Journal of Preventive Medicine and Public Health

Original Articles

Prescription of Systemic Steroids for Acute Respiratory Infections in Korean Outpatient Settings: Overall Patterns and Effects of the Prescription Appropriateness Evaluation Policy: Taejae Kim, Young Kyung Do; J Prev Med Public Health. 2020;53(2):82-88. Published online November 18, 2019; DOI: https://doi.org/10.3961/jpmph.19.090

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Objectives
The objective of this study was to identify individual and institutional factors associated with the prescription of systemic steroids in patients with acute respiratory infections and to investigate the role of a policy measure aimed to reduce inappropriate prescriptions. Methods: We used data from the National Health Insurance Service-National Sample Cohort from 2006 to 2015 and focused on episodes of acute respiratory infection. Descriptive analysis and multiple logistic regression analysis were performed to identify individual-level and institution-level factors associated with the prescription of systemic steroids. In addition, steroid prescription rates were compared with antibiotic prescription rates to assess their serial trends in relation to Health Insurance Review and Assessment Service (HIRA) Prescription Appropriateness Evaluation policy. Results: Among a total of 9 460 552 episodes of respiratory infection, the steroid prescription rate was 6.8%. Defined daily doses/1000 persons/d of steroid increased gradually until 2009, but rose sharply since 2010. The steroid prescription rate was higher among ear, nose and throat specialties (13.0%) than other specialties, and in hospitals (8.0%) than in tertiary hospitals (3.0%) and other types of institutions. Following a prolonged reduction in the steroid prescription rate, this rate increased since the HIRA Prescription Appropriateness Evaluation dropped steroids from its list of evaluation items in 2009. Such a trend reversal was not observed for the prescription rate of antibiotics, which continue to be on the HIRA Prescription Appropriateness Evaluation list. Conclusions: Specialty and type of institution are important correlates of steroid prescriptions in cases of acute respiratory infection. Steroid prescriptions can also be influenced by policy measures, such as the HIRA Prescription Appropriateness Evaluation policy.

Summary

Korean summary
이 연구에서는 요양급여 청구자료를 기준으로 급성 상기도 감염에서 스테로이드를 처방하는 경우와 관련하여 다음과 같은 특징을 확인하였다. 첫째, 환자 특성과 기관 특성을 모두 고려하였을 때 진료과목과 기관의 종별 구분에서 감기 스테로이드 처방률은 상당한 변이를 보였다. 둘째, 약제급여적정성평가 항목에서 스테로이드가 제외된 직후 처방률이 시계열적으로 상승하였으며, 이는 처방 행태에 정책 요인이 중요한 영향을 미칠 수 있음을 뜻한다.

Citations

Citations to this article as recorded by

Assessment of systemic steroid use and its determinants among admitted patients at Debre Berhan University Hakim Gizawu Teaching Hospital
Abate Wondesen Tsige, Kalkidan Simegn, Dessale Abate Beyene, Kassahun Dires Ayenew, Yehualashet Teshome Wondmkun, Bedilu Linger Endalifer, Abyou Seyfu Ambaye, Samuel Berihun Dagnew, Siraye Genzeb Ayele
Scientific Reports.2024;[Epub] CrossRef
Measurement of Ambulatory Medication Errors in Children: A Scoping Review
Lisa Rickey, Katherine Auger, Maria T. Britto, Isabelle Rodgers, Shayna Field, Alayna Odom, Madison Lehr, Alexandria Cronin, Kathleen E. Walsh
Pediatrics.2023;[Epub] CrossRef
Trends and Patterns of Systemic Glucocorticoid Prescription in Primary Care Institutions in Southwest China, from 2018 to 2021
Xiaoyi Li, Zhen Zeng, Xingying Fan, Wenju Wang, Xiaobo Luo, Junli Yang, Yue Chang
Risk Management and Healthcare Policy.2023; Volume 16: 2849. CrossRef
Effects of monthly evaluations on the rates of irrational antimicrobial prescription in the outpatient and emergency departments at Ningbo No. 6 Hospital, Ningbo, China
Qiong Yang, Fangfang Yuan, Li Li, Jianfeng Jin, Junhong He
European Journal of Medical Research.2022;[Epub] CrossRef
Systemic glucocorticoid prescriptions pattern and factors of inappropriate use in primary care institutions of Southwest China
Xiaobo Luo, Shitao Yu, Zhen Zeng, Xunrong Zhou, Yuxi Liu, Lei Wang, Jiaqi Hu, Yue Chang
Frontiers in Public Health.2022;[Epub] CrossRef
Effects of Antiviral Therapy and Glucocorticoid Therapy on Fever Duration in Pediatric Patients with Influenza
Ji Yoon Han, Eun Ae Yang, Jung-Woo Rhim, Seung Beom Han
Medicina.2021; 57(12): 1385. CrossRef

