|
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
|