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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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