全民健保糖尿病門診問題處方之分析－以北台灣為中心之研究

Inappropriate Prescriptions Issued to Ambulatory Diabetic Patients in National Health Insurance-A Study Based on Northern Taiwan

10.6288/TJPH2006-25-01-06

高淑真(Su-Cheng Kao)；李玉春(Yu-Chun Lee)；黃文鴻(Weng-Foung Huang)；李龍騰(Long-Ten Lee)

糖尿病 ； 健保門診 ； 問題處方 ； Diabetic mellitus ； NHI ambulatory visits ； inappropriate prescriptions

台灣公共衛生雜誌

25卷1期（2006 / 02 / 01）

58 - 64

繁體中文

目標：糖尿病病患常使用多重藥物，本研究探討健保糖尿病門診病人可能存在的問題處方。方法：採次級資料分析，以健保局北區分局提供之1997年9月至1998年6月醫療院所門診申報檔，擷取符合糖尿病及糖尿病相關併發症診斷碼之病人，篩選出處方箋中有使用降血糖藥者為研究對象，計有35,981名，處方總數為333,414張，而藥品醫令總數則為17,795,911筆。結果：糖尿病門診病患研究期間換算成每年每人平均看診次數14.6次，平均門診醫療費用11,822元，其中平均藥品費用佔78.6%（9,292元）；平約每處方用藥日數為18.41天，平均用藥筆數為4.1筆。在可判讀之口服降血糖藥處方中，劑量有問題之處方佔4.7%，重複用藥處方佔2.9%，處方出現重度、中度不良交互作用問題者分別佔3.02%與40.02%，整體有45.28%處方有前述三者之任一問題。以對數複回歸比較病人與不同醫院特質，其處方問題之勝算比皆有顯著差異，勝算比從診療科別的其他科1.09（95%信賴區間＝1.06-1.13）到區域醫院的8.39（95%信賴區間＝7.56-9.30）不等。結論：女性、年齡較大及有其他糖尿病慢性合併症的病人，出現問題處方的風險較高；醫院層級亦呈現不等程度的開立問題處方之風險，非醫學中心在超量處方開立的勝算比最高（介於3.83-8.39），相對於公立醫院，財團法人醫院勝算比為3.95（95%信賴區間＝3.66-4.26），和立醫院亦達1.21（信賴區間95%=1.13-1.30）。

Objectives: Diabetic patients generally are users of multiple medications. This study explored potential inappropriate prescription problems of ambulatory diabetic patients in the National Health Insurance (NHI). Methods: This study applied secondary data analysis based on a claim database (September 1997~June 1998) provided by the Northern Branch of the NHI Bureau by selecting patients diagnosed with diabetes mellitus (DM) and DM complications ICD-9 codes. 35, 981 patients receiving hypoglycemic medications were included, and a total of 333,414 prescriptions with 17,795,911 medicines written in the prescriptions were identified. Results: The diabetic patients in this study had an average of 14.6 ambulatory visits per year, with average medical expenses of NT$11,822, 78.6% (NT$9,292) attributable to pharmaceuticals. The average days per prescription were 18.41 days, and there were 4.1 drugs per prescription. In the valid prescriptions, 4.7% of prescriptions had over-dosage problems, while 2.9% of prescriptions had duplicated hypoglycemic medication. Besides, 40.02% had moderate and 3.02% had severe adverse drug interactions. Overall, there were 45.28% of prescriptions that had one or more kinds of problem prescriptions. After controlling the patient characteristics and types of providers, there was statistical significance in term of odds ratio in written inappropriate prescriptions. The odds ratio varied from 1.09 (95% CI=1.06-1.13) of the other clinical departments versus family medicine to 8.39 (95% CI=7.56-9.30) of metropolitan hospital versus academic medical center. Prescriptions with over-dosage were more likely found among hospitals and clinics than academic medical centers with odds ratios ranging from 3.83 to 8.39. Comparing with public hospitals, the odds ratios were 3.93 (95% CI=3.66-4.26) for non-proprietary hospitals and 1.21 (95% CI=1.13-1.30) for private hospitals. Conclusions: The odds ratio of patients who receive inappropriate prescriptions were higher for females, patients with older age, and patients with DM complications. There were also various risks among different types of providers.

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