跳到主要內容

臺灣博碩士論文加值系統

(34.204.180.223) 您好!臺灣時間:2021/08/05 16:56
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:詹益祥
研究生(外文):Yi-Hsiang Chan
論文名稱:非管制性抗生素管制表對抗生素使用量之影響-中部某區域教學醫院為例
論文名稱(外文):The Impact of the Unregulated Antibiotic Control Policy on the Regional teaching Hospital in Taichung
指導教授:廖述誼廖述誼引用關係
學位類別:碩士
校院名稱:國立中興大學
系所名稱:應用經濟學系所
學門:社會及行為科學學門
學類:經濟學類
論文種類:學術論文
論文出版年:2008
畢業學年度:96
語文別:中文
論文頁數:75
中文關鍵詞:抗生素管制迴歸分析
外文關鍵詞:AntibioticControlRegression Analysis
相關次數:
  • 被引用被引用:2
  • 點閱點閱:214
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
抗生素最早被發現於1928年,從此展開了人類與細菌的對抗賽。隨著抗藥性的問題發生後,抗生素的使用要如何管制,一直是醫療界討論的話題,對於控制住院的抗生素使用,則較少人利用計量方式討論。由於政府實施新制醫院評鑑制度,加入新的抗生素管制評鑑措施,中部某地區教學醫院實施非管制性抗生素管制表,故希望藉由此次研究探討抗生素管制使用問題。
本研究從非管制性抗生素管制表實施前後各半年時間,研究管制表是否對抗生素使用造成影響,進一步探討當年齡、科別、抗生素種類不同時,影響因素的差異性。以最小平方法進行迴歸模型參數估計。並分別以全體樣本、一線抗生素樣本及後線抗生素樣本進行模型參數估計之結果作一說明,全體樣本方面:管制前後、年齡、科別、藥品別皆具有顯著影響效果,管制表對抗生素產生影響,開立用量明顯下降,而年齡、不同科別、不同藥品也都造成抗生素使用上具有顯著的影響。分開就不同抗生素類別方面:一線抗生素在管制前後有顯著影響,開立天數明顯下降,為負相關因素;年齡愈大抗生素用量愈大,為正相關因素;其他科別與小兒科的一線抗生素用量相比皆為負相關因素。後線抗生素在管制前後雖有下降,但沒有顯著影響,顯示管制表對後線抗生素沒有造成影響,也沒有因為一線抗生素使用量減少,而轉移至後線抗生素形成替代效果產生;年齡方面雖為正相關因素,但是也不顯著;科別方面則只有婦產科較不顯著,且其他科別則是正相關因素,說明在後線抗生素方面,其他科別使用量比小兒科為多。

關鍵字:抗生素、管制、迴歸分析
Antibiotics were firstly found in 1928. From then on, humans began the competition with germs. With the issues of drug resistance starting to occur, how to control antibiotics had been always the hot discussion issues in the medical fields. About the antibiotic control over impatient medication, there were few people conducting quantitative researches. Currently governments implement new assessment systems on hospitals with new assessment measures over antibiotic control additionally. There is a regional hospital on Taichung City implementing the control table over unregulated antibiotic. It is hoped that this research can explore the issues about the control over antibiotic usage.
This research was based on the periods with half a year both after and before the implementation of unregulated antibiotic control tables to explore whether the control table affected antibiotic usage. It was further explored the influence variance when ages, medicinal departments and antibiotic categories were different. The least square method was used for estimation of regression modal parameters. Also, separately by using overall samples, the first line antibiotic samples and the secondary optional antibiotic samples to make description for the results estimated by modal parameters. Overall Samples: all variables of the periods both before and after control, ages, medicinal departments and medicine items all caused significant influence. The control table caused influence on antibiotic with significantly decreased dosage. Additionally, the variables of ages, medicinal departments and medicine items really caused significant influence on antibiotic usability. Various Types of Antibiotics: the first line antibiotic caused significant influence during the periods both after and before the control. The number of prescribing days was significantly decreases and it was the negative correlation factor. Patients with increasing ages consumed larger antibiotic dosage and it was a positive correlation factor. For other medicinal departments and the pediatrics department, all the dosages of the first line antibiotics were negative correlation factor. Although the dosage of secondary optional antibiotic decreased in the periods both before and after the control measures, there was still no significant influence caused. It revealed that the control table caused no influence on secondary optional antibiotics. There was no substitutive of transferring to secondary optional antibiotics due to decreased consumption dosage. Although patients’ age was a positive correlation factor but the influence was not significant. About medicinal departments, insignificant influence only happened to the obstetrics and gynecology department. Other medicinal departments were positively correlation departments. It meant higher dosage of secondary optional antibiotics was consumed by the pediatrics department than any other medicinal departments.

