four tablets/day), and heavy pill burden (≥ five tablets/day). Patients were analyzed according to gender, age at index date, medical insurance type, comorbidities, depression, HIV/AIDS disease burden as indicated by HIV-RNA viral load and CD4, and laboratory variables. In a multivariate logistic regression model, the STR group demonstrated adherence 5.10 times more often than the heavy pill burden group. Females and patients with an initial viral load of 500,000 or more were 0.090- and 0.040-fold less adherent to the ART regimen. Among these patients, 95% or more of the MPR group were 7.38 times more likely to have a lower limit of detection (LLOD) of viral load suppression. The highest initial viral load group was 0.090-fold less likely to have an LLOD than the reference group. These results suggest that a single-tablet regimen could improve medication adherence and the clinical virologic outcome. Therefore, general population research on ART adherence and polypharmacy is needed.

Antibiotics induced acute kidney injury (AKI) risk in critically ill patients is not well known. This study aimed to evaluate the AKI development and clinical outcomes in critically ill adult patients treated with vancomycin (VAN) or combined with piperacillin-tazobactam (TZP) or meropenem (MEM). This was a retrospective study on critically ill adult patients who were given VAN, TZP or MEM and maintained for at least 48 h. The risk of AKI development and clinical outcomes were compared using the simple analysis and multivariate logistic regression. Three hundred forty patients were eligible. The incidence of any AKI was significantly higher in patients treated with VAN + TZP than those with VAN + MEM or VAN alone (52.7% vs. 27.7% vs. 25.7%; p < .0001). The adjusted odds of AKI increased 2.43-fold in VAN + TZP versus VAN, but not different in VAN + MEM versus VAN. However, AKI duration and recovery rate were not statistically different. In addition, all-cause death within 30 days after AKI onset was not significantly associated with antibiotic regimens. AKI incidence is higher in critically ill patients administered with VAN + TZP than those with VAN + MEM or VAN. However, no obvious evidence was found to prove that antibiotic-induced AKI leads to poor clinical outcomes.

Type 2 diabetes mellitus (T2DM) is a chronic disease that requires long-term therapy and regular check-ups to prevent complications. In this study, insurance claim data from the National Health Insurance Service (NHIS) of Korea were used to investigate insulin use in T2DM patients according to the economic status of patients and their access to primary physicians, operationally defined as the frequently used medical care providers at the time of T2DM diagnosis. A total of 91,810 participants were included from the NHIS claims database for the period between 2002 and 2013. The utilization pattern of insulin was set as the dependent variable and classified as one of the following: non-use of antidiabetic drugs, use of oral antidiabetic drugs only, or use of insulin with or without oral antidiabetic drugs. The main independent variables of interest were level of income and access to a frequently-visited physician. Multivariate Cox proportional hazards analysis was performed. Insulin was used by 9,281 patients during the study period, while use was 2.874 times more frequent in the Medical-aid group than in the highest premium group [hazard ratio (HR): 2.874, 95% confidence interval (CI): 2.588-3.192]. Insulin was also used ~50% more often in the patients managed by a frequently-visited physician than in those managed by other healthcare professionals (HR: 1.549, 95% CI: 1.434-1.624). The lag time to starting insulin was shorter when the patients had a low income and no frequently-visited physicians. Patients with a low level of income were more likely to use insulin and to have a shorter lag time from diagnosis to starting insulin. The likelihood of insulin being used was higher when the patients had a frequently-visited physician, particularly if they also had a low level of income. Therefore, the economic statuses of patients should be considered to ensure effective management of T2DM. Utilizing frequently-visited physicians might improve the management of T2DM, particularly for patients with a low income.

BackgroundSedative agents are avoided in older adults because of potential risks including cognitive impairment, fall, frailty, and mortality. However, no studies addressing both prediagnostic and postdiagnostic period of dementia have evaluated sedative agent usage over an extended period.ObjectivesTo describe a longitudinal change in sedative medication use before and after the diagnosis with dementia over 10 years compared to patients without dementia.MethodsWe conducted a retrospective cohort study using longitudinal claims data for senior national health insurance beneficiaries. After 1:4 propensity score matching, 54,165 older patients (≥60 years) were included. Difference-in-difference (DID) of sedative burden and use of sedative agents pre- and post-dementia diagnosis were estimated, and compared to those of patients without dementia. The yearly average daily sedative load (adSL) for each individual was calculated after applying duration, dose, and sedative score of medications from the sedative load model. The medication use for each sedative category was calculated using the defined daily dose (DDD) per 1000 patient-days.ResultsThe adSL in patients with dementia was consistently high before and after diagnosis and significantly increased after diagnosis, compared to those of patients without dementia (DID 0.123 unit/day, 95% confidence interval 0.117-0.129). DID of medication use was the highest for antidepressants (64.764 DDD/1000 patient-days) followed by Z-drugs and antipsychotics. Atypical antipsychotic and antidepressant usage steeply increased after dementia diagnosis.ConclusionSedative burden in patients with dementia before and after dementia diagnosis was higher than that in patients without dementia, and was further increased after dementia diagnosis.

