Patient factors affecting frequent potential unnecessary injection use in outpatient care setting

Abstract

This study aimed to investigate the prevalence of potential unnecessary injection (PUNI) and to identify factors associated with frequent PUNI uses. Population-based National Health Insurance claims data for outpatient health care settings during the six month period from July to December 2011 were retrospectively reviewed. Patients aged 18–80 without severe diseases and visited healthcare centers more than 25 times during study period were included. PUNI was defined as injection used where substitutable oral agents were available and where injection uses are not warranted. A total of 801,532 patients were included for this analysis. Among them, 29.0 % were frequent PUNI user defined as ≥10 PUNI used during the study period. In multivariate logistic regression results revealed significant associations between frequent PUNI use and several patient and healthcare utilization factors. Women than men, elderly than younger people, residents in rural areas than in big cities, and more frequent visitors to healthcare centers than less frequent visitors were more likely to be frequent PUNI users. Larger number of healthcare center utilized and higher out-of-pocket expense level showed significant lower risks of frequent PUNI uses. Identified factors associated with frequent PUNI use in this study could be the targets to develop programs for reducing injection overuse.

This is a preview of subscription content, log in to check access.

Fig. 1

References

  1. Abkar, M.A., I.M. Wahdan, A.A. Sherif, and Y.A. Raja’a. 2013. Unsafe injection practices in Hodeidah governorate, Yemen. Journal of Infection and Public Health 6: 252–260.

    PubMed  Article  Google Scholar 

  2. Barnes, M.G., C. Ledford, and K. Hogan. 2012. A “needling” problem: shoulder injury related to vaccine administration. Journal of the American Board of Family Medicine 25: 919–922.

    PubMed  Article  Google Scholar 

  3. Choi, K.H., S.M. Park, J.H. Lee, and S. Kwon. 2012. Factors affecting the prescribing patterns of antibiotics and injections. Journal of Korean Medical Science 27: 120–127.

    PubMed Central  PubMed  Article  Google Scholar 

  4. Dong, L., D. Wang, J. Gao, and H. Yan. 2011. Doctor’s injection prescribing and its correlates in village health clinics across 10 Provinces of Western China. Journal of Public Health (Oxford) 33: 565–570.

    Article  Google Scholar 

  5. Dziekan, G., D. Chisholm, B. Johns, J. Rovira, and Y.J. Hutin. 2003. The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings. Bulletin of the World Health Organization 81: 277–285.

    PubMed Central  PubMed  Google Scholar 

  6. Fiechter, R., M. Batschwaroff, and D. Conen. 2005. Anaphylactic reaction after Fe-injection. Praxis 94: 209–212.

    CAS  PubMed  Article  Google Scholar 

  7. Gupta, E., M. Bajpai, P. Sharma, A. Shah, and S. Sarin. 2013. Unsafe injection practices: a potential weapon for the outbreak of blood borne viruses in the community. Annals of Medical and Health Sciences Research 3: 177–181.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  8. Gyawali, S., D.S. Rathore, P.R. Shankar, and K.V. Kumar. 2013. Strategies and challenges for safe injection practice in developing countries. Journal of Pharmacology and Pharmacotherapeutics 4: 8–12.

    PubMed Central  PubMed  Article  Google Scholar 

  9. Health Insurance Review and Assessment Service. 2012. Evaluations on Drug Reimbursement Appropriateness in the first half of 2012.

  10. Hwang, J.H., D.S. Kim, S.I. Lee, and J.I. Hwang. 2007. Relationship between physician characteristics and their injection use in Korea. International Journal for Quality in Health Care 19: 309–316.

    PubMed  Article  Google Scholar 

  11. Kahn, L.H., and B.A. Styrt. 1997. Necrotizing soft tissue infections reported with nonsteroidal antiinflammatory drugs. Annals of Pharmacotherapy 31: 1034–1039.

    CAS  PubMed  Google Scholar 

  12. Kaipilyawar, S.B. 2005. History, magnitude and rationality of injection use–a compilation. Journal of the Indian Medical Association 103: 206–208.

