폐렴상병에서의 항생제 사용의 질적 적정성 평가 연구

Abstract

[한글]이 연구는 항생제 적정성평가에서 적정처방평가지표를 개발하고 질적 평가를 시도하고자 일개 병원에 내원하여 폐렴상병으로 항생제를 원외처방 받은 환자를 대상으로 진료내역 분석 및 문헌고찰을 통해 적정처방평가지표를 개발하였고, 환자의 일반적 특성과 질환적 특성 및 의사의 일반적 특성에 따른 적정과 부적정, 처방율과 투약일수율을 파악하여 적정  부적정, 처방율 및 투약일수율에 영향을 미치는 요인을 분석하였다. 이 연구의 주된 결과로는첫째, 처방율과 투약일수율에 영향을 미치는 요인으로 환자의 특성 중 연령과, 의사의 특성 중 진료과목 및 전문의 여부였다. 5세 미만의 환자에서, 호흡기내과보다는 소아과가 그리고 전문의 보다는 전공의에서 처방율과 투약일수율이 높았다.둘째, 개발된 적정처방평가지표는 환자의 연령, 동반질환, 방사선판독소견, 청진소견, 체온, 증상 등 6가지 지표이다. 적정처방평가지표를 이용한 적정은 87.4%였으며, 부적정 12.6% 중 의무기록 미비로 인해 ‘모름’으로 분류된 10.1%를 제외하면 지표에서 제시한 적정기준을 벗어난 부적정 사례는 2.5%만 해당되므로 의무기록 충실도를 높이는 노력이 필요하다 하겠다.셋째, 적정과 부적정에 영향을 미치는 요인으로는 의사의 특성 중 연령과 진료분야 및 전문의 여부로, 연령과 진료분야에서는 동반질환 지표군에서, 전문의 여부에서는 체온 지표군에서 적정과 부적정례가 유의하였다.이 연구 결과를 종합해 볼 때, 현재 건강보험심사평가원에서 시행되고 있는 항생제 적정성평가에서 제 1상병을 기준으로 시행하고 있는 평가에 동반질환을 포함한 상병의 확대가 필요하며 소아 연령군은 세분류하여 적정여부를 평가하여야 할 필요가 있다. 또한 양적 평가의 수준에서 벗어나 질적 평가로 발전하기 위해서는 적정처방평가지표에 대한 연구가 지속되어 환자의 다양한 질환적 특성, 중증도 등을 고려한 표준화된 적정처방평가지표가 개발되어야 하겠다.

[영문]The purpose of this study is to analyze the data of the appropriateness and inappropriateness of antibiotics, the prescription rate of antibiotics, and the rate of medication days of antibiotics according to the patient's general characteristics and illness characteristics and the doctor's general characteristics. And then to find out some important factors influencing the appropriateness and inappropriateness of antibiotics, in order to develop the index of assessment of appropriate prescriptions for antibiotics and then to try its qualitative evaluation through analysis of medical care services and a review of the Literature of some patients with Pneumonia. Some important findings from this study are as follows:First, it could find out that the factors influencing the rate of prescription of antibiotics and the rate of medication days of antibiotics were the age of the patient in the patient's characteristics and the Clinical Departments and whether the doctor is a medical specialist or residents in the doctor's characteristics. Also, it was found out that both the rate of prescription of antibiotics and the rate of medication days of antibiotics were high in Pediatrics than in the Internal Medicine of respiratory organs, in residents than in a medical specialist, and in patients who were old less than 5 years.Second, the developed the index of assessment of appropriate prescriptions for antibiotics concerns itself with the patient's age, associated diseases, X-ray examination, auscultation opinion, body temperature, and symptoms. It appeared that the appropriateness utilizing the developed the index of assessment of appropriate prescriptions for antibiotics showed 87.4%, and in 12.6% which represents inappropriateness. The case of inappropriateness deviated from the appropriate standard suggested by the index showed itself with 2.5% except for 10.1% which belongs to the `unknown' for the insufficient medical records. Therefore it indicates that there should be the effort giving to completeness of medical records.Third, it appeared that those factors influencing appropriateness and inappropriateness in the doctor's characteristics were age, the Clinical Departments, and whether the doctor is a medical specialist or residents, Both the cases of appropriateness and inappropriateness were significant in the index group of associated diseases concerning age and the Clinical Departments, and in the index group of body temperature concerning whether the doctor is a medical specialist or residents.When synthesizing the findings of this study, it requires that the expansion of diseases including associated diseases in the evaluation being assessed, basing Priority Diagnosis in the evaluation of the appropriateness of antibiotics usage which is now being assessed by the Health Insurance Review Agency. And also it needs to evaluate whether there is appropriateness or not with subdividing the group of children's age. Also, in order to develop the standard of qualitative evaluation apart from the standard of quantitative evaluation, studies of the index of assessment of appropriate prescriptions for antibiotics should be continued and then the standardized index of assessment of appropriate prescriptions for antibiotics. It should be developed in that the patient's various illness characteristics, severity of disease etc. are considered.