Reliability and Validity of the Appropriateness Evaluation Protocol for Public Hospitals in Korea: Clara Lee, Stella Jung-Hyun Kim, Changwoo Lee, Euichul Shin; J Prev Med Public Health. 2019;52(5):316-322. Published online September 12, 2019; DOI: https://doi.org/10.3961/jpmph.19.125

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Abstract Summary PDF

Objectives
This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea.
Methods
In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared.
Results
The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively.
Conclusions
Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.

Summary

Korean summary
이 연구는 우리나라 공공병원을 대상으로 Appropriateness Evaluation Protocol(AEP) 도구를 적용가능성을 검토하기 위해 실시되었다. 우리나라의 지역공공병원 입원자료(2016년 5월 기준)를 층화무작위추출을 통해 1,500건을 추출하였으며, 이중 37개 병원의 560건에 대해 입원적정성을 분석하였다. 의무기록사 2인은 AEP 도구를 이용하여 입원적정성을 각각 검토하였고, 의사 1인은 전문가적 판단을 기준으로 검토하였다. AEP 도구의 적용가능성을 판단하기 위해 의무기록사간 그리고 의무기록사-의사간 일치율을 산출하였다. 의무기록사간 일치율은 거의 완벽한 수준으로 나타났고, 의무기록사-의사간은 중등도의 일치율을 보였다. 민감도, 특이도는 각각 0.86 그리고 0.56이었다. 이러한 결과는 AEP 도구가 우리나라 공공병원의 입원적정성을 평가하기 위한 일관적이고 정확한 도구임을 제시한다.

Citations

Citations to this article as recorded by

Development of an evaluation index system for inappropriate hospital admissions after colorectal cancer surgery in the context of enhanced recovery after surgery
Jianan Sun, Qing Zhang, Jingyu Ma, Dongxue Wang, Luyao Zhang, Liang He, Xuan Sun, Yuchen Guo, Yinquan Zhao, Yanpeng Xing, Haiyan Hu, Quan Wang
BMC Nursing.2025;[Epub] CrossRef
Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study
Diego San Jose-Saras, Jorge Vicente-Guijarro, Paulo Sousa, Paloma Moreno-Nunez, Jesús María Aranaz-Andres, Cristina Díaz-Agero Pérez, Miguel Ignacio Cuchi Alfaro, Juan Manuel Ramos López, Mercedes García Haro, Abelardo Claudio Fernández Chávez, Cornelia B
BMC Medicine.2023;[Epub] CrossRef
Inappropriate Hospital Admission According to Patient Intrinsic Risk Factors: an Epidemiological Approach
D. San Jose-Saras, J. Vicente-Guijarro, P. Sousa, P. Moreno-Nunez, M. Espejo-Mambié, J. M. Aranaz-Andres
Journal of General Internal Medicine.2023; 38(7): 1655. CrossRef
Strategies to improve the flow of admissions and hospital stays: a Delphi study of an adaptation of the Appropriateness Evaluation Protocol (AEP)
A. Morillo-Rodríguez, S. Alonso-Fernández, J.M. Mòdol Deltell, B. Soldevila Madorell, Ll. Benito-Aracil, D. Parés
Revista Clínica Española (English Edition).2023; 223(5): 270. CrossRef
Estrategias para mejorar el flujo de ingresos y estancias hospitalarias: adaptación del cuestionario Appropriateness Evaluation Protocol (AEP): estudio Delphi
A. Morillo-Rodríguez, S. Alonso-Fernández, J.M. Mòdol Deltell, B. Soldevila Madorell, Ll. Benito-Aracil, D. Parés
Revista Clínica Española.2023; 223(5): 270. CrossRef

