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研究生:李金翰
研究生(外文):Gin-HanLi
論文名稱:小兒西醫門診抗生素處方型態及用藥品質分析
論文名稱(外文):Prescribing Quality of Antibiotics in Pediatric Outpatients in Taiwan
指導教授:高雅慧高雅慧引用關係
指導教授(外文):Yea-Huei Kao
學位類別:碩士
校院名稱:國立成功大學
系所名稱:臨床藥學與藥物科技研究所
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:2012
畢業學年度:100
語文別:中文
論文頁數:135
中文關鍵詞:西醫門診小兒抗生素處方品質
外文關鍵詞:OutpateintsPadiatric populationAntibioticPrecription quality
相關次數:
  • 被引用被引用:0
  • 點閱點閱:264
  • 評分評分:
  • 下載下載:15
  • 收藏至我的研究室書目清單書目收藏:0
研究背景
我國自民國八十四年實施全民健康保險,實行之初雖有抗生素
的使用規範,但在臨床上有證據發現,抗生素的浮濫使用及細菌
抗藥性的產生,當時有近一半抗生素處方使用於感冒的診斷上。
為解決國內細菌抗藥性議題,健保局於民國 90 年實施對上呼吸
道感染的抗生素使用規範。但在此之後,則未有針對台灣小兒抗
生素使用之探討。考量抗生素議題對小兒族群的重要性,因此想
透過此研究,評估當前小兒門診抗生素處方的處方形態以及處方
品質,以裨益國內小兒族群的抗生素合理使用。

研究方法
使用 2006 年和 2007 年健保資料庫 18 歲以下之 1/3 系統抽
樣檔,篩選研究族群為 12 歲以下,並接受過一筆以上抗細菌類
抗生素用藥紀錄者,分析研究族群之抗生素處方型態及處方品
質。

研究結果
研究族群為 12 歲以下,並接受過一筆以上抗細菌類抗生素之紀
錄。於 2006及2007年篩選出的研究族群各有542,417人與
502,498人, 且在2006年與2007年分別有,抗生素用藥筆數
1,779,313 筆和 1,628,708 筆,及就醫人次 1,711,376人次與
1,570,057 人次。抗生素處方率顯示,在 2006 年與 2007 年,
各為 3.3及 3.2。處方盛行率的部分,2006 年和 2007 年都是
99%,表示研究族群中,幾乎所有人都接受過一筆以上的抗細菌
類的抗生素用藥。而當把處方盛行率推估至國內 12 歲以下之全
人口時,則在 2006 年與 2007 年各為 49.8%與 48.1%。
評估抗生素處方品質,比較所定義之合理與不合理抗生素處方在
列舉與簡表申報上的不同,可發現,對比於合理抗生素處方,在
不合理抗生素處方上,簡表申報比列舉申報有更多的用藥筆數。
另外,評估不符合年齡建議之抗生素處方,tetracyclines 不符
合年齡建議之就醫人數,於 2006 年及 2007 年各有就醫人數
7,869 人和 6,752 人。且觀察到,從用藥筆數及使用年齡層分布
,簡表申報都較列舉申報有較多的用藥筆數,與使用於較低年齡
層的情況。Quinolones的部分,列舉申報中,於 2006 年及
2007 年各有就醫人數 17,384 人與 16,467人,並且用藥筆數和
使用年齡層分布,簡表申報都較列舉申報有較高的用藥筆數,與
使用於較低年齡層的情況。

結論
本研究分析限用政策後的小兒抗生素處方情形,發現 12 歲以下
的研究族群,其抗生素處方率約為 3.3 (用藥筆數/人/年),高於
他國文獻。處方品質分析的部分,不合理抗生素處方在簡表申報
的用藥筆數比例是高過於列舉申報。同樣地,在不符合年齡之抗
生素處方,在簡表申報的部分有較高的用藥筆數,並使用於較低
的年齡層。

臨床藥事服務
自 2012/2/27 開始於小兒感染科診間,進行抗生素小兒製劑的
用藥指導,共指導 21 名患者家屬,針對成大醫院處方集收載的
抗生素懸液用粉劑,像小兒患者家屬講解藥品泡製、注意事項及
儲存等細節,並紀錄用藥指導成果。

Background
Children differ in physiologic characteristics with adults.
So we need to be more catious about prescription of
antibiotics. Taiwan instituted National Health Insurance
in 1995. Over use of antibiotics was found despite
reimbursement guideline on the use of antibiotics in the
beginning of implementation of the insurance. Research
into the problem found that the upper respiratory tract
infections were the main diagnosis in antibiotic
prescriptions, and nearly half of antibiotic prescriptions
were for common cold. As a result, the Bureau of National
Health Insurance implemented more strict reimbursement
regulation focusing on antibiotics for upper respiratory
infection. However, there is little literature to assess
the antibiotic prescriptions in pediatric population
after this policy. According to literature review, in
other countries, they all consider the evaluation of
antibiotic prescriptions in pediatric population is an
important issue. The objective of the study is to assess
the antibiotic prescription pattern and quality in
pediatric outpatients.