Objectives: The goal of this study was to examine the association of various demographic and socioeconomic factors with risk factors for chronic kidney disease (CKD). Methods: We used nationally representative pooled data from the Korea National Health and Nutrition Examination Survey (KNHANES), 2007–2013. We estimated the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease equation. We defined CKD as a GFR

Inappropriate antibiotic use significantly contributes to antibiotic-resistance, resulting in reduced antibiotic efficacy and increasing physical burden and cost of disease. The goal of this study was to explore antibiotic usage patterns in South Korea using 2007-2014 health insurance claims data.We used the Health Insurance Review & Assessment Service data, which represents nearly the entire population of South Korea, to discern patterns in antibiotic prescribing practices. The daily dose, as defined by the World Health Organization ([defined daily doses]/1000 inhabitants/day, [DID]), was used as a measure of antibiotic use. Subgroup analyses were performed on the basis of patient characteristics (sex, age, and disease) and provider characteristics (type of medical institution).Antibiotic use in DID increased from 23.5 in 2007 to 27.7 in 2014. The ≤ 6 years old age group showed the highest level of usage at 59.21 DID in 2014, and showed an increasing trend each year. DIDs of beta-lactam antibacterials, penicillins (J01C), other beta-lactam antibacterials (J01D), lincosamides and streptogramins (J01F), quinolone antibacterials (J01M), and other antibacterials (J01X) increased over time.This study provides valuable statistics regarding antibiotic usage in South Korea; this is important for guiding health policy with regard to antibiotic usage. There is a need for further study exploring antibiotics use and resistance.

Purpose: The aim of this study was to systematically analyze the prescription trends of medical narcotic appetite suppressants in South Korea. Materials and Methods: Data was extracted from the Narcotics Information Management System dataset from 2020, which encompasses nationwide information concerning the use of medical narcotics. The selected variables for this study included the types of prescribed medical narcotic appetite suppressants, gender, age, region, and the category of medical institution. Regional prescription trends were compared by utilizing the defined daily doses for statistical purposes (S-DDD). Results: The prescription of medical narcotic appetite suppressants was predominantly for females (94%), with the highest prescription rates identified in the 30–40 age group. The majority of these prescriptions were dispensed by clinics. Within the category of narcotic appetite suppressants, phentermine and phendimetrazine were found to have higher prescription rates. Notably, the region of Daegu recorded the highest S-DDD value (12.66) in phentermine consumption. Conclusion: Our findings underscore the need for governmental policy and guidance to address the risks linked to the long-term use of medical narcotic appetite suppressants. This is crucial to ensure their safe and efficacious prescription and administration. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine the effect of visual impairment (VI) onset on the use of healthcare services across four types of institutions in South Korea. Materials and Methods: We utilized data from the National Health Insurance Service database from 2006 to 2015 for 714 persons who experienced VI onset in 2009–2012 and for 2856 matched persons for a 1:4 ratio of matching controls. We compared trends in healthcare use and expenditures for eye diseases at clinics, hospitals, general hospitals, and tertiary teaching hospitals using 3 years of data prior to and after the onset of VI. Results: The inpatient and outpatient healthcare expenditures of individuals with VI were higher than those without VI, peaking at the pre-VI onset period in tertiary teaching hospitals. During the pre-VI onset period, the proportion of healthcare expenditures attributed to eye diseases ranged 11%–40.8% among individuals with VI, but 1.9%–11% among individuals without VI at the four types of institutions. The differences in healthcare use between the pre- and post-VI periods were primarily observed in tertiary teaching hospitals for inpatient care. There was a peak in utilization of outpatient care in the year preceding VI onset at tertiary teaching hospitals, clinics, and hospitals, but there was a decrease in outpatient care over time during the post-VI period. Conclusion: Our findings suggest economic burden of healthcare in tertiary teaching hospitals during pre-VI onset period and a potential lack of regular management and continuity of care in post-VI periods. [ABSTRACT FROM AUTHOR]

Purpose: Polypharmacy can cause drug-related problems, such as potentially inappropriate medication (PIM) use and medication regimen complexity in the elderly. This study aimed to investigate the feasibility and effectiveness of a collaborative medication review and comprehensive medication reconciliation intervention by a pharmacist and hospitalist for older patients. Materials and Methods: This comprehensive medication reconciliation study was designed as a prospective, open-label, randomized clinical trial with patients aged 65 years or older from July to December 2020. Comprehensive medication reconciliation comprised medication reviews based on the PIM criteria. The discharge of medication was simplified to reduce regimen complexity. The primary outcome was the difference in adverse drug events (ADEs) throughout hospitalization and 30 days after discharge. Changes in regimen complexity were evaluated using the Korean version of the medication regimen complexity index (MRCI-K). Results: Of the 32 patients, 34.4% (n=11/32) reported ADEs before discharge, and 19.2% (n=5/26) ADEs were reported at the 30-day phone call. No ADEs were reported in the intervention group, whereas five events were reported in the control group (p=0.039) on the 30-day phone call. The mean acceptance rate of medication reconciliation was 83%. The mean decreases of MRCI-K between at the admission and the discharge were 6.2 vs. 2.4, although it was not significant (p=0.159). Conclusion: As a result, we identified the effect of pharmacist-led interventions using comprehensive medication reconciliation, including the criteria of the PIMs and the MRCI-K, and the differences in ADEs between the intervention and control groups at the 30-day follow-up after discharge in elderly patients. Trial Registration: (Clinical trial number: KCT0005994). [ABSTRACT FROM AUTHOR]