| 摘要: | 研究動機與目的：抗生素抗藥性的問題已成為全球醫療界最關心的議題，為防止抗生素之抗藥性增加，目前國內外已有研究針對抗生素使用情形探討，為了更進一步瞭解個別醫院對抗生素的使用狀況，故本研究欲以某醫學中心為例，探討該醫學中心門診病患之抗生素利用情形，進而分析影響抗生素利用之相關因素。
研究方法：本研究以 1974 年 Aday & Andersen 之醫療服務利用行為模式為主要研究架構，擷取南部地區某醫學中心 2007 年 1 月 1 日至 2007 年 12 月 31 日期間之門診抗生素藥品給藥案件數進行分析，共計 65,982 筆，在進行資料整理與清檔後，利用 SPSS 12.0 統計分析套裝軟體進行描述性及推論性統計分析。
結果：本研究發現門診抗生素藥品費用平均每人 190 元，藥品種類平均每人 1.09 種，給藥數量平均 23 顆，給藥日數平均 7.7 天，至於在影響因素部分，在傾向因素部份，性別以男性具顯著正向影響，年齡以 45-54 歲具顯著正向影響，就醫科別以感染科及內科具顯著正向影響；在能用因素部份，需部分負擔者具顯著正向影響；在需要因素部份，3 種疾病診斷數目、有重大傷病者、有慢性病者及有職業傷病者具顯著正向影響；在醫師人力因素部份，醫師性別以男性具顯著正向影響，醫師年齡以 55-64 歲及65 歲以上具顯著正向影響。
結論：本研究發現醫院門診抗生素之利用情形，皆會因傾向因素、能用因素、需要因素及醫師人力因素而有所差異，因此，建議衛生主管機關與醫院管理者應針對上述的差異來制訂與實施正確的抗生素使用宣導、教育訓練、管理規範。
Motivation and Objectives: The problem of antibiotic resistance has become the most concerned issue for the medical field all over the world. To prevent the increase of antibiotic resistance, there have been some researches into the antibiotic utilization in Taiwan and overseas. In order to understand the antibiotic utilization in individual hospitals further, this research takes a medical center for instance, probes into the antibiotic utilizing condition of ambulatory patients in the medical center, and analyzes the relevant factor affecting the usage of antibiotic.
Methods: This research takes Aday & Andersen’s Behavior Model of Health Service Utilization in 1974 as the main research framework, extracts outpatient antibiotic cases in a southern Taiwan’s medical center from January 1st, 2007 to December 31st, 2007 for analysis, and amounts to 65,982 cases. After sorting up and clearing the files, we uses SPSS 12.0 to run descriptive and inferential statistics.
Results: This research found that the antibiotic expenditure per outpatient is NT190, 1.09 for average number of antibiotic categories, 23 for average amount of antibiotic used in each patient and 7.7 for length of each prescription. In influencing factors, as to predisposing factors, 45 to 54 year-old or male patients have a positive significant effect on antibiotic utilization. In addition, patients in Infectious Disease or Internal Medicine Departments have a higher antibiotic utilization than ones in other departments. As for enabling factors, people with co-payment have a positive significant effect. Regarding need factors, patients with the diagnostic amount of 3 types of diseases, catastrophic illnesses, chronic diseases or occupational harm also have positive significant impact. Concerning doctor manpower factors, above 55 year-old or male doctors have a higher antibiotic usage than others.
Conclusion: The research confirmed that the condition of antibiotic utilization is affected by the predisposing, enabling, need and doctor manpower factors. Therefore, I suggest the health authorities and hospital managers should establish and execute correct utilization guidance, education and training, and managing standards towards these factors above. |
