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研究生:陳慧櫻
研究生(外文):Hui-Yin Chen
論文名稱:醫院更換Metformin廠牌對於糖尿病患者治療之影響研究-以某醫學中心為例
論文名稱(外文):The Influence of Metformin Brand Shift by Hospital on Diabetic Therapy
指導教授:郎慧珠郎慧珠引用關係
指導教授(外文):Hui-Chu Lang
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:90
中文關鍵詞:糖尿病治療藥品廠牌學名藥口服抗糖尿病藥物醣化血色素藥物持有率
外文關鍵詞:diabetic therapydrug brandgeneric drugmetforminoral antidiabetes drugHbA1cMedication Possession Ratio
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  • 收藏至我的研究室書目清單書目收藏:2
由於全民健保開辦,醫療照護可近性增加,國人醫療照護提升,本國人民平均餘命逐年上升,相對地,老年慢性病患人數亦逐年上升,參考中央健保局網站資料,民國94年,前20大疾病統計:糖尿病無併發症之門診申報件數達504萬件,平均每件點數1,457點,為前20大疾病之冠。糖尿病照護主要以藥物控制病情為主要支出項目,目前健保給付口服抗糖尿病藥物以藥理分類可分為五大類,其中biguanide與sufonylurea這二大類上市時間最久,市場上有許多學名藥,屬市場競爭激烈之藥品,本研究欲探討醫院更換藥品廠牌,對於糖尿病患者治療是否有影響。
本研究醫院於93年7月後,在四年內更換metformin的廠牌四次,本研究藉由分析健保申報檔之藥品使用資料與檢驗數值HbA1c,探討更換廠牌對病患就醫行為、醫師處方行為、以及治療成果之影響;研究方法為選取93年1月~93年6月間曾於醫院開過糖尿病藥物,且用藥情況穩定之糖尿病病患為研究對象,採回溯性族群研究(retrospective cohort study),使用spss套裝軟體12.0版進行統計分析,以卡方檢定、t檢定、pearson相關係數分析、邏吉斯迴歸、ANOVA等推論性統計分析。研究結果:一、醫院更換metformin廠牌並未影響藥品之月用量以及使用人次,反而有微量上升趨勢,連結持續就醫族群之藥物使用資料,發現metformin用量增加應是新發生糖尿病個案的使用人數增加。二、由族群追蹤方式,發現年齡介於40~80歲、女性、居住在台北市、患有高血壓或高血脂的病人,就醫持續性較好;至於就診科別、糖尿病用藥種類、每日服藥顆數、處方是否含metformin等,與就醫之持續性無顯著性相關。三、在metformin五個時期,回溯分析持續就醫的病人族群之口服抗糖尿病處方,結論:(一)平均每張處方內抗糖尿病藥物品項數有逐年上升的趨勢,處方開立一種或二種藥物的比例減少,開立三種、四種藥物的比例增加。(二)處方比例增加的藥物為acarbose與insulin,處方比例減少的藥品為metformin、glibenclamide、rosiglitazone。(三)metformin日劑量在不同廠牌時期大致呈現略為增加趨勢,平均日劑量在1565mg~1611mg之間,各期以paired t-test結果,不具顯著性差異。(四)藥物持有率逐期下降,影響因素為連續處方回院拿藥比例下降造成。(五)HbA1c值有增加的趨勢,但每期兩兩相比結果並無顯著性差異。
學名藥的使用愈趨普遍,能有效降低健保藥費支出,本論文藉由某醫學中心的糖尿病藥物metformin更換廠牌的不同時期,觀察藥品使用狀況,以及病人與醫師對藥物的接受程度,與藥品療效確認,希望本研究能提供醫院管理者議價與選用藥品之參考。
The implementation of national health insurance significantly improves the availability of health care in taiwan; which resulted in the increment of average life expectancy. Consequently, the cases of older adults suffer from chronic diseases are also increasing. According to the data published on bureau of national health insurance, there are more than five million cases claimed for diabetic outpatient services at 2005. the average payment of each diabetic outpatient service is 1457 points, which is the highest of the top 20 diseases. The majority of diabetic care expense is for pharmaceutical service, according to the pharmacological classification, five kinds of the oral anti-diabetes drugs are undertaken by the national health insurance. Among these drugs, biguanide and sufonylurea are the oldest drugs with highly competitive markets and numerous available generic drugs. In the present study, we will focus on the influence of replacement of drug manufacturer on the care of diabetic patients.
Our target hospital has changed four times of metformin manufacturers in five years since july, 2004. in this study, we will investigate the influences of changing drug brands on the behavior of patients seeking for medical service, and doctors prescribing habits , and therapeutic outcome by analyzing the claiming database of target medical center for national health insurance and patients’ glycated hemoglobin value.we select patients who had received antidiabetic drugs from 2004 january to 2004 june at target medical center and taking medicine steadily to included in this retrospective study. Chi-square test, t test, pearson correlation coefficient analysis, logistic regression and analysis of variance will be introduced to analysis by using spss software version 12.0. two major issues will be investigated. Firstly, we will study the influence factors on patients keeping/quit on visiting doctors in the target hospital. Secondly, for patients keeping on visiting doctors, further analysis on prescription types to study the attitudes of doctors on using generic drugs, analyzing the dose variation and the glycated hemoglobin values of patients to study the efficacies of drugs from different manufacturers, analyzing medication possession rate to study the altitudes of patients on changing the drug manufacturers. .
The general use of generic drugs can effectively reduce the expense in national health insurance.by analyzing the efficacy of drugs, attitudes of patients and prescription pattern on changing drug manufacturers of a medical center, this study will provide references for the administrators of hospital in choosing drugs and negotiating prices with drug manufacturers. Furthermore, by analyzing the acceptance of generic drugs of patients and doctors, this study will also provide important information for health education of the population.
中文摘要 I
ABSTRACT III
目 錄 V
表目錄 VII
圖目錄 VIII
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究問題 4
第三節 研究目的與重要性 5
第二章 文獻探討 7
第一節 糖尿病之藥物治療 7
第二節 METFORMIN藥物發展史與臨床研究 13
第三節 學名藥相關研究文獻探討 15
第三章 研究設計與方法 22
第一節 研究架構 22
第二節 研究假設 24
第三節 資料來源與資料處理 25
第四節 變項名稱及定義 28
第五節 分析方法 30
第四章 研究結果 31
第一節 全院口服抗糖尿病藥物用量與使用人次分析 31
第二節 研究族群之描述性統計 39
第三節 病人看病持續性之影響因素分析 43
第四節 持續看病組在五個時期藥品使用狀況分析 50
第五章 討論 64
第一節 研究結果之討論 64
第二節 研究限制之討論 69
第六章 結論與建議 70
第一節 結論 70
第二節 建議 72
參考文獻 73
附件: 馬偕紀念醫院人體試驗委員會同意臨床試驗證明書 78
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