管理決策支援系統對醫師處方行為影響之實證研究

An Empirical Study on Physician Prescription Behavior Modification with Decision Support System (DSS)

10.30136/ZXYGLKX.201112.0004

黃維民(Wei-Min Huang)；陳虹君(Hung-Chung Chen)；許恒韶(Heng-Shao Hsu)

醫院管理 ； 決策支援系統 ； 醫師行為 ； Healthcare Organization Management ； Decision Support System ； Physician Behavior

資訊與管理科學

4卷2期（2011 / 12 / 30）

62 - 84

繁體中文

在全民健保總額預算制度下，為了有效控制藥品費用，使得醫院達到成本效益之目標，而決策支援系統（DSS）即為其中主要管理工具。導入決策支援系統能夠達到醫院成本管控（CC）之目的，但相關研究亦指出醫師行為（PB）也是影響藥品費用的重要因素。因此，本研究是以實證調查方法和統計分析，探討決策支援系統是否能夠協助醫院進行費用控制改善，及影響相關醫師行為之模式。研究結果發現，決策支援系統確實能夠協助醫院進行藥品費用之改善，且醫師行為亦能影響藥品費用之改善程度。醫院導入系統後，醫師特性變數中學歷越高者或擔任主管職者，其開立藥品費用將較決策支援系統導入前為低。此外，由於醫院同時存在管理與醫療雙軌系統，而部分專業醫療人員可能同時身兼管理職務，因此醫師行為中對文化衝突與角色衝突之變數，亦將對藥品費用之產生顯著影響。

The dramatically increasing pharmaceutical expenditures in healthcare organizations assumed to be one of the major expenditures, especially under the Global Budget Policy of National Health Insurance in Taiwan. In order to control costs in hospitals to achieve cost-effective management and control objectives, and decision support system is the one of the options, which can provide improved information gathering and analysis, management decision-making to improve decision making and effectiveness. According to several results of researches, all showed that not only the decision support system can make significant contribution to cost control, but also physician behavior. Therefore, this study is designed to investigate the decision support system in controlling medicine expenses, and further explore the physician behavior in influencing on pharmaceutical costs. The results showed that decision support system can statistically assist in controlling costs. In order to achieve the goal of cost control, physician characteristics may also affect the process. The more implementation of decision support system, with the more educated physicians or higher managerial positions of physician, the prescription costs will be much more. Moreover, it indicated that physician with professional and managerial positions at the same time will face more challenges with cultural and role conflicts, which might have implication on cost control.

