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研究生:楊軒佳
研究生(外文):Hsuan-Chia Yang
論文名稱:事先偵測並減少藥物交互作用的無效警示
論文名稱(外文):Proactive identification and elimination of pseudo-alerts for drug-drug interaction
指導教授:李友專李友專引用關係
指導教授(外文):Yu-Chuan Li
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:生物醫學資訊研究所
學門:工程學門
學類:生醫工程學類
論文種類:學術論文
論文出版年:2010
畢業學年度:98
語文別:中文
論文頁數:75
中文關鍵詞:藥物交互作用臨床決策支援系統無效警示
外文關鍵詞:drug-drug interactionclinical decision support systempseudo-alert
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從藥物交互作用警示研究發現,無效警示(pseudo-alerts)會造成目前醫師對藥物交互作用警示的忽略率(overridden rate )高達85-90%。無效警示是一種假陽性(false positive)警示,會造成醫師懷疑藥物交互作用警示系統的正確性或是警示疲勞(alert fatigue)。
造成無效警示的原因,主要是目前的藥物交互作用警示系統只能針對藥名進行偵測。但就醫師或藥師在確認藥物交互作用時,會再確認時間、途徑、頻率、檢驗值或生命徵象等資料,再進行是否有藥物交互作用的判斷,因此目前藥物交互作用警示系統會偵測許多無效警示。
但目前對於降低無效警示的研究仍然不多,因此本研究的目的為事先偵測並減少藥物交互作用的無效警示。本研究為回溯性分析台灣的全民健康保險資料庫,依照專家建議選擇抗生素與制酸劑的交互作用進行分析,因為其最能說明確認頻率與途徑對偵測藥物交互作用的重要性。
就結果顯示,無效警示的比率平均為17%,且在醫院有37.5%的無效警示,超過診所11.2%的無效警示。所以藥物交互作用警示系統,除了單純藥名比對,如果再進行頻率或途徑的偵測,則能有效的降低藥物交互作用的無效警示。本研究也將詳細的無效警示資訊提供給藥師與醫療管理者,讓他們能選擇增加藥物交互作用規則的方式或修正醫療機構的藥物交互作用警示系統。
Researchers of drug-drug interaction alert (DDI) systems have often suggested that there were high overridden rate (85-90%) for alerts partly due to high percentage of pseudo-alerts. Pseudo-alerts are false positive alerts and make prescribers be fatigue to alerts or doubt the accuracy of the DDI alert system.
The cause of pseudo-alerts is that current DDI alert systems often only consider drug names. But when the doctors or pharmacists confirm DDI, they use additional factors such as date, frequency, route, lab data, vital signs and so on at the same time. So DDI alert systems would determine more pseudo-alerts than the pharmacists or doctors.
However, research about decreasing pseudo-alerts is scant. Therefore, the aim of this article is to provide a method to identify and eliminate pseudo-alerts of drug-drug interaction. This research involved retrospective analysis of the National Health Insurance Research database in Taiwan (NHIRD). The experts suggested selecting DDI which are the combination of antibiotics and antacids because it could explain how important to detect frequency or route when DDI occurred.
Results of the study showed an average rate of 17% for pseudo-alerts and also that the hospitals has a higher pseudo-alert rate (37.5%) than clinics(11.2%). To conclude, this study demonstrated a significant reduction of DDI pseudo-alerts through the detection of drug frequency or route in addition to compare to drug name only. This study also could offer the detail pseudo-alerts to the pharmacists and medical management. They could base on detail information of the pseudo-alerts and choose the best way to add DDI rules or modify DDI alert systems.

目錄 I
表目錄 IV
圖目錄 V
中文摘要 VI
Abstract VII
第一章 緒論 1
第二章 文獻探討 3
第一節 藥物交互作用 3
2.1.1 藥物交互作用的定義 3
2.1.2 藥物交互作用的分級 5
2.1.3 藥物交互作用的發生率 7
第二節 藥物交互作用警示系統 8
2.2.1 藥物交互作用警示系統 8
2.2.2 藥物交互作用警示系統的評估 11
2.2.3 忽略交互作用警示之原因 16
第三節 無效警示 19
2.3.1 無效警示的代價 19
2.3.2 無效警示的原因 21
第四節 研究目的 22
第三章 研究方法 23
第一節 研究設計 23
3.1.1 研究類型 23
3.1.2 研究材料 23
3.1.3 制酸劑與抗生素交互作用之解釋 24
第二節 研究步驟 28
3.2.1 建立抗生素與制酸劑的交互作用規則 29
3.2.2 建立抗生素與制酸劑的交互作用資料庫 32
3.3.3 警示真假之案例 33
3.3.4 警示分類規則 38
3.3.5 描述性統計 39
第四章 結果 40
第一節 描述性統計 40
4.1.1資料處理 40
4.2.2 藥物交互作用科別分佈 42
4.1.2 無效警示比率 43
第五章 討論 46
第一節 資料處理說明 46
5.1.1 資料處理效能 46
第二節 抗生素與制酸劑之無效警示處置 48
5.2.1 抗生素與制酸劑之無效警示 48
5.2.2 無效警示之處置 48
第三節 Overlapping之建議 53
第三節 藥物交互作用警示規則設定 55
5.3.1 途徑規則設定 55
第六章 結論與建議 58
第一節 結論與建議 58
第二節 研究限制 59
第七章 參考文獻 60
第八章 附錄 64
附錄一 門診處方醫令明細檔 65
附錄二 中央健保局的ATC藥品分類碼 66
附錄三 全民健康保險藥品使用標準碼 67
附錄四 科別代號 69
附錄五 醫療機構權屬別 70
附錄六 Overlapping 71
附錄七 Non-Overlapping 73

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