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研究生:姚淑惠
研究生(外文):Yaw, Shu-Whei
論文名稱:健保特約醫事服務機構抗生素處方型態之探討
論文名稱(外文):A Study on Antibiotic Prescription patterns among NHI Contracted
指導教授:黃文鴻, 高雅慧
指導教授(外文):Weng-Foung Haung, Yea-Huei Kao Yang
學位類別:碩士
校院名稱:國立成功大學
系所名稱:臨床藥學研究所
學門:醫藥衛生學門
學類:藥學學類
論文種類:學術論文
論文出版年:1998
畢業學年度:86
語文別:中文
論文頁數:168
中文關鍵詞:處方型態抗生素健保特約醫事服務機構
外文關鍵詞:prescription patternantibioticsnational health insurance
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摘 要本研究目的在於經由分析健保特約醫事服務機構向中央健康保險局
申報的醫療費用資料,瞭解抗生素的處方型態,以及可能導致這些處方型
態分佈的相關影響因素。本研究根據民國八十六年六月份健保特約醫事服
務機構門、住診醫療費用申報檔,分析與比較不同醫事服務機構特質(分
局別、醫院層級、權屬別、就診科別、給付類別、案件分類) 及不同病人
特質(年齡層、性別、疾病診斷) 抗生素處方型態的差異,並且統計抗生
素使用分佈狀況。本研究從健保給付的用藥品項中選出口服及注射劑型抗
生素,然後進行ATC 編碼,並與健保醫令檔用藥資料關聯,經資料校正及
除錯後,進一步與治療明細檔及醫事機構資料檔關聯,再將所篩選出的資
料分成住院、西醫門診(列舉申報、簡表申報) 及牙醫門診三大單元進行
描述性統計分析,及分析抗生素的使用分佈狀況。從健保局的樣本分析資
料中發現,住院申報案件含抗生素的比例64.6%,西醫門診申報處方含抗
生素之比例是19.1%,牙醫門診只有12.4%,而且這些含抗生素之申報案件
或處方在各分局間的分佈比例都不一樣。住院抗生素申報案件中,抗生素
佔案件藥費比例的總平均是49.3%,平均案件藥費台北分局的8,536元最高
,平均住院日以東區分局10.9天最高。醫學中心的平均用藥筆數、平均抗
生素筆數、平均案件藥費、平均住院日及每日平均藥費都是最高的,隨著
醫院層級降低,各組平均值都呈現逐層下降的趨勢。醫院的分局別、層級
別、權屬別、住院科別、給付類別及案件分類不同各組平均值差異很大,
而且在統計上有顯著差異。病人的年齡及性別特質也會影響處方型態,而
且在統計上有顯著差異。論病例計酬的生產案件,相同醫院層級的申報案
件藥費差別很大,在用藥筆數與剖腹產的平住院日方面 4.1~5.9日都有顯
著差異。住院部份抗生素用掉 40,718.0萬元(64.8%),其中93.7%都是針
劑的花費。西醫門診列舉申報處方有1,864,634張,抗生素佔藥費的百分
之四十。每一申報處方平均用藥筆數5.5筆、平均抗生素筆數1.23筆、平
均處方藥費230元、平均抗生素藥費91.4元、平均給藥日數3.7天、平均每
日藥費64.0元。醫院的分局別、層級別、權屬別、住院科別、給付類別及
案件分類不同,各組平均值差異很大,而且在統計上有顯著差異。病人的
年齡及性別特質也會影響處方型態,而且在統計上有顯著差異。簡表申報
處方張數以不分科、內科及耳鼻喉科居多,平均處方用藥筆數6.0筆、平
均抗生素筆數1.15筆、平均處方藥費90.0元、平均抗生素藥費27.4元、平
均給藥日2.6天、平均每日藥費35.3元,抗生素佔藥費比例是30.5%。西醫
門診病人的疾病主診斷列舉申報有45.1%是呼吸道感染,簡表申報有78.0%
是呼吸道感染,所佔比例最高。簡表與列舉申報的處方型態不同,t-test
檢定有顯著差異,而且公立診所列舉與簡表之間的差異比私立診所的差異
大。西醫門診的抗生素分佈以國產居多,而且大部份都是口服劑型。使用
筆數與使用金額的前三名都是頭孢黴素類、青黴素類巨環類抗生素,以抗
生素成份而言頭孢黴素類使用得最多。牙科門診主要以處置為主,處方的
比例低,但是百分之八十的處方含有抗生素。抗生素處方佔總申報案件
的12.4%。牙科處方型態各特質間的平均值雖然有統計上的顯著差異,但
是數值的差異不大。抗生素總花費只有411.5萬元,98.1%是口服劑型,其
中 amoxicillin, ampicillin及cephalexin佔81.9%。從本研究結果,可
以看到抗生素在國內的使用分佈情況,醫事機構特質與病人特質會影響處
方型態。國內的抗生素使用狀況,不論是住院或門診都比國外的統計數字
高,這種過度使用情況應該與國內常見致病菌株偏高的抗藥性比例相關。
中央主管機關要針對這些現況制定更有效的管理辦法,健保局在支付制度
上也要作合理的調整才能避免醫療資源的浪費。關鍵字: 處方型態,抗生
素,健保特約醫事服務機構
AbstractThe objectives of this research was to analyze the
claimed reimbursement database of NHI, describe the antibiotic
prescription patterns among NHI contracted medical care
institutions, and to evaluate the factors influencing of the
prescription patterns.The study was based on the NHI''s claimed
reimbursement database in June, 1997. It analyze and compared
the prescription containing antibiotics and respective
distribution among NHI contracted medical care institution''s
characteristics (branch locale, level, ownership, function-type,
benefit-type and case classification) and patient''s
characteristics (age, sex, disease diagnosis), the distribution
of antibiotics among NHI contracted medical care institutions.
