보건행정학회지 (Health Policy and Management)

  • 제20권2호
  • /
  • Pages.128-143
  • /
  • 2010
  • /
  • 1225-4266(pISSN)
  • /
  • 2289-0149(eISSN)
한국보건행정학회 (Korean Academy of Health Policy and Management)
권호 표지
DOI QR코드

DOI QR Code

우리나라 성인 2형 당뇨환자에서의 외래 투약 순응도와 관련요인 분석

Oral Antihyperglycemic Medication Adherence and Its Associated Factors among Ambulatory Care with Adult Type 2 Diabetes Patients in Korea

  • 홍재석 (건강보험심사평가원 심사평가정책연구소) ;
  • 강희정 (건강보험심사평가원 심사평가정책연구소)
  • Hong, Jae-Seok (Health Insurance Review & Assessment Policy Institute, Health Insurance Review & Assessment Service) ;
  • Kang, Hee-Chung (Health Insurance Review & Assessment Policy Institute, Health Insurance Review & Assessment Service)
  • 투고 : 2010.04.28
  • 심사 : 2010.06.17
  • 발행 : 2010.06.30
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objectives : This study aims to estimate the oral antihyperglycemic medications adherence among ambulatory care with adult type 2 diabetes patients and to identify factors affecting the medication adherence in Korea. Methods : This study used the Korean National Health Insurance Database. Study population was 40,082 patients who were 20 years of age or older and first diagnosed with type 2 diabetes (ICD-10: E11) in 2004. The patients were followed up for two years in order to measure adherence with oral antihyperglycemic medications. The level of medication adherence was measured by the medication possession ratio (MPR). Results : The average MPR in the study population was 49.5%. The appropriate adherence rate (MPR$\geq$80%) was 29.4% and showed variation according to the characteristics of individual patients. Multiple logistic regression analysis revealed that the odds of appropriate adherence increased with female (OR:1.21, CI:1.14-1.27), older age, increasing ambulatory care visits, health insurance (OR:1.53, CI:1.33-1.76), decreasing ambulatory care providers, using a specialized general hospital as their main attending medical institution (OR:10.08, CI:8.96-11.33), having co-morbidity, using polytherapy (OR:1.07, CI:1.01-1.13). Conclusions : The medications adherence for patient with type 2 diabetes is low in Korea, and shows variation according to the characteristics of patients. For proper management of diabetes, health care policy is expected to be enacted to improve medications adherence continuously. In particular, more intensive management is needed for patients with low medications adherence. Also, health care policy makers need to develop the program to induce health care utilization by a patient to be more concentrated with the same provider.

