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研究生:陳毅軍
研究生(外文):Yi-Chun Chen
論文名稱:抗生素選擇對急性中耳炎的治療成果與成本分析
論文名稱(外文):Analysis of Therapy and Cost for Selection of Antibiotics in Acute Otitis Media
指導教授:蔡東榮蔡東榮引用關係
指導教授(外文):Tong-Rong Tsai
學位類別:碩士
校院名稱:高雄醫學大學
系所名稱:藥學研究所碩士在職專班
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:2005
畢業學年度:93
語文別:中文
論文頁數:101
中文關鍵詞:費用抗生素急性中耳炎
外文關鍵詞:costantibioticsacute otitis media (AOM)
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  • 被引用被引用:2
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中文摘要
目的:
以急性中耳炎抗生素處方觀察其第一次回診的機率及頻率來評估抗生素處方對病患的影響.
方法:
本研究為retrospective cohort.從國民健康保險局高屏分局資料庫全部收集共89370位病人,期間從2001年三月一日到2003年十二月三十一日,疾病分類依照International Classification of Disease, Ninth Revision,樣本篩選依照急性中耳炎病人ICD-9診斷碼為381.0, 381.00, 381.01, 381.4, 382.00, 382.01, 382.4, 382.9,本研究建構決策樹來比較兩種決策,第一線抗生素(依健保局給付規範表列第一線抗生素加erythromycin)及第二線抗生素(Augmentin, cefuroxime, cefaclor, cefpodoxime, ceftriaxone),評估兩者病患的回診率.Initial visit:前九十天沒有出現因急性中耳炎治療就醫紀錄的病患,第一次因急性中耳炎就醫紀錄,return visit:病患在initial visit後持續觀察六十天因急性中耳炎回診就醫紀錄.利用univariate 與 multivariate 分析方法做資料庫的統計分析.
結果:
在全部的病患中有75.31%的病患接受抗生素的治療,在接受抗生素治療的群組內有67.70%的病患接受第一線抗生素的治療,而在第一線抗生素的群組中的回診率為41.6%,第二線抗生素的群組中的回診率為52.9%.希顯然的,第一線抗生素組的回診率較第二線抗生素組較低.除此之外,第一線抗生素組得平均回診次數為0.84,第二線抗生素組為1.22.接受第一線抗生素治療的病患在回診期間,85.7%的病患還是接受第一線抗生素的治療,14.3%的病患改成第二線抗生素治療, 接受第二線抗生素治療的病患在回診期間,78.1%的病患還是接受第二線抗生素的治療,21.9%的病患改成第一線抗生素治療,同時,接受第一線抗生素治療組的抗生素藥費為80.33元,其他合併藥物的藥費為186.58元,全部所有的醫療支出為729.89元,再相對的另一組, 接受第二線抗生素治療組的抗生素藥費為174.33元,其他合併藥物的藥費為300.09元,全部所有的醫療支出為891.57元,第一線抗生素組在費用上顯示更合適的結果.
結論:
根據本研究的結果,針對急性中耳炎病患第一線抗生素的處方在費用及效益上會更符合我們的目的.
Abstract
Objectives: To determine the impact of antibiotic prescribing at initial visit on the probability and frequency of acute otitis media (AOM)-related return visit.
Methods: This study was a retrospective cohort. Total 89,370 patients were continuously enrolled this study from the National Health Insurance Database, period between March 1, 2001 to December 31, 2003. On the basis of International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-Code). Sample selection were claimed ICD-9 (381.0, 381.00, 381.01, 381.4, 382.00, 382.01, 382.4, 382.9) for AOM. We constructed the decision tree to compare two strategies, first-line (from the NHI reimbursement and erythromycin) and second-line (Augmentin, cefuroxime, cefaclor, cefpodoxime, ceftriaxone) antibiotics treated, by estimating the return visit of patients. Initial visit: absence of AOM-related visit 90 days prior to visit, return visit: AOM-related visit that occurs within 60 days after an initial visit. Data was analysis statistical by using univariate and multivariate analysis.
Results : There were totally about 75.31% of the enrolled patients being prescribed antibiotics, 67.70% of them accepted first-line antibiotics, 41.6% of the subjects in first-line antibiotics treated group experienced a return visit and the ratio among those treated with second-line was 52.9%, Obviously, the ratio of requiring a first return visit was observed to be lower in treating with first-line antibiotics. Besides, the mean return visit number required for the first-line was 0.84 and second-line was 1.22 in average. During the return visit, for those initially treated with first-line, 85.7% of them would stay in same group and 14.3% of them will be changed to second-line. Among second-line group, 78.1% of them would stay in same group and 21.9% of them will be changed to first-line. By the way, for first-line group: the cost of antibiotics only was NT$ 80.33, if combined with other drugs: NT$186.58 and if all the medical expense were included: NT$729.89. In contract to second-line group: antibiotics only cost: NT$174.33, combining drug cost: NT$300.09 and total cost: NT$891.57. The first-line antibiotic therapy also showed more preferable result in the cost.
Conclusion: Base on the results collected from AOM patients enrolled in this study, the first-line antibiotics can meet the purpose of prevention and also be cost saving.
目錄
中文摘要……………………………………………………………Ⅰ
英文摘要……………………………………………………………Ⅲ
目錄…………………………………………………………………Ⅳ
圖表目錄……………………………………………………………Ⅴ
第一章 前言……………………………………………………1
第一節 研究背景與動機………………………………… 1
第二節 研究重要性……………………………………………8
第三節 研究目的………………………………………………9
第二章 文獻探討…………………………………………………10
第一節 兒童及青少年中耳炎之現況………………………10
第二節 診斷及致病因子……………………………………13
第三節 治療模式……………………………………………15
第四節 不同抗生素使用及費用之狀況……………………21
第三章 材料與方法………………………………………………24
第一節 研究設計與架構……………………………………24
第二節 資料收集與研究對象………………………………26
第三節 資料合併與處理……………………………………29
第四節 研究變項與操作定義……………………………32
第五節 統計分析方法與模式建構…………………………35
第四章 研究結果…………………………………………………36
第一節 研究樣本基本資料之描述性統計分析……………36
第二節 使用不同抗生素其回診分析………………………54
第五章 討論與建議………………………………………………59
第一節 結果討論……………………………………………59
第二節 結論…………………………………………………64
第三節 研究限制與未來研究建議………………………68
參考文獻………………………………………………………………71
附錄…………………………………………………………………76
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