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研究生:林怡君
研究生(外文):Yi-Chun Lin
論文名稱:健保日劑藥費支付標準對於台灣兒童鼻竇炎及中耳炎門診抗生素製劑型態之影響
論文名稱(外文):健保日劑藥費支付標準對於台灣兒童鼻竇炎及中耳炎門診抗生素製劑型態之影響
指導教授:黃光華黃光華引用關係
學位類別:碩士
校院名稱:中國醫藥大學
系所名稱:醫務管理學系碩士在職專班
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:2016
畢業學年度:104
語文別:中文
論文頁數:64
中文關鍵詞:兒童專用製劑抗生素製劑型態日劑藥費
外文關鍵詞:Pediatric oral liquid medicineAntibioticsFormulation patternsdaily drug payment
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目標:台灣西醫小兒藥品多是以成人錠劑磨粉分包,劑量不穩及交叉汙染問題時有所聞,但兒童專用製劑因單價較高推行不易。本研究探討兒童鼻竇炎及中耳炎門診抗生素製劑型態之分布,以及健保日劑藥費支付標準修正後抗生素兒童專用製劑使用之差異。方法:資料來源為2004-2012年全民健保資料庫百萬抽樣歸人檔(LHID2010),分析6歲以下兒童中耳炎及鼻竇炎開立含有Amoxicillin , Amoxicillin- Clavulanate, Cefaclor, Cefuroxime抗生素處方,製劑型態分為成人錠劑磨粉、兒童專用製劑及併用三種,觀察期為首次開藥後180天。使用SAS 9.3.1套裝軟體進行資料處理及統計分析,探討開立兒童專用製劑的影響因素,以及2008年9月健保日劑藥費支付標準修正前後,抗生素兒童專用製劑之使用率的差異。結果:2003至2012年6歲以下兒童中耳炎或鼻竇炎門診共有106,216人次。使用成人錠劑磨粉共92,528人次,其中基層診所開立78,305人次最多。在健保日劑藥費支付標準修正後,基層診所抗生素兒童專用製劑的使用率有顯著提高。
結論:兒童專用製劑以醫學中心使用最多,成人錠劑磨粉則以基層診所最多。在健保日劑藥費支付標準修正後,基層診所抗生素兒童專用製劑的使用率有顯著提高。


Objectives: Beginning in September 2008, the National Health Insurance (NHI) daily drug payment was amended for promoting the liquid oral pediatric medicine prescription. The aim of this study was to analyze the antibiotic liquid oral pediatric medicine prescribing among preschool children with sinusitis and otitis media to investigate the effect of NHI daily drug payment amendment.
Methods: This retrospective study conducted with NHI database from January 2004 to December 2012. The subject was the antibiotic prescriptions of Amoxicillin , Amoxicillin- Clavulanate, Cefaclor, Cefuroxime prescribed for children aged younger than 6 years. We devided whole prescriptions into three group: using liquid oral pediatric formulation、using adult formulations in divided powders and using both within 180 days after the first prescription. We use SAS 9.3.1 software to performed data processing and statistical analysis , investigating the effect of NHI daily drug payment amendment .Results: There are total of 106, 216 outpatient children under 6 years with sinusitis and otitis media from 2003 to 2012. 92,528 of which using adult formulation in divided form , which including 78,305 primary care , probably due to the cost considerations . Using liquid oral pediatric formulations are 10,189 children, 3,131 of which are from medical center, and 1,881 from primary care.. In addition, primary care significant improved in using liquid oral pediatric formulations after the NHI daily drug payment was amended.
Conclusion: Liquid oral pediatric formulations are used mostly in medical center and adult formulations are used mostly in primary care. Primary care significant improved in using liquid oral pediatric formulations after the NHI daily drug payment was amended.


目錄 2
表目錄 4
圖目錄 5
中文摘要 6
Abstract 8
謝誌 10
第一章 緒論 12
第一節 研究背景與動機 12
第二節 研究目的 16
第二章 文獻探討 17
第一節 小兒藥品磨粉分包的潛在問題 17
第二節 兒童門診口服兒童專用製劑使用情形 21
第三節 開立抗生素兒童專用製劑的影響因素 23
第三章 研究方法 27
第一節 研究架構 27
第二節 研究設計 29
第三節 研究對象與資料來源 31
第四節 資料處理流程及變項操作型定義 32
第五節 統計方法 36
第四章 結果 37
第一節 抗生素兒童專用製劑開立之分布 37
第二節 各年度兒童抗生素專用製劑使用情形 41
第三節 健保日劑藥費修正前後兒童專用製劑使用率之差異 44
第五章 討論 45
第一節 抗生素兒童專用製劑的開立分布情形 45
第二節 台灣兒童歷年抗生素兒童專用製劑使用率分析 51
第三節 健保日劑藥費修正對兒童專用製劑使用率的影響 53
第四節 研究限制 54
第六章 結論與建議 55
第一節 結論 55
第二節 建 議 56
參考文獻 57


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