개인정신치료 수가개편과 우울증, 불안장애 환자의 복약이행도 분석

Abstract

Objective: Although Individual psychotherapy (IP) is an effective treatment for mental disorder, 73.5% of IPs lasted less than 15 minutes. To encourage more extensive IP, the National Health Insurance Service (NHIS) differentiated the payment system for the IP from 3 to 5 groups in July 2018. We sought describe the impact of the changed payment system on the Medication Adherence and Persistence of depression and anxiety disorder patients in Korea in 2018. Methods: We used national patient claims database from National Health Insurance Service (NHIS) the from 2016 to 2019. Patients who were primarily diagnosed with psychiatry and utilized the Individual Psychotherapy treatment (NN011, NN012, NN013, NN001, NN002, NN003, NN004, NN005) during the study period were identified. The demographic characteristics and the Medication Adherence and Persistence in the pre-policy (before the change of the payment system, before July 2018) and the post-policy (after the change, after July 2018) were presented. Chi-square test (categorical variable) was used to analyze the effect of reorganized Individual psychotherapy. All data collection and statistical analysis was performed using SAS 9.4 (SAS Institute, Cary, NC, USA) Results: Total 240,992 patients in depression and total 156,174 patients in anxiety disorder met our inclusion criteria. The mean MPR and mean Persistence in depression patients increased significantly from 0.22, 38days in the pre-policy to 0.34, 58days respectively(p<.001). The mean MPR and mean Persistence in anxiety disorder patients increased significantly from 0.20, 35days in the pre-policy to 0.31, 51days respectively(p<.001). Logistic regression analysis showed that patients who are pro-policy were significantly associated with greater rates of adherence in depression and anxiety disorder (odds ratio (OR)=5.424 and 5.312, respectively) and persistence adherence in depression and anxiety disorder (OR=2.313 and 2.25, respectively) during the 6 months. Conclusion: The changed payment system is associated with the increased Medication Adherence and Persistence of depression and anxiety disorder patients. (This study was supported by a research fund from the National Center for Mental Health, Ministry of Health & Welfare, Republic of Korea.);목표: 개인심리치료(IP)가 정신질환자에게대한 효과적인 치료법이지만 IP의 73.5%가 15분 미만의 상담치료가 다수였다. IP의 치료활성화를 장려하기 위해 2018년 7월 IP에 대한 수가개편으로 3개에서 5개 그룹으로 세분화하였습니다. 한국에서 2018년 우울증 및 불안장애 환자의 복약이행도 및 치료지속성에 대한 수가개편으로 인한 영향을 연구하고자 하였습니다. 방법: 2016~2019년까지의 국민건강보험공단 전수자료를 사용했습니다. 정신건강의학과에서 개인정신치료받은 환자를 포함하였습니다. 수가개편 인전과 이후의 인구학적 특징, 복약이행도 및 치료지속성에 대하여 비교하였습니다. 통계분석에는 Chi-square test 를 사용하였으며, 모든 데이터 수집 및 통계분석은 SAS 9.4 (SAS Institute, Cary, NC, USA)를 이용하여 분석하였습니다. 결과: 총 240,992명의 우울증 환자와 총 156,174명의 불안장애 환자가 포함기준에 충족되었습니다. 우울증환자의 평균 MPR과 치료지속성은 0.22/ 38일에서 0.34/58일로 수가개편 후 유의하게 증가하였습니다. 불안장애환자의 평균 MPR과 치료지속성은 0.20/ 35일에서 0.31/ 51일로 수가개편 후 유의하게 증가하였습니다. Logistic regression 분석 결과, 우울증, 불안장애 환자 모두 수가개편 후에 Adherent군과 Persistent군이 높았습니다. (우울증: odds ratio (OR)=5.424 and 5.312, respectively), (불안장애: OR=2.313 and 2.25, respectively) 결론; 정신치료 수가개편은 우울증 및 불안자앵 환자의 복약이행도 및 치료지속성의 증가와 관련이 있습니다. (본 연구는 보건복지부 국립정신건강센터 연구비를 지원받아 수행되었습니다.)