觀察某區域醫院ivabradine治療慢性心衰竭病人的療效

Efficacy of Ivabradine Treatment in Chronic Heart Failure Patients in a Regional Hospital: An Observational Study

10.6314/JIMT.202002_31(1).07

李紀慧(Chi-Hui Lee)；林庭光(Tin-Kwang Lin)；李易達(Yi-Da Li)；郭孟璇(Meng-Hsuan Kuo)

Ivabradine ； 心衰竭（Heart failure） ； 標準化（Standard）

內科學誌

31卷1期（2020 / 02 / 01）

40 - 48

繁體中文

主要探討在醫囑電腦系統建立規範對ivabradine治療慢性心衰竭病人影響指標。本研究為重複性橫斷式研究主要分成建立使用規範醫囑電腦系統前及後兩個時期。實施前資料收集為2016年1月至12月使用ivabradine病人，以回溯性評估處方合理性，系統建置期間為2017年8月至11月藉由跨職類小組會議討論及建立醫囑系統開立藥品之標準診斷碼。實施後資料收集為2017年12月至2018年11月使用ivabradine病人，比較建立藥品使用規範醫囑系統實施前後適應症及劑量合理性比率。療效評估同一病人使用藥品前後12個月心跳速度之差異性、因心衰竭急診入院人次及導致住院相關醫療費用。共收入93人，不合理適應症比率從實施前12.5%下降至0%（P = 0.013），系統建置後避免合併使用交互作用發生比率從實施前3%下降至0%（P = 0.88），起始劑量未依據仿單建議劑量比率從實施前25.0%下降至18.9%（P = 0.48）。使用ivabradine確實可以降低病人心跳及因心衰竭導致入院次數。建置醫囑電腦系統之標準化確實可以有效改善在病歷上不合理適應症之比率。

This study was conducted to evaluate the impact indicators of computerized physician order entry (CPOE) standard intervention on the use of ivabradine in patients with heart failure (HF). This study was divided into two periods of repetitive cross-sectional analyses: before and after CPOE intervention. Data were collected between 2016 and 2018 describing ivabradine use. Standard diagnostic codes for ivabradine were established by a multidisciplinary team. The CPOE standard system was set to remind doctors of the appropriate diagnostic codes of ivabradine for patients. The indications and dosage irrationality rates before and after the intervention (12 months) were evaluated. Data on symptoms, hospitalizations for HF, and hospitalization costs were collected. The study was conducted with 93 patients with HF. After 12 months, the irrationality rate indicator decreased from 12.5% to 0% (P = 0.013). The rate of avoiding the combination medication decreased from 3% to 0% (P=0.88). The rate of inappropriate dosage decreased from 25% to 18.9% (P=0.48). Using ivabradine can reduce the heart rate of patients and the number of hospitalization admission for HF. Establishing the CPOE standard system can improve the irrationality rate of indications.