智能障礙者使用抗精神疾病用藥情形之分析

The Exploration of Psycholeptics Using in Intellectual Disability

張剛準(Gang-Zhun Zhang)；張育嘉(Yu-Chia Chang)；江博煌(Po-Huang Chiang)；徐尚為(Shang-Wei Hsu)

抗精神疾病用藥 ； 智能障礙 ； 醫療利用 ； Antipsychotics ； intellectual disability ； medical utilization

身心障礙研究季刊

11卷2期（2013 / 06 / 01）

85 - 100

繁體中文

精神疾病是智能障礙者最常見合併症之一，需透過藥物治療來穩定病情。國內對智能障礙者治療精神疾病之相關研究相當缺乏，故本研究將探討智能障礙者使用抗精神疾病用藥，針對該弱勢族群的醫療利用進行研究。本研究使用2007年全民健康保險資料庫，擷取ICD-9編碼為317~319之智能障礙編碼者作為本研究樣本，再串聯醫令檔與藥品主檔篩選使用ATC編碼為N05A用藥之智能障礙者，分析影響其醫療耗用與用藥差異之情形。研究結果顯示，2007年智能障礙者使用抗精神疾病藥物之盛行率為15.57%；女性盛行率為16.61%高於男性的14.89%。就醫場所以區域醫院最高，佔44.5%。醫療耗用上，年累積藥費，男性比女性多866.7元；年累積給藥天數，男性比女性多16.2天。障礙程度、部分負擔及投保地區之差異，均會影響藥費與給藥天數。進一步以邏輯斯迴歸分析各種抗精神疾病用藥發現，因個人特質以及就醫場所差異而有所不同。本研究初步探討智能障礙者對抗精神疾病用藥情形，釐清個人特質與就醫場所影響抗精神疾病用藥之差異。醫療資源配置上，建議需重視鄉村與偏遠地區之智能障礙者就醫可近性，以增進其醫療福址。此外，建議往後研究者，可以針對智能障礙者長期用藥或合併其他疾病影響醫療耗用情形作探討。

Mental illness is one of the most common complications among the intellectual disability and needs medication to stabilize. However, the domestic researches on this subject are quite few. This research explored the usage and National Health Insurance resource consumption of antipsychotics by the intellectual disability. Using 2007 National Health Insurance Reimbursement Database, claimants with ICD-9-CM codes 317-319, defined as intellectual disability, were selected as the study subjects. Subjects who prescribed ATC N05A medicine were screened and analyzed outpatient health care utilization. The prescription rate of antipsychotics among research subjects was 15.57 % in which the female's 16.61% is higher than the male's 14.89%. On yearly medical expense, the male is 866.7 dollar more than his counterpart; and as to the annual days of medicine prescription, the male is 16.2 days more than the female. The differences of degree of disability, copayment situation and residential area of claimants will affect the cost of medicine and the number of days of administration. After logistic regression analysis, we found receiving antipsychotics treatment of the intellectual disabled was influenced by personal characteristics and medical facility. In conclusion, the health authority should pay more attention to the availability of medical treatment for the intellectual disabled in countryside and remote areas. In addition, research on the trend on long-term antipsychotics treatment and effect on NHI resource allocation is recommended.

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