Keyword: Antibiotic, Control, Regression Analysis
第一章 緒論..............................................01
第一節 研究動機........................................01
第二節 研究目的........................................03
第三節 研究範圍........................................04
第四節 研究步驟........................................05

第二章 抗生素使用制度概況與醫療現況......................07
第一節 抗生素簡介及使用規範............................07
第二節 抗生素使用相關文獻..............................10
第三節 抗生素使用制度規定..............................13
第四節 中部地區西醫門診醫療現況分析....................15

第三章 研究方法..........................................20
第一節 理論模型與基礎..................................20
第二節 實證模型之建立..................................22

第四章 實證分析..........................................29
第一節 樣本資料分析....................................29
第二節 抗生素開立總量之影響因素分析....................40

第五章 結論與未來方向....................................44
第一節 結論............................................44
第二節 未來研究方向....................................46
 

參考文獻..................................................47

附錄1-新制醫院評鑑基準及評分說明..........................50
附錄2-新制醫院評鑑資料表..................................63
附錄3-非管制性抗微生物製劑使用理由電腦化管制表............70
附錄4-抗微生物劑用藥給付規定通則..........................72
中央健康保險局(2002):全民健康保險藥品給付規定(九十一年版)。
台北市:中央健康保險局,中華民國91年3月。

何曼德,Mcdonal LC,楊采菱等(2000):1998年台灣地區之抗生素抗藥性監深。感控雜誌;10:277-293。

張上淳,謝維銓(1996):目前台灣地區抗藥性菌株流行概況。中華感染醫誌;7;83-88

張上淳(1997):台灣區常見致病細菌抗藥性情形近十年來之演變。中華民國感染症醫學會成立十週年紀念大會暨第四屆第二次會員大會與學術討論會手冊:第36頁。

張上淳(2001),衛生署疾病管制局抗生素合理仗用監測與研議小組,衛生署中央健保險局醫審小組:醫學中心及區域醫院清潔手術預防性抗生素使用之分析。感控雜誌;11(6):341-354。

張上淳(2003):台灣近年來抗生素使用改善措施及其影響。感控雜誌;13(1):33-42

許清曉,王立信,王任賢等(2001):台灣住院病患抗生素使用適當性及相關問題的調查結果。感控雜誌;11(5):273-288。

許清曉(2003):台灣住院病患抗生素使用管制過度所可能引起的嚴重後果及其補救辦法。感控雜誌;13(4):209-220

許清曉(2005):抗生素的使用如何管制?感控雜誌;15(2):81-87

陳怡心(2004):年齡變化對醫療資源耗用的影響。長榮大學醫務管理學系研究所碩士論文。

賴麗娜(2005):醫院實施『卓越計劃』對主治醫師醫療行為、專業角色、工作生活品質之影響-以中部四縣市為例。大葉大學事業經營研究所碩士論文。

財團法人醫院評鑑暨醫療品質策進會:台灣醫療品質指標計晝三週年成果發表研討論文集。台北市:醫策會,2002年11月。

Chang Shan-Chwen, Chang Hong-Jen, Lai Mei-Shu (1999); Antibiotic usage in primary care units in Taiwan. International Journal Antimicrobial Agents ;11:23-30.

Chang Shan-Chwen, Hsieh Wei-Chuan, Liu Cheng-Yi (2000), the Antibiotic Resistance Study Group of the Infectious Disease Society of the Republic of China: High prevalence of antibiotic resistance of common pathogenic bacteria in Taiwan. Diagnostic Microbiology and Infectious Disease 36:107-112.

Bantar Carlos, Sartori Beatriz, Vesco Eduardo, Heft Claudia, Mariano Saul, Francisco Salamone, and Maria Eugenia Oliva(2003);A Hospitalwide Intervention Program to Optimize the Quality of Antibiotic Use:Impact on Prescribing Practice, Antibiotic Consumption, Cost Savings, and Bacterial Resistance. Chicago Journal Clinical Infectious Diseases ;37(2)180-186.

Ho M, Mcdonald LC, Lauderdale TL, et al(1999); Surveillance of antibiotic resistance in Taiwan, 1998. Journal of Microbiology Immunology and Infection ;32:239-249.

Fakih Mohamad G., Hilu Raymone. C, Savoy-Moore Ruth T., and Saravolatz Louis D. (2003);Do Resident Physicians Use Antibiotics Appropriately in Treating Upper Respiratory Infections? A Survey of 11 programs. Chicago Journal Clinical Infectious Diseases ;37(6)853-856.

Samore Matthew H., Bateman Kim, Alder Stephen C., Hannah Elizabeth, Donnelly Sharon , Stoddard Gregory J., Haddadin Bassam, Rubin Michael A., Williamson Jacquelyn , Stults Barry, Rupper Randall, Stevenson Kurt (2005);Clinical Decision Support and Appropriateness of Antimicrobial Prescribing A Randomized Trial. The Journal of American Medical Association;294(18)2305-2314.

Gonzales Ralpt, Steiner John F., Lum Andrew, Barrett Paul H., Jr,(1999);Decreasing Antibiotic Use in Ambulatory Practice Impact of a Multidimensional Intervention on the Treatment of Uncomplicated Acute Bronchitis in Adults. The Journal of American Medical Association ;281(16)1512-1519.

Nijssen S., Bootsma M., and Bonten M. (2006);Potential Confounding in evaluating Infection-Control Interventions in Hospital Settings: Changing Antibiotic Prescription. Chicago Journal Clinical Infectious Diseases ;43(5)616-623.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top
無相關期刊