目的：探討癲癇初診個案抗癲癇藥物（antiepileptic drugs, AEDs）替換之影響因素與醫療利用改變之情形。方法：回溯性追蹤年齡5歲以上之2004年與2009年間之一年前無癲癇就醫紀錄之健保癲癇病患，排除使用AEDs一年以下病患，最後本研究世代有312人，共接受3,159人次處方箋。以Kaplan-Meimer方法分析使用AEDs6個月後之替換情形，廣義估計方程式進行AEDs替換影響因素分析，並以Wilcoxon符號等級檢定比較AEDs替換前後之醫療利用。結果：研究世代AEDs未替換時間之中位數為38.87個月。癲癇病患之處方藥品品項數每增加1個，則AEDs替換的勝算比增加44％。病患AEDs替換後之急診次數顯著低於替換前；門診與住院次數則替換前後皆無顯著差異。在235人次AEDs替換處方之醫師與替換前的醫師不同的有75％，處方中保留和替換前相同成分的AEDs有80％；保留相同的AEDs主成份的處方有56.2％。結論：AEDs替換發生在多重用藥之處方的機率較高，癲癇病患之AEDs替換之醫療利用並沒有增加。半數以上AEDs替換處方有保留同成份或同併用藥物，此結果顯示醫師替換AEDs頗為謹慎。 Objectives: To investigate the factors and medical utilization associated with the substitution of antiepileptic drugs (AEDs) in Taiwan. Methods: The cohort of patients was over 5 years of age with a primary diagnosis of epilepsy from Longitudinal Health Insurance Database (LHID) between 2004 and 2009 and have no prior medical care diagnosis of epilepsy within the past one year were selected. Receiving AEDs < 1 year were excluded. The final cohort consisted of 312 patients for whom 3,159 prescriptions were filled. The Kaplan-Meier approach was used to estimate probability of having AEDs substitution over time since 6 months after initiation of AEDs therapy. Generalized estimating equation (GEE) logistic regression models were fit to identify factors associated with AEDs substitution. Medical utilization differences between before and after AEDs substitution was compared by means of Wilcoxon sign ranked test. Results: The median AEDs no substitution time for the cohort was 38.87 months. GEE logistic regression showed a 44% increased incidence of AEDs substitution (odds ratio = 1.44, p=0.002), increase in AEDs substitution for each increment in number of AEDs prescribed. AEDs substitution periods (six months after substitution) had significantly lower emergency care than before. However, no difference was found after AEDs substitution as to outpatient visits and hospitalizations. A total of 235 prescriptions with AEDs substitution was found, prescribing physician changed was in 75%, remaining the same AEDs combination was in 80% and 56.2% was substituted with the same active ingredient AEDs. Conclusions: Patients who had polytherapy were more likely to have an antiepileptic drug substitution. The study was not revealed medical utilization increase after AEDs substitution. More than half of AEDs substitution prescriptions were replaced with the same active ingredient AEDs and the other co-prescribed AEDs were the same, these results implicate physicians substitute AEDs for patients with epilepsy cautiously.
