目的：全民健康保險局(健保局)於2008年9月修正日劑藥費支付方式，期望藉此政策來推廣兒童專用藥劑(原瓶包裝口服液劑)的使用。本研究目的為探討日劑藥費支付方式修正前後的兒童專用藥劑使用狀況及其影響因素，並調查兒童照顧者及醫院護理人員對兒童專用藥劑的看法，藉以了解兒童藥劑使用狀況。方法：採回溯性橫斷式研究設計，資料來源為2008年5月至2008年12月全民健康保險學術研究資料庫之系統抽樣檔，以9歲以下兒童原瓶包裝口服液劑ATC Code之藥品處方醫令為研究樣本，資料分析方法包含描述性統計與推論性統計。另外，透過自填式問卷調查南部某區域教學醫院門診病患之兒童照顧者與醫院護理人員對兒童專用藥劑的看法。結果：本研究顯示診所開立兒童原瓶包裝口服液劑可分為27種ATC Code。市面上與這些ATC Code同成分的藥品之中，有12.7%為口服液劑，而口服液劑之使用率與健保局修正日劑藥費支付方式有顯著關聯(OR = 6.92, 95%CI = 6.23, 7.68)。廣義估計方程式分析結果顯示，在其他預測因子調整之後，兒童原瓶包裝口服液劑於日劑藥費支付方式修正後的使用率顯著高於修正前(p<.001)，國內廠商的藥品比國外廠商的藥品使用率顯著較高(p<.05)。調查資料指出，目前兒童用藥大多是藥粉與藥水合併使用，容易餵藥是兒童藥品劑型選擇的主要因素。結論：健保日劑藥費支付方式修正案在2008年9月1日至12月31日期間看來是有效的，但這些正面的影響可能會因為廣泛地藥品磨粉現象而打折扣。此外，國內使用兒童原瓶包裝口服液劑在兒童用藥安全是具有正面的意義。 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 liquid oral pediatric medicine prescribing among primary children to investigate the effect of NHI daily drug payment amendment. We also assessed the experiences of child's caregiver and hospital nurses about children's formulation. Methods: This retrospective cross-sectional study conducted with systematic sampling NHI database from May 2008 to December 2008. The subject was the drugs classified in the same ATC code as NHI liquid oral pediatric medicine prescribed for children aged younger than 9 years. Data analysis included the descriptive and inferential statistical methods. In addition, child caregivers' and hospital nurses' perspectives about children's formulation was gathered via self administered questionnaires in a regional hospital in Southern Taiwan. Results: Liquid oral pediatric medicines prescribed in primary care children were classified in 27 different ATC codes. Among these, 12.7% of medicines were liquid oral pediatric formulation whose prescribing practice were significantly associated with NHI daily drug payment amendment (OR = 6.92, 95%CI = 6.23, 7.68). The results of GEE analysis showed that the utilization rate of liquid oral pediatric medicines during post-NHI daily drug payment amendment period (p<.001) had significantly higher compared with pre- amendment period, domestic medicines were prescribed more than medicines from foreign country (p<.05) after having adjusted for other predictive factors. Survey data noted current pediatric formulations for the most children were powder in combination with liquid; easy-to-administration was the main reason to make child's dosage form choice. Conclusions: NHI daily drug payment amendment appears to be effective over the time period between September 1, and December 31, 2008, but the positive effects might be diminished by oral powder extended use. Besides, domestic liquid oral pediatric medicines will contribute to liquid oral pediatric medicine utilization benefiting children's medication safety.