The study antibiotics were selected from NHI''s reimbursement
drug items, followed by coding with WHO''s Anatomical Therapeutic
Chemical (ATC) classification method. These antibiotic items
were then linked with NHI''s physician order files. After
validating the extracted order file, it was then linked with
patient treatment file and medical care institutional files.
There data files selected for analysis include inpatient,
outpatient (detail and simplified claimed procedures) and dental
visits.There were 64.6% inpatients cases that have used
antibiotics during the days of hospital stay. 19.1% outpatient
cases had antibiotics at ambulatory visits and 12.4% in dental
clinic visits. Prescription patterns containing antibiotics were
different among different NHI branch locales.The average cost
ratio of antibiotics versus total drug cost per inpatient case
was 49.3%, The highest average case claims was in Taipei Branch
(NT$ 8,536) while the highest average length of hospital days
was in Eastern Branch (10.9 days). On the average, medical
centers had the highest mean drug items, mean antibiotic items,
mean drug cost per case, average length of hospital days and
average daily drug cost. There was a decreasing trend in terms
of these dependent variable means in proportional to decreasing
levels of the institution. The difference of means between the
characteristics of hospitals and patients were statistically
significant. As for the case payment on birth-delivery, the
difference of drug reimbursement claims per case among medical
care institutions were statistically significant, especially in
mean drug items and mean length of hospital stay (4.1~5.9 days).
Total antibiotic cost of inpatient was NT$ 407,180,000
representing 64.8% of total inpatient drug bill, injectable
antibiotic has a share of 93.7%. There were 1,864,634
outpatient visit prescriptions via detail claim procedure,
antibiotic has a 40% share of total drug cost. The average
statistics of drug items per visit was 5.5, 1.23 for antibiotic
items, NT$230 for prescription cost, NT$91.4 for antibiotics,
3.7 days for length of medication, NT$64.0 for daily drug cost.
The difference of mean values among different characteristics of
hospitals and patients statistically significant. Simplified
procedure claims were most often submitted by general practice,
internal medicine and ENT, with mean values of drug items per
prescription 6.0, antibiotic items 1.15, drug cost per
prescription NT$90.0, antibiotic cost per prescription NT$27.4,
medication days 2.6, daily drug cost NT$35.3. The average
antibiotic cost ratio per prescription cost was 30.5%. Among the
major disease diagnosis of detail claim procedures, 45.1%
suffered from respiratory tract infections while 78.0% have same
diagnosis in simplified claim procedures. The prescription
patterns were statistically significantly different between
simplified claim procedures by t-test. Public clinics had
greater differences than private clinics in terms of such
differences. Oral dosage forms of domestic generic antibiotics
were the most common prescribed among outpatient visits. The top
3 antibiotics in terms of frequency and cost were
cephalosporins, penicillins and macrolides, cephalosporins were
the most common prescribed antibiotic category.Dental visit were
mostly by cleansing or fixing, prescription drug therapy is less
common. Whenever there is prescribed medication, 80% of patients
received antibiotic prescriptions. Only 12.4% of dental cases
claimed antibiotics. Prescription patterns had differences in
different categories of practices, but the variations were
minimal. Total cost of dental antibiotics used were
NT$4,115,000, 98.1% by oral dosage forms, and top 3 antibiotics
used were amoxicillin , ampicillin and cephalexin, which totaled
81.9% of antibiotic cost.The results of this study portrayed the
distribution of antibiotic use among NHI''s contracted medical
care institutions. Variables relevant to institutions and
patients affect the antibiotic prescription patterns. This study
also demonstrated that medical institutions in Taiwan are more
inclined than their foreign counterparts to prescribe
antibiotics for infectious disease management. There is a strong
connection between antibiotic overuse and increased bacterial
resistant strains. The health authority should take necessary
measures improve such situations, it is also suggested that the
NHI Bureau should adjust reimbursement measures in order to
prevent the waste of medical resources.Key words: antibiotics,
prescription patterns, national health insuance
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