Method
Cases were extracted from National Health Insurance
Research Database from January 1, 2006 to December 31,
2007. The study population included pediatric outpatients
aged less or equal to 12 years old and received more than
one prescription of antibacterial agens. As analyzing
prescription pattern, we present the distribution of
diagnosis and antibacterial agents. Inappropriate
prescription and contraindicated-age prescription were
defined as indicators in quality assessment. We defined
tetracyclines for aged below 8 years old and quinolones
for aged below 18 years old as contraindicated-age prescriptions.

Result
There were 542,417 cases and 502,498 cases in 2006 and
2007 respectively. The number of antibiotic prescription
and patient-visit was 1,779,313 antibiotic prescriptions
and 1,711,376 patient-visits in 2006. And in 2007, it
has 1,628,708 antibiotic prescriptions and 1,570,057
patient-visits. The antibiotic prescription rate
in 2006 and 2007 were 3.3 and 3.2 (prescription/person/
year). The prevalence of antibiotic prescription was
nearly 99% . The estimated prevalence of residents
under 12 years old was 49.8% and 48.1% in 2006 and 2007.
To assess the prescription quality, we compare the
differences in inappropriate antibiotic prescriptions
between claim by simplified processes and by complete
processes. In the part of inappropriate antibiotic
prescription, we find the higher prescritption rate in
claim by simplified processes than by complete processes.
As to quality, we also assess contraindicated
prescription of tetracyclines for those aged below 8
years old and quinolones for those aged below 18 years
old. In the part of tetracyclines, there were 7,869
cases in 2006 and 6,752 cases in 2007. In the part of
quinolones, there are 17,384 cases in 2006 and 16,467
cases in 2007. Compared to claim by complete processes,
the claim by simplified processes had more proportion
of prescription in lowest age group.

Conclusion
In this study, it revealed the prescription rate was
about 3.3 prescriptions/person/year in Taiwan. The result
in this study was higher than other countries. We found
higher proportion of inappropriate antibiotic
prescription and contraindicated-age prescriptions with
the claim by simplified processes.
摘要 I
ABSTRACT III
致謝 V
目錄 VI
表目錄 VIII
圖目錄 X
第一篇、小兒西醫門診抗生素處方型態
及用藥品質分析 1
第一章、研究背景 1
第二章、文獻回顧 2
第一節、國外小兒門診抗生素處方型態 2
第二節、台灣小兒抗生素處方型態 10
第三節、門診常見呼吸道感染治療 13
第三章、研究目的與重要性 36
壹、研究目的 36
貳、重要性 36
第四章、研究方法 37
第一節、研究設計 37
第二節、研究變項與操作定義 44
第三節、資料處理流程 49
第四節、統計資料分析 50
第五章、研究結果 51
第一節、研究族群納入與排除 51
第二節、研究族群之基本資料 54
第三節、處方型態 60
第四節、處方品質 70
第六章、研究討論 86
第一節、研究族群的納入與排除 86
第二節、研究族群基本資料分析 87
第三節、處方型態 90
第四節、處方品質 95
第五節、研究限制 99
第七章、結論與建議 100
第八章、未來研究方向 101
第二篇、臨床藥事服務 102
第一章、源起與背景 102
第二章、服務目的與服務方法 103
第一節、服務目的 103
第二節、服務方法 103
第三節、服務流程 105
第三章、衛教內容 106
第四章、衛教結果 107
第一節、衛教對象基本資料 107
第二節、常見問題 110
第五章、藥事服務討論 115
第六章、心得與感想 116

參考文獻 117
附錄一、萬博懸液用粉指導單張及評估表 124
附錄二、安滅菌糖漿用粉劑指導單張及評估表 126
附錄三、日舒懸液用粉劑指導單張及評估表 128
附錄四、欽納特懸液劑指導單張及評估表 130
附錄五、優力黴素口服懸液用顆粒指導單張及評估表132
附錄六、優樂黴素口服懸液用顆粒指導單張及評估表134
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