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研究生:彭美芳
研究生(外文):Mei-fang Peng
論文名稱:青光眼門診醫療使用狀況及醫師處方型態的演變—分析2002~2005年全民健保資料庫
論文名稱(外文):Medical Utilization of Glaucoma of Outpatient Sector and and Evolution of Physician Prescription Patterns :An Analysis of 2002- 2005 National Health Insurance Research Database in Taiwan
指導教授:陳俞成陳俞成引用關係
指導教授(外文):Yu-cheng Chen
學位類別:碩士
校院名稱:嘉南藥理科技大學
系所名稱:醫療資訊管理研究所
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:2011
畢業學年度:99
語文別:中文
論文頁數:80
中文關鍵詞:全民健保青光眼醫療資源耗用處方型態
外文關鍵詞:Medical UtilizationPrescription PatternsNational Health InsuranceGlaucoma
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中文摘要
目標:青光眼是全世界造成不可逆眼盲的主因之一,而東南亞的病例幾乎佔全世界的一半。對於名列已開發國家之首的美國,對此方面的統計數據及治療情形都是大家時常引用的數據。反觀台灣,過去十年關於青光眼的用藥紀錄卻付之闕如。近年來,由於全民健康保險研究資料庫之設置與開放,一般人可透過分析實際資料,更加了解台灣的青光眼發生率、盛行率及年齡分布情形。方法:本研究採次級資料分析方法,以健保資料庫之門診申報資料進行青光眼疾病醫療之特性、整體醫療資源利用趨勢以及處方型態演變以供相關單位參考。結果:本研究引用的資料庫抽樣共10萬人,研究結果顯示,罹病人數在2002年有 464人,到2005年有625人,增加35 %。就診次數在2002年有1955人到2005年有3035人,增加55 %。每年每人就診次數在2002年有 4.22次到2005年有4.68次, 增加11 %。醫療費用方面 2002年為新台幣2,048,891元到2005年為3,135,419元,增加 53%。每人每年因青光眼所需治療費用2002 年為4,415元到2005年為5,016元,增加率為11 %。其中藥費使用,2002 年為861,127元到2005年為1,394,945元,增加62 %。每次就診之藥費,2002 年為新台幣440元到2005年為459元,增加4 %,每次就診之醫療費用,2002年為新台幣1,048元到2005年為1,033元,減少2%。青光眼的藥費占全部就診費用的比率由2002年的42%增加到2005年的44%。每年開出之藥瓶數,2002 年為2,574瓶到2005年為3,699瓶,增加了44%,同時期新的青光眼治療處方藥物亦逐年增加。分別比較2002年和2005年的處方開立趨勢,若用藥效果不佳,處方藥物使用方式以更換藥物為主而非增加藥物。每次就診醫療開出之藥瓶數:2002 年為 1.29瓶到2005年為1.21瓶,減少7%,其中β-阻斷劑藥物數量最多,但增加比例有緩慢現象(2002年為1,203瓶到2005年為1,762瓶增加46 %。前列腺素衍生物則增加最快,由2002 年的414 瓶到2005年的969瓶,增加134 %成為主流藥物。碳酸酐酶抑制劑則隨後:2002 年為324瓶到2005年為369瓶,增加7%。結論:青光眼的眼疾治療在國內已有長足進步,民眾持續治療的比率及花費皆有增加的趨勢。藥物使用的趨勢中,前列腺素衍生物藥物的使用是趨勢,已有和歐美新藥使用同時,但使用率仍有差異。這可能與健保局在健保費用的控制方法及部分負擔有關,藥物費用上升之經濟效益仍待評估。雖然台灣健保有便利及高品質的醫療服務,但由上述青光眼就診的資料分析及比率可知青光眼嚴重眼疾患者在接受診療,以及從事醫療保健人員、眼科醫師對青光眼這個眼疾應更加重視及宣導,也期喚起政策制定者對這個重要致盲眼疾的注意!
