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研究生:陳舒亭
研究生(外文):Shu-Ting Chen
論文名稱:台灣糖尿病人初次口服降血糖之處方品質探討
論文名稱(外文):Prescribing quality of oral hypoglycemic agents among newly treated diabetics in Taiwan
指導教授:賴美淑賴美淑引用關係
指導教授(外文):Mei-shu Lai
口試委員:莊立民陳建煒張家勳
口試日期:2013-07-19
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:流行病學與預防醫學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2013
畢業學年度:101
語文別:中文
論文頁數:73
中文關鍵詞:處方品質雙胍類新治療糖尿病患處方影響因素
外文關鍵詞:prescribing qualitymetforminnewly treated diabeticsprescription factors
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目的
糖尿病的處方型態及用藥治療越見複雜,其糖尿病的負擔亦造成全球的影響,因此分析國內處方箋中,新治療糖尿病人使用口服降血糖藥物的處方趨勢,探討病患、醫師、 醫院特性及照護情形等不同層次,與初次降血糖藥物處方是否遵循為metformin之處方品質的相關性研究。
材料與方法
利用國家衛生研究院之全民健康保險研究資料庫(2005年承保抽樣歸人檔),於2006年至2010年新使用治療20到100歲的新治療糖尿病患為研究族群,首次治療之降血糖處方箋為研究處方。利用描述性統計分析處方型態趨勢是否變化,觀察首次治療處方是否遵循指引建議使用metformin,並利用多層次分析偵測其病患及醫療提供者影響處方選擇降血糖藥物的影響因素。
結果
2006年到2010年新治療第二型糖尿病患處方未以第一線metformin藥品開立的占率從44%降至35%,且無論病患或是醫師、醫院之特性都有下降之趨勢。男性或是年齡越大之病患、年紀越大或非內分泌專科醫師及醫療院所所在地較不都市化、權屬別為私立或分局別為中區和高屏分局之醫療院所,為較不遵循首次治療使用metformin第一線藥品之影響因素。
結論
至2010年仍有約30%的新接受治療的第二型糖尿病患不會依照ADA/EASD等指引建議而處方第一線metformin藥品,利用該處方指標探究病患、醫師及醫院層次之影響因素可作為一處方品質。控制病患的因素後,醫療提供者對於不同專科或年齡之醫師及不同權屬和分局別之醫療院所仍有影響處方的效果,則可作為改善處方品質照護的介入方式。


第一章 前言 1
第一節 研究背景 1
第二節 研究目的 4
第二章 文獻回顧 5
第一節 降血糖藥物治療之分類與健保給付情形 5
第二節 糖尿病人降血糖藥品耗用之相關研究 7
第三節 糖尿病用藥處方型態之相關研究 9
第四節 糖尿病處方品質指標相關研究 11
第五節 糖尿病治療首選藥物雙胍類之實證 14
第六節 糖尿病處方箋用藥型態之影響因素 16
第七節 文獻小結 19
第三章 材料方法 21
第一節 研究設計 21
第二節 研究架構 21
第三節 研究資料來源 23
第四節 研究族群及研究處方之建立 25
第五節 研究變項及操作型定義 26
第六節 統計分析 29
第四章 結果 32
第一節 初使用口服降血糖的第二型糖尿病之病人特性 32
第二節 第二型糖尿病病患之首次降血糖處方箋型態 32
第三節 排除禁忌用藥為metformin之新降血糖治療病患重要特性及首次處方使用不含metformin占率依處方箋型態分析 34
第四節 第二型糖尿病病患首次降血糖處方箋使用不含metformin占率及年度趨勢 34
第五節 影響首次降血糖處方是否使用metformin第一線治療之因素 36
第五章 討論 40
第一節 新治療糖尿病人之首次處方型態 40
第二節 新治療糖尿病人之首次處方是否含metformin之降血糖藥物趨勢 41
第三節 多變項羅吉斯回歸分析與多層次模型比較 41
第四節 影響首次治療處方是否開立metformin之影響因素 42
第六章 研究結論與建議 45
結論 45
建議 47
研究限制 48
參考文獻 67


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