Kim Taejae, Do Young Kyung
Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea.
Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Korea.
J Prev Med Public Health. 2020 Mar;53(2):82-88. doi: 10.3961/jpmph.19.090. Epub 2019 Nov 18.
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.
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.
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.
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.
本研究的目的是确定与急性呼吸道感染患者全身用类固醇处方相关的个体和机构因素，并调查一项旨在减少不适当处方的政策措施的作用。
我们使用了2006年至2015年国家健康保险服务-全国样本队列的数据，并重点关注急性呼吸道感染发作情况。进行描述性分析和多因素逻辑回归分析，以确定与全身用类固醇处方相关的个体层面和机构层面因素。此外，将类固醇处方率与抗生素处方率进行比较，以评估它们与健康保险审查和评估服务（HIRA）处方适宜性评估政策相关的序列趋势。
在总共9460552例呼吸道感染发作中，类固醇处方率为6.8%。类固醇的限定日剂量/1000人/天在2009年前逐渐增加，但自2010年以来急剧上升。耳鼻喉专科的类固醇处方率（13.0%）高于其他专科，医院的类固醇处方率（8.0%）高于三级医院（3.0%）和其他类型机构。在类固醇处方率长期下降之后，自2009年HIRA处方适宜性评估将类固醇从其评估项目清单中删除以来，该比率有所上升。抗生素处方率未观察到这种趋势逆转，抗生素仍在HIRA处方适宜性评估清单上。
专科和机构类型是急性呼吸道感染病例中类固醇处方的重要相关因素。类固醇处方也可能受到政策措施的影响，如HIRA处方适宜性评估政策。