Abstract
Objective : Glaucoma is one of the main causes of irreversible blindness. In south east Asia, the number of glaucomas are about half of the cases all over the world . Even in USA, the first among the developed nations, for which the statistical data and treatment of all cases are often cited in recent years is well investigated . The conditions of pharmacological treatment in glaucoma over the past decade in Taiwan is not available. A survey of National Health Insurance claims for outpatient glaucoma services can be conducted to evaluate the utilization and the trend of prescription of glaucoma topical medication and a better understanding of the incidence of glaucoma in Taiwan, the prevalence and age distribution. Methods : This study used secondary data analysis of National Health Insurance database of outpatient claimed data to conduct medical glaucoma disease characteristics, the overall trend in health care resource utilization and to prescribe patterns for the evolution of related organizations. The sampling databases from the National Health Insurance Research Databases served as data sources. Results : In the database we applied, 100,000 subjects were enrolled .The follow up period is between 2002 and 2005. In 2002 glaucoma is diagnosed of 464 subjects and 625 subjects in 2005, the number of patients treated increased (by 35%). The number of clinical visits is 1,955and 3,035 in 2002 and 2005 respectively (increased 55%). During the follow-up period the number of visits- per-patient-per-year is increased from 4.22 to 4.68(increased 11%).The total cost of glaucoma therapy from 2002(NTD 2,048,891) to 2005(NTD 3,135,419) rose dramatically, with an increase of 53%. The cost of glaucoma patient per year is NTD 4,415 in 2002 growing to 11% (NTD 5,016 in 2005). The total cost of anti-glaucoma agents prescriptions is increasing 62%(NTD 861,127 in 2002, NTD 1,394,945 in 2005), and the cost of the anti-glaucoma drugs in each treatment per visit pay NTD 440 in 2002 with an increase of 4% to NTD 459 in 2005, but decreasing 2% when the cost per visit is considered (NTD 1,048 in 2002, NTD 1,033 in 2005). Medication costs ranged from 42% in 2002 to 44% in 2005 of total direct cost. The prescriptions of glaucoma medication items rise from 2002 (2,574 bottles) by 44% more in 2005(3,699 bottles). The number of newly prescribed anti-glaucoma ophthalmic solutions gradually increased with time.Comparing the prescription trend 2002 and 2005 respectively. From 2002 to 2005 there was a trend towards drug substitution rather than addition, so that the number of drugs used per patient decreased ( 1.29 bottles per visit in 2002 to 1.21 bottles in 2005, decreased 7%), the prescriptions of beta blockers is increasing slowly (1,203 bottles in 2002 and 1,762 bottles in 2005, increased 46%) and marked increase in the use of prostaglandins analogue (414 bottles in 2002 and 969 bottles in 2005, increased 134%) are becoming the mainstay of medical treatment, followed by topical carbonic anhydrase inhibitors agents (324 bottles in 2002 and 369 bottles in 2005, increased 7%) . Conclusion: The usage level of glaucoma drugs in Taiwan was lower than in most industrialized countries, especially for prostaglandin derivatives. The availability of prostaglandin derivatives has strongly influenced the medical approach to glaucoma.The increased number of treatments also suggested that the approach of ophthalmologists towards these diseases has changed more aggressively. The future goals are to focus on the longitudinal analysis of general trend for each glaucoma substance and to associate the pharmacoepidemiological data in parallel with the upcoming epidemiological study of glaucoma in Taiwan. Although the system of Taiwan''s National Health Insurance provides convenient and high quality medical services, but by analyzing the database of glaucoma treatment shows that glaucomas, a serious eye disease can not be ignore. Even health care workers and ophthalmologist provided glaucoma care should put more emphasis on it and also arouse the policy maker’s attention to this important blindness-causing disease!
目 錄
中文摘要 .....................................I
英文摘要 .....................................III
致 謝 .....................................V
目 錄 .....................................VI
表 目 錄 .....................................VIII
圖 目 錄 .....................................IXX
第一章 緒論.............. ...................1
第一節 研究背景與動機...... ...................1
第二節 研究目的............ ...................5
第三節 研究流程設計........ ...................6
第二章 文獻探討.......... ...................8
第一節 青光眼的定義與機轉......................8
第二節 青光眼的分類........ ..................10
第三節 青光眼的診斷與流行病學.................12
第四節 青光眼的治療...........................14
第五節 青光眼藥物的價格比較...................20
第三章 研究方法...............................22
第一節 資料來源...............................22
第二節 研究架構...............................26
第三節 研究變項與操作型定義...................28
第四節 資料處理與研究方法.....................29
第四章 資料分析結果...........................33
第一節 描述性統計分析.........................33
第二節 醫療資源耗用差異分析...................36
第三節 醫師處方藥物型態分析...................43
第五章 研究結果討論...........................48
第一節 青光眼疾病醫療之特性...................48
第二節 青光眼整體醫療資源利用趨勢.............50
第三節 青光眼醫療處方型態之演變...............52
第六章 結論與建議.............................58
第一節 結論...................................58
第二節 研究限制與建議.........................59
參考文獻......................................61
中文文獻......................................61
英文文獻......................................62
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