J Korean Med Sci.  2011 Nov;26(11):1461-1468. 10.3346/jkms.2011.26.11.1461.

Overlapping Medication Associated with Healthcare Switching among Korean Elderly Diabetic Patients

• Shin JY
• Choi NK
• Jung SY
• Kim YJ
• Seong JM
• Park BJ

• KMID: 1123446
• DOI: http://doi.org/10.3346/jkms.2011.26.11.1461

Abstract

This study was performed to describe the patterns of healthcare switching with overlapping use of anti-diabetic medication in the elderly using the Korea Health Insurance Review and Assessment Service's claims data. The study subjects were ambulatory elderly diabetic patients (ICD-10, E10-14) receiving at least one oral anti-diabetic drug or insulin, and visiting healthcare facilities more than two times between January and December 2005. A total of 457,975 elderly diabetic ambulatory care patients were identified. The mean of visiting frequencies was 9.0 ( +/- 3.6) and switching frequencies was 1.5 ( +/- 0.8) during 2005. Switching group consisted of 33% of total study subject. Healthcare switching was common in female patients who were older, and had treated polytherapy more in rural areas. The movement among primary care medical services was very common among the patients in the switching group (52.6%). A statistically significant correlation was observed between the healthcare switching and concomitant drug use (rho = 0.96), and overlapping days (rho = 0.57). The use of overlapping anti-diabetic medication increased with the extent of healthcare switching. Further, frequent switching of healthcare between primary clinics was observed. Efforts should be made to establish continuity for the elderly diabetic patients with the identification of frequent switching with overlapping medication.

Keyword

Elderly People; Diabetes Mellitus; Healthcare Seeking Behaviour; Prescribing Pattern; Co-medication; Delivery of Health Care; Referral and Consultation; National Health Insurance

MeSH Terms

Aged
Aged, 80 and over
*Continuity of Patient Care
Delivery of Health Care
Diabetes Mellitus/*drug therapy
Female
Humans
Hypoglycemic Agents/*administration & dosage
Male
*Medication Errors
Physician's Practice Patterns
Republic of Korea

Figure

• 

  Fig. 1 The distribution of individuals by the number of visiting frequency (VF), and switching frequency (SF) per year (A) The number of patients in 2005 was plotted as a function of the number of VF and SF. (B) Distribution crosstable. Data are the VF and SF in 2005. (1A): Visiting frequency (VF) among Korean elderly diabetic patients. Total N=457,975, median=10; mean = 9.0; starndard deviation = 3.6; range: 2-62. (2A): The switching frequency (SF) among Korean elderly diabetic patients. Total N = 457,975, median = 1; mean = 1.5; starndard deviation = 0.8; range: 0-17.

• 

  Fig. 2 Trends in antidiabetic medication according to the number of switching frequency (SF) among elderly diabetic patients during 2005. (A) Y1 = Mean number of total prescription days (TPD), Y2 = The proportion of the patients who had TPD longer than 365days (TPD365) (B) Y1 = The proportion of the patients that had concomitant drug use (CDU), that is, those with prescriptions from different who healthcare providers during the same period overlapping more than two days, Y2 = The extent of the overlapping days (OD), all were plotted as a function of the number of SF; Spearman's rho (TPD) = 0.99, P < 0.001; Spearman's rho (TPD365) = 0.92, P < 0.001; Spearman's rho (CDU) = 0.96, P < 0.001; Spearman's rho (OD) = 0.57, P = 0.05.

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