醫院處方三高重複用藥之研究-層級醫院間之比較

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標題:	醫院處方三高重複用藥之研究-層級醫院間之比較 Evaluation of therapeutic duplication of medication in patients with high blood pressure, high blood sugar, and high blood lipids between local hospitals, regional hospitals, and medical centers in Taiwan
作者:	王文芬
貢獻者:	醫務管理系錢才瑋吳世望
關鍵字:	高血糖高血壓探索性因素分析重複用藥高血脂 hypertension exploratory factor analysis duplicate medication high blood sugar high blood lipid
日期:	2014
上傳時間:	2015-10-26 20:31:01 (UTC+8)
摘要:	背景與目的：重複用藥不僅對病患健康照護產生危害，對日益上升的醫療支出更是雪上加霜。在有限的資源下，提升醫療品質並抑制醫療浪費避免重複醫療資源利用，已成為重要的課題。本研究比較不同層級醫院的三高藥品重複用藥日數比率之嚴重度及改善程度，以作為主管機關與醫院未來改善之參考。方法：自2011年第1季至2013年第2季擷取健保署在網路上公佈醫院層級的各季三高（即降血壓、降血糖、及降血脂藥物）給藥日數重複率，有效樣本計350家醫院。利用探索性因素分析及平行模擬法決定因素的個數。再以組間均方和除以組內均方和的最適權重比值，換算出新座標權重比例的變數。利用單因子變異數分析及scheffe的事後檢定方法，檢定不同層級醫院三高重複用藥日數比率的差異。利用標準化迴歸係數，來檢測不同層級醫院的三高重複用藥日數比率的改善程度。結果：層級間醫院的三高重複用藥日數比率的程度，呈現地區醫院不如醫學中心或區域醫院。其改善程度，在血壓用藥方面，只呈現出區域醫院改善情形優於地區醫院；在血糖及血脂用藥方面，則都呈現出區域醫院及醫學中心改善情形優於地區醫院。結論：三高用藥重複日數的比率，已是健保署的重要監測指標。本研究發現各醫院在最近的5季（2012年第2季至2013年第2季）期間，三高藥品重複用藥日數比率都呈明顯的改善。惟地區醫院仍不如區域醫院或醫學中心，說明重複用藥在大型醫院電腦系統的協助下已具成效。藉由未來健保雲端藥歷的協助，能使醫院重複用藥的費用節省，及對病人重複用藥安全的維護，做出貢獻。 Background and Objectives: Duplicate prescribing occurs across health systems and is one of the most frequently reported drug-related problems. Therapeutic duplication (TD) of medication increases the risk of adverse drug reactions without additional therapeutic benefits. We evaluated the degree of TD of medication in local hospitals, regional hospitals, and medical centers in Taiwan hospitals for outpatients with [i] high blood pressure (hypertension), [ii] high blood sugar (hyperglycemia), and [iii] high blood lipids, e.g., cholesterol and triglycerides (hyperlipidemia), and determined whether the situation has improved or become worse in the recent 10 fiscal quarters.Methods: Data from the 1st quarter of 2011 to the 2nd quarter of 2013 of duplicate prescription rates of anti-hypertension, anti-hyperglycemia, and anti-hyperlipidemia drugs were retrieved from the Taiwan government-run National Health Insurance Department website. Data from 350 hospitals were used. Two methods of exploratory factor analysis and parallel analysis were used to determine the number of factors. Two periods of 3-type studied duplicate days’ ratios were respectively used to construct a newly weighted and coordinated variable referring to the greatest ratio value of between-group to within-group in sum of mean squares of analysis of variance (ANOVA) with the Scheff? post-hoc method to examine the differences between hospital levels. Standardized regression coefficients were used to investigate the data.Results: We found that TD problems are significantly more serious in local hospitals than in medical centers and regional hospitals. The reduction of TD for anti-hypertension drugs was significantly greater (P = 0.001) in regional hospitals than in local hospitals. The reduction of TD for anti-hyperglycemia and anti-hyperlipidemia drugs was greater (P = 0.05) in medical centers and regional hospitals than in local hospitals.Conclusions: Controlling TD rates in patients with hypertension, hyperglycemia, and hyperlipidemia is an urgent problem in healthcare settings. We found substantial improvement in controlling TD in the recent 5 quarters. However, local hospitals did not improve as much as medical centers and regional hospitals did, possibly because of differences in computerization. Our findings can be used to improve the national TD problem and to increase the National Health Insurance system’s cost-effectiveness and patient safety in Taiwan.
關聯:	網際網路公開：2019-07-16，62頁
顯示於類別:	[醫務管理系(所)] 博碩士論文

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