    PubMed  Google Scholar 

  13. Kim, D.S., J.H. Hwang, and J.I. Hwang. 2012. A multi-level analysis of injection requests and associated patient characteristics in the Korean acute-care outpatient setting. Korean Journal of Clinical Pharmacy 22: 13–20.

    Google Scholar 

  14. Kotwal, A. 2005. Innovation, diffusion and safety of a medical technology: a review of the literature on injection practices. Social Science and Medicine 60: 1133–1147.

    PubMed  Article  Google Scholar 

  15. Lee, I.H., S. Park, and E.K. Lee. 2014. Sociodemographic factors influencing the use of injections in South Korean outpatient care. Pharmacoepidemiology and Drug Safety 23: 51–59.

    PubMed  Article  Google Scholar 

  16. Logez, S., G. Soyolgerel, R. Fields, S. Luby, and Y. Hutin. 2004. Rapid assessment of injection practices in Mongolia. American Journal of Infection Control 32: 31–37.

    PubMed  Article  Google Scholar 

  17. Mclaws, M.L., S. Ghahramani, C.J. Palenik, V. Keshtkar, and M. Askarian. 2014. Assessment of injection practice in primary health care facilities of Shiraz, Iran. American Journal of Infection Control. doi:10.1016/j.ajic.2013.09.006.

    Google Scholar 

  18. National Health Insurance Service, Health Insurance Review & Assessment Service. 2013. National Health Insurance Statistical Yearbook 2012. Seoul.

  19. Rajasekaran, M., G. Sivagnanam, P. Thirumalaikolundusubramainan, K. Namasivayam, and C. Ravindranath. 2003. Injection practices in southern part of India. Public health 117: 208–213.

    CAS  PubMed  Article  Google Scholar 

  20. Ramtahal, J., S. Ramlakhan, and K. Singh. 2006. Sciatic nerve injury following intramuscular injection: a case report and review of the literature. Journal of Neuroscience Nursing 38: 238–240.

    PubMed  Article  Google Scholar 

  21. Reynolds, L., and M. Mckee. 2011. Serve the people or close the sale? Profit-driven overuse of injections and infusions in China’s market-based healthcare system. International Journal of Health Planning and Management 26: 449–470.

    PubMed  Article  Google Scholar 

  22. Schwartz, N.A., M.A. Turturro, D.J. Istvan, and G.L. Larkin. 2000. Patients’ perceptions of route of nonsteroidal anti-inflammatory drug administration and its effect on analgesia. Academic Emergency Medicine 7: 857–861.

    CAS  PubMed  Article  Google Scholar 

  23. Shatsky, M. 2009. Evidence for the use of intramuscular injections in outpatient practice. American Family Physician 79: 297–300.

    PubMed  Google Scholar 

  24. Simonsen, L., A. Kane, J. Lloyd, M. Zaffran, and M. Kane. 1999. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bulletin of the World Health Organization 77: 789–800.

    CAS  PubMed Central  PubMed  Google Scholar 

  25. Vong, S., J.F. Perz, S. Sok, S. Som, S. Goldstein, Y. Hutin, and J. Tulloch. 2005. Rapid assessment of injection practices in Cambodia, 2002. BMC public health 5: 56.

    PubMed Central  PubMed  Article  Google Scholar 

Download references

Acknowledgments

We thank the National Health Insurance Service for providing us with the NHI data for this study. This work was supported by the NHIS (2012).

Conflict of interest

All authors certify that there is no conflict of interest with any financial, personal or other relationships with other people or organizations that could inappropriately influence or be perceived to influence this study.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Ju-Yeun Lee.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sohn, H.S., Jang, S., Han, E. et al. Patient factors affecting frequent potential unnecessary injection use in outpatient care setting. Arch. Pharm. Res. 38, 1389–1396 (2015). https://doi.org/10.1007/s12272-014-0406-5

Download citation

Keywords

  • Potential unnecessary injection
  • Overuse
  • Outpatient