키워드

참고문헌

  1. 김남순. 우울증 외래 환자의 항우울제 투약 순응도와 건강결과와의 연관성. [박사논문]. 서울 ; 서울대학교 대학원 ; 2008.
  2. 김재용, 김혜영, 김화영, 민경환, 박성원, 박이병 등. 우리나라 당뇨병환자의 외래이용 지속성이 건강결과(health outcome)와 의료비에 미치는 영향 : 건강보험자료 분석 결과. 당뇨병 2006 ; 30(5) : 377-387 https://doi.org/10.4093/jkda.2006.30.5.377
  3. 김재용. Diabetes in Korea 2007. 건강보험심사평가원. 대한당뇨병학회. 서울 ; 2007.
  4. 대한당뇨병학회. 당뇨병 진료지침. 서울 ; 2007.
  5. 박재현. 우리나라 건강보험 가입자의 고혈압약 투약 순응도와 이에 영향을 미치는 요인. [박사논문]. 서울 ; 서울대학교 대학원 ; 2006.
  6. 박종혁, 신영수, 이상이, 박재현. 고혈압약 투약을 시작한 장애인의 투약 순응도와 이에 영향을 미치는 요인. 예방의학회지 2007 ; 40(3) : 249-258. https://doi.org/10.3961/jpmph.2007.40.3.249
  7. 신숙연, 송현종, 장선미, 성예나. 고지혈증약제(지질저하제) 평가지표 개발. 건강보험심사평가원. 서울 ; 2009.
  8. 신영석. 의료급여 환자의 의료이용 적정성 고찰. 보건복지포럼 2006 ; 4 : 91-101.
  9. 장선미, 송현종, 신숙연, 성예나, 김성옥, 김창수. 고혈압약제(혈압강하제) 평가지표 개발. 건강보험심사평가원. 서울 ; 2008.
  10. 홍재석, 강희정, 김재용. 우리나라 외래서비스 이용 당뇨환자의 특성에 따른 당화혈색소(HbA1c)검사 시행률 변이 분석. 보건행정학회지 2009 ; 19(1) : 49-61(b). https://doi.org/10.4332/KJHPA.2009.19.1.049
  11. 홍재석, 김재용, 강희정. 우리나라 성인 2형 당뇨환자의 외래진료 지속성과 관련요인 분석. 보건행정학회지 2009 ; 19(2) : 51-70(a). https://doi.org/10.4332/KJHPA.2009.19.2.051
  12. 홍재석, 김재용, 이은미. 만성질환 적정관리 현황 평가방안 연구. 건강보험심사평가원. 서울 ; 2008.
  13. Agency for Healthcare Research and Quality. Diabetes care quality improvement : A resource guide for state action. AHRQ;2004. Available from : http://www.qualityindicators.ahrq.gov
  14. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2004 ; 27(1) : S15-35. https://doi.org/10.2337/diacare.27.2007.S15
  15. Balkrishnan R, Rajagopalan R, Camacho FT, Huston SA, Murray FT, Anderson RT. Predictors of medication adherence and associated health care costs in an older population with type 2 diabetes mellitus : a longitudinal cohort study. Clin Ther 2003 ; 25(11) : 2958-2971. https://doi.org/10.1016/S0149-2918(03)80347-8
  16. Center for Chronic Disease Preventive and Control : Diabetes in Canada. Health Canada. CDC ; 2002.
  17. Cramer JA. A systematic review of adherence with medications for diabetes. Diabetes Care 2004 ; 27(5) : 1218-1224. https://doi.org/10.2337/diacare.27.5.1218
  18. DiMatteo MR. Variations in patients' adherence to medical recommendations : a quantitative review of 50 years of research. Med Care 2004 ; 42(3) : 200-209. https://doi.org/10.1097/01.mlr.0000114908.90348.f9
  19. Duncan JC, Rogers R. Medication compliance in patients with chronic schizophrenia : implications for the community management of mentally disordered offenders. J Forensic Sci 1998 ; 43(6) : 1133-1137.
  20. Gary TL, Crum RM, Cooper-Patrick L, Ford D, Brancati FL. Depressive symptoms and metabolic control in African-Americans with type 2 diabetes. Diabetes Care 2000 ; 23(1) : 23-29. https://doi.org/10.2337/diacare.23.1.23
  21. Gill JM, Mainous AG 3rd, Diamond JJ, Lenhard MJ. Impact of provider continuity on quality of care for persons with diabetes mellitus. Ann Fam Med 2003 ; 1(3) : 162-170. https://doi.org/10.1370/afm.22
  22. Hearnshaw H, Lindenmeyer A. What do we mean by adherence to treatment and advice for living with diabetes? A review of the literature on definitions and measurements. Diabet Med 2006 ; 23 : 720-728. https://doi.org/10.1111/j.1464-5491.2005.01783.x
  23. Hertz RP, Unger AN, Lustik MB. Adherence with pharmacotherapy for type 2 diabetes : a retrospective cohort study of adults with employer-sponsored health insurance. Clin Ther 2005 ; 27(7) : 1064-1073. https://doi.org/10.1016/j.clinthera.2005.07.009
  24. Ho PM, Rumsfeld JS, Masoudi FA, McClure DL, Plomondon ME, Steiner JF, Magid DJ. Effect of medication nonadherence on hospitalization and mortality among patients with diabetes mellitus. Arch Intern Med 2006 ; 166(17) : 1836-1841. https://doi.org/10.1001/archinte.166.17.1836
  25. International Diabetes Federation. Diabetes Atlas, 2nd edition ; 2003.
  26. Karve S, Cleves MA, Helm M, Hudson TJ, West DS, Martin BC. An empirical basis for standardizing adherence measures derived from administrative claims data among diabetic patients. Med Care 2008 ; 46(11) : 1125-1133. https://doi.org/10.1097/MLR.0b013e31817924d2
  27. Lau DT, Nau DP. Oral antihyperglycemic medication nonadherence and subsequent hospitalization among individuals with type 2 diabetes. Diabetes Care 2004 ; 27(9) : 2149-2153. https://doi.org/10.2337/diacare.27.9.2149
  28. McCombs JS, Nichol MB, Newman CM, Sclar DA. The costs of interrupting antihypertensive drug therapy in a Medicaid population. Med Care 1994 ; 32(3) : 214-226. https://doi.org/10.1097/00005650-199403000-00003
  29. Schectman JM, Nadkarni MM, Voss JD. The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care 2002 ; 25(6) : 1015-1021. https://doi.org/10.2337/diacare.25.6.1015
  30. Shah NR, Hirsch AG, Zacker C, Taylor S, Wood GC, Stewart WF. Factors associated with first-fill adherence rates for diabetic medications : a cohort study. J Gen Intern Med 2009 ; 24(2) : 233-237 https://doi.org/10.1007/s11606-008-0870-z
  31. Skaer TL, Sclar DA, Markowski DJ, Won JK. Effect of value-added utilities on prescription refill compliance and Medicaid health care expenditures - a study of patients with non-insulin-dependent diabetes mellitus. J Clin Pharm Ther 1993 ; 18(4) : 295-299. https://doi.org/10.1111/j.1365-2710.1993.tb00591.x
  32. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Med Care 2005 ; 43(6) : 521-530. https://doi.org/10.1097/01.mlr.0000163641.86870.af
  33. The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993 ; 329(14) : 977-986. https://doi.org/10.1056/NEJM199309303291401
  34. UK Prospective Diabetes Study (UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). Lancet 1998 ; 352(9131) : 854-865. https://doi.org/10.1016/S0140-6736(98)07037-8
  35. Wagner EH, Sandhu N, Newton KM, McCulloch DK, Ramsey SD, Grothaus LC. Effect of improved glycemic control on health care costs and utilization. JAMA 2001 ; 285(2) : 182–189.

피인용 문헌

  1. Effects of Diabetic Camp in Type 2 Diabetic Patients vol.83, pp.2, 2012, https://doi.org/10.3904/kjm.2012.83.2.210
  2. Relationship Between Continuity of Ambulatory Care and Medication Adherence in Adult Patients With Type 2 Diabetes in Korea vol.52, pp.5, 2014, https://doi.org/10.1097/MLR.0000000000000110
  3. Concept Analysis for Psychological Insulin Resistance in Korean People with Diabetes vol.46, pp.3, 2016, https://doi.org/10.4040/jkan.2016.46.3.443