臺灣博碩士論文加值系統

背景：安眠鎮靜藥品具有藥物依賴性，長期使用易導致成癮性及副作用等危害健康的風險。為避免跨院就醫所帶來之藥品濫用，2013年起中央健康保險署規定，凡開立Nimetazepam、Flunitrazepam、Zolpidem等三項安眠鎮靜藥品，務必進入「保險對象特定醫療資訊查詢平台」進行查詢，並給予保險對象必要之用藥輔導。
研究目的：分析安眠鎮靜藥品跨院重複領藥之影響因素，並探討「保險對象特定醫療資訊查詢平台」對安眠鎮靜藥品跨院重複領藥抑制之影響。
研究方法：本研究為次級資料分析，資料來源為「全民健康保險資料庫」之2010年「承保百萬抽樣歸人檔」申報資料；擷取「保險對象特定醫療資訊查詢平台」管制前半年（即2012年7月至12月間）18歲以上領用安眠鎮靜藥品之患者為研究對象，依領用平台管制查詢藥品大於250DDD，以及領用非管制查詢安眠鎮靜藥品大於250DDD分組，分別觀察次一年跨院重複領藥之情形，並比較安眠鎮靜藥品有無管制查詢之兩組間差異。
結果：研究對象以女性較多（54.9%），兩組年齡分佈皆為40-49歲及50-59歲居多。平台管制後實驗組跨院重複領藥，相較於管制前為低(-12.99%)；而對照組跨院重複領藥情形則為成長5.62%。實驗組原有跨院重複領藥者177人中，有44人行為改善（2013年無跨院重複領藥），且達顯著意義(p=0.008)。經控制相關因素後，跨院重複領藥之影響因素包含年齡越輕、患有共病症及基層診所等因素，且達統計顯著意義。
結論與建議：本研究結果發現健保署推動安眠鎮靜藥品管理措施，對於導正患者跨院重複領藥情形具有成效，但對於安眠鎮靜藥物的使用年輕化及其他非管制藥品的管理，仍需強化監控管理及衛生教育，以減少重複領藥情形，提升國人用藥安全。

Background: Sedative hypnotic drugs have the drug dependence, and the long-term uses would be easily caused risks, such as addiction and side effect, that hazardous to people’s health. In order to prevent the drug abuse that came from cross-hospital medical treatment. Since 2013, according to the regulations stipulated by National Health Insurance Administration, for giving these 3 sedative hypnotic drugs, including Nimetazepam, Flunitrazepam and Zolpidem, physicians have to logon “Specific Medical Information Query System of the Insured” to inquire and give necessary medication advice to insured objects.
Research Purpose: This Study intended to analyze the affecting factors of repeated requisition of drugs from multiple hospitals, as well as inspected the influence of “Specific Medical Information Query System of the Insured” for restraining the repeated requisition of sedative hypnotic drugs from multiple hospitals.
Methodology: This Study is a secondary data analysis, and the data source is the claim data of 2010 “Longitudinal Health Insurance Database t” which extracted from “National Health Insurance Research Database”; and retrieved the data of patients more than 18 years old who required sedative hypnotic drugs that controlled by “Specific Medical Information Query System of the Insured” within the second half of 2012 (within July and December 2012) as the research subject. In addition, it divided into two groups, one group is the patients of requiring medicine greater than 250DDD controlled by the Specific Medical Information Query System of the Insured, and a group is the patients of requiring sedative hypnotic drugs greater than 250DDD and not controlled by the Specific Medical Information Query System of the Insured. Separately observed the situation of repeated requisition of drugs from multiple hospitals in next year, and compared the difference between these two groups of requiring sedative hypnotic drugs with and without controls.
Results: The research subjects contained more females (54.9%), and ages distribution are mainly 40-49 and 50-59 years old. After controlled by this System, the experimental group’s situation of repeated requisition of drugs from multiple hospitals is lower than the percentage before controlling (-12.99%); however, the control group’s repeated requisition of drugs from multiple hospitals is growing 5.62%. Among 177 persons of the experimental group for repeated requisition of drugs from multiple hospitals, there’re 44 persons have improved such behavior (no repeated requisition of drugs from multiple hospitals in 2013), and reached the significance (p=0.008). After controlled corresponding factors, the influential factors of repeated requisition of drugs from multiple hospitals included the younger ages, have comorbidity and primary care clinics, and reached the significance.
Conclusions and Suggestions: This Study results discovered the management measures of sedative hypnotic drugs that promoted by National Health Insurance Administration that possessed effectiveness on leading patients behavior of repeated requisition of drugs from multiple hospitals, but it still needs to enhance the monitoring management and health education for the younger ages of using sedative hypnotic drugs and the management of other non-controlled medicines, in order to reduce the situation of repeated requisition of drugs from multiple hospitals to improve the medication safety for our nationals.

第一章 緒論1
第一節 研究背景與動機1
第二節 研究目的2
第二章 文獻探討3
第一節 安眠鎮靜藥品概述3
第二節 安眠鎮靜藥品重複領藥之影響因素6
第三節 處方藥濫用管制之初探11
第四節 文獻小結15
第三章 研究設計與方法16
第一節 研究架構16
第二節 研究假設17
第三節 研究對象或資料來源17
第四節 研究工具19
第五節 研究變項操作型定義21
第六節 分析方法25
第四章 結果27
第一節 研究對象之基本特質描述27
第二節 平台管制查詢與否對安眠鎮靜藥品患者跨院重複領藥之影響29
第三節 安眠鎮靜藥品患者跨院重複領藥之影響因素31
第五章 討論34
第一節 安眠鎮靜藥使用者特質34
第二節 平台管制查詢與否對跨院重複領藥之影響35
第三節 安眠鎮靜藥品患者跨院重複領藥之影響因素36
第六章 結論與建議39
第一節 結論39
第二節 建議39
第三節 研究限制41
參考文獻43

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