1. Abernethy, M. A.,Stoelwinder, J. U(1995).The Role of Professional Control in the Management of Complex Organizations.Accounting Organizations and Society,20(1),1-17.
2. Achan, J. A.,Ucakachon, P., Nakayaga, J(2008).Prescribing Habits and Associated Factors in the Event of the New Antimalarial Treatment Policy in a Rural Ugandan Hospital.International Journal of Infectious Diseases,12(1),434-435.
3. Bacharach, S. B.,Bamberger, P.,Conley, S. C.(1991).Negotiating the See-Saw of Managerial Strategy: A Resurrection of the Study of Professionals in Organizational Theory.Research in the Sociology of Organizations,8,217-238.
4. Barley, S. R.,Tolbert, P. S.(1991).At the Intersection of Organizations and Occupations.Research in the Sociology of Organizations,1,1-16.
5. Berner, E. S.,Houston, T. K.,Ray, M. N.,Allison, J. J.,Heudebert, G. R.(2006).Improving Ambulatory Prescribing Safety with a Handheld Decision Support System: A Randomized Controlled Trial.Journal of the American Medical Informatics Association,13(2),171-179.
6. Carpenter, M. A.,Geletkanycz, M. A.,Sanders, W. G.(2004).Upper Echelon Research Revisited: Antecedents, Elements, and Consequences of Top Management Team Composition.Journal of Management accounting Research,30(6),749-778.
7. Chang, C. S.,Lin, Y. C.,Wu, Y. C.,Yeh, C. J.,Lin, Y. C(2011).The Effects of a Computerized Transfusion Decision Support System on Physician Compliance and Its Appropriateness for Fresh Frozen Plasma Use in a Medical Center.Am J Clin Pathol,417-422.
8. Deber, C.,Schwartz, W. A.(1991).New Mandarins or Mew Proletariat? Professional Power at Work.Research in the Sociology of Organization,1979(2),71-96.
9. Durieux, P.,Nizard, R.,Ravaud, P.,Mounier, N.,Lepage, E.(2000).A Clinical Decision Support System for Prevention of Venous Thromboembolism: Effect on Physician Behavior.The Journal of the American Medical Association,283(21),2816-2821.
10. Evans, J. H.,Hwang, Y.,Nagarajan, N.(1995).Physicians' Response to Length-of-Stay Profiling.Medical Care,33(11),1106-1119.
11. Evans, R. S.,Pestotnik, S. L.,Classen, D. C.,Clemmer, T. P.,Weaver, L. K.,Orme, J. F.(1998).A Computer-assisted Management Program for Antibiotics and Other Anti-infective Agents.N Engl J Med,338,232-238.
12. Fernandez, L. E.,Modamio, P.,Catalan, A.,Lastra, C. F.,Rodriguez, T.,Mari˜no, E.L(2007).Identifying How Age and Gender Influence Prescription Drug Use in a Primary Health Care Environment in Catalonia, Spain.British Journal of Clinical Pharmacology,65,401-417.
13. Hunt, D. L.,Haynes, R. B.,Hanna, S. E.,Smith, K.(1998).Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes: A Systematic Review.The Journal of the American Medical Association,280(15),1339-1346.
14. Kisely, S.,Linden, M.,Bellantuono, C.,Simon, G.(1996).Why Do Doctors Prescribe Psychoactive Drugs in Primary Care-Results of an International Study.European Psychiatry,11(4),266.
15. Konsynski, B. F.,Fedorowicz, J.(1992).Organization Support Systems:Bridging Business and Decision Processes.Journal of Management Information Systems,8(4),5-25.
16. Levy, A. R.,Tamblyn, R. M.,McLeod, P. J.,Fitchett, D.,Abrahamowicz, M.(2002).The Effect of Physicians' Training on Prescribing Beta-blockers for Secondary Prevention of Myocardial Infarction in the Elderly.Annals of Epidemiology,12(2),86-89.
17. Lin, C.,Lin, C. M.,Lin, B.,Yang, M. C.(2009).A Decision Support System for Improving Doctors' Prescribing Behavior.Expert Systems with Applications,36(4),7975-7984.
18. Majeed, A.,Malcom, L.(1999).Unified Budget for Primary Care Groups.British Medical Journal,318,772-776.
19. Naranjo-Gil, D.,Hartmann, F.(2007).How CEOs Use Management Information System for Strategy Implementation in Hospitals.Health Policy,81,29-41.
20. Omar, R. Z.,O''Sullivan, C.,Petersen, I.,Islam, A.,Majeed, A.(2008).A Model Based on Age, Sex and Morbidity to Explain Variation in UK General Practice Prescribing: Cohort Study.British Medical Journal,337,238.
21. Orzella, L.,Chini, F.,Giorgi R. P.,Borgia, P.(2010).Physician and Patient Characteristics Associated with Prescriptions and Costs of Drugs in the Lazio Region of Italy.Health Policy,95(2-3),236-244.
22. Paredes, P.,de la Peña, M.,Flores-Guerra, E.,Diaz, J.,Trostle, J.(1996).Factors Influencing Physicians' Prescribing Behavior in the Treatment of Childhood Diarrhoea: Knowledge May Not Be the Clue.Social Science & Medicine,42(8),1141-1153.
23. Roe, C. M.,McNamara, A. M.,Motheral, B. R.(2002).Gender and Age-related Prescription Drug Use Patterns.Annals of Pharmacotherapy,36,30-39.
24. Rokstad, K.,Straand, J.,Fugelli, P.(1995).Can Drug Treatment Be Improved by Feedback on Prescribing Profiles Combined with Therapeutic Recommendations? A Prospective, Controlled Trial in General Practice.Journal of Clinical Epidemiology,48(8),1061-1068.
25. Ruland, C. M.,Bakken, S.(2002).Developing, Implementing, and Evaluating Decision Support Systems for Shared Decision Making in Patient Care: A Conceptual Model and Case Illustration.Journal of Biomedical Informatics,35(5-6),313-321.
26. Schiff, G. D.,Rucker, D.(1998).Computerized Prescribing: Building the Electronic Infrastructure for Better Medication Usage.The Journal of the American Medical Association,279,1024-1029.
27. Schirm, E.,Berg, P. V. D.,Gebben, H.,Sauer, P.,De Jong-van der Berg, L.(2000).Drug Use of Children in the Community Assessed through Pharmac Dispensing Data.British Journal of Clinical Pharmacology,50,473-478.
28. Senior, M. L.,Williams, Huw,Higgs, Gary(2003).Morbidity, Deprivation and Drug Prescribing: Factors Affecting Variations in Prescribing between Doctors' Practices.Health & Place,9(4),281-289.
29. Sintchenko, V.,Coiera, Enrico,Iredell, Jonathan R.,Gilbert, Gwendolyn, L.(2004).Comparative Impact of Guidelines, Clinical Data, and Decision Support on Prescribing Decisions: An Interactive Web Experiment with Simulated Cases.Journal of the American Medical Informatics Association,11(1),71-77.
30. Sintchenko, V.,Iredell, J. R.,Gilbert, G. L.,Coiera, E.(2005).Handheld Computer-based Decision Support Reduces Patient Length of Stay and Antibiotic Prescribing in Critical Care.Journal of the American Medical Informatics Association,12(4),398-402.
31. Sprague, R.H., Jr.,Carlson, E.D.(1982).Building Effective Decision Support Systems.Englewood Cliffs, NJ:Prentice Hall.
32. Stevens, S. S.(ed.)(1951).Handbook of experimental psychology.New York:Wiley.
33. Sturdy, P.,Naish, J.,Pereira, F.,Griffiths, C.,Dolan, S.,Toon, P.,Chambers, M.(1995).Characteristics of General Practices that Prescribe Appropriately for Asthma.British Medical Journal,311,1547-1548.
34. Teich, J. M.,Osheroff, J. A.,Pifer, E. A.,Sittig, D. F.,Jenders, R. A.(2005).Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan: Report of the Joint Clinical Decision Support Workgroup.Journal of the American Medical Informatics Association,12(4),365-376.
35. Veninga, C. C. M.,Denig, P.,Zwaagstra, R.,Haaijer-Ruskamp, F. M.(2000).Improving Drug Treatment in General Practice.Journal of Clinical Epidemiology,53(7),762-772.
36. 中央健康保險局(2011)。行政院衛生署年報。
37. 王宏育(2009)。西醫基層之藥費占率。台灣醫界，52(7)，14。
38. 吳政(2001)。碩士論文(碩士論文)。私立天主教輔仁大學資管研究所。
39. 徐碧麟(1997)。碩士論文(碩士論文)。中央大學資訊管理研究所。
40. 梁定澎(2002)。決策支援系統與企業智慧。智勝文化事業有限公司。