The epidemiology of delays in a teaching hospital.: Yoon Kim, Kun Sei Lee, Chang Yup Kim, Yong Ik Kim, Young Soo Shin, Sang Il Lee; Korean J Prev Med. 1993;26(4):650-660.

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Abstract PDF: This study aims to describe the causes of medically unnecessary hospital stay at a teaching tertiary hospital, using modified version of Delay Tool in which the causes of delay are divided into six major categories ; delay related to test scheduling, test results, surgery, medical staff, patient/family, and administration. For the analysis of hospital stay, 6,479 inpatient-days were reviewed in two medical and four surgical departments for one month. Initially inappropriate hospital stays were identified using Appropriateness Evaluation Protocol(AEP), and causes of delay listed in Delay Tool were assigned to each of them. In both medical and surgical services, the most important cause of delay was related to medical staffs, ranging from 3.6% to 51.6% of total inpatient days. Next important category was delay related to test scheduling in medical services(4.7~9.2%), and delay related to surgery in surgical services(7.3~15.0%). Among subcategories of delay related to medical staffs, delay due to conservative care was the most important cause of inappropriate hospital stay(2.9~46.4%). Each clinical departments had different distribution among delay categories, which could not be fully justified by their clinical characteristics. The Delay Tool would be helpful in exploring factors related to the inefficient use of hospital beds. As a measurement tool of inappropriate hospital stay, however, the Delay Tool should be refined in the definitions of categories and its contents.; Summary

An Appropriateness Evaluation of Cesarean Section, Cholecystectomy, and Admission in Pediatric Pneumonia.: Chang Yup Kim, Hyeong Sik Ahn, Young Seong Lee, Young Dae Kwon, Yong Ik Kim, Young Soo Shin; Korean J Prev Med. 1992;25(4):413-428.

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Abstract PDF: The aim of this study was to evaluate the appropriateness of some kinds of surgery and admission, such as cesarean section (C/S), cholecystectomy, and pediatric pneumonia. For appropriateness evaluation, we ourselves developed some criteria, which were included in the category of explicit and linear criteria, with the assistance of specialists of relevant clinical field. The evaluation of appropriateness was performed by two family physicians. The major findings were as follows: 1. For ceserean section, 77.6% of deliveries were determined to be 'appropriate', but the level of appropriateness was not significantly different among hospitals between hospital groups by size. The most frequent indication of C/S was repeated operation, followed by cephalopelvic disproportion(CPD). The labor trials for vaginal delivery among repeated C/S and CPD cases were performed in 24.5% of pertinent deliveries. 2. About 73.8% of cholecystectomy cases was appropriate to one of the surgical indications, without significant differences among hospitals. Of surgical indications, 'sufficiently frequent and intense symptom recurrence' was the most frequent, and 'confirmed acute cholecystitis' was the second. 3. Of children admitted due to pneumonia, only 57.4% of cases satisfied admission criteria, and the level of appropriateness of admission was different among hospitals. The common reasons for admission were 'failure to initial treatment', 'suspected bacterial pnermonia', 'young infant', etc. We could find that there were differences of quality among hospitals in some procedures, especially in the pediatric pneumonia and labor trial before C/S, which suggested that the implementation of quality assurance activities would be necessary in this country. In this study, we used some simple and primitive research tools and the numbers of subjects and tracer procedures were limited. So advanced studies with plentiful subjects and more representative diseases or procedures should be tried.; Summary

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