台灣高血壓用藥之問題處方及其影響因素的研究

A study on the Inappropriate Prescription of Medications to Treat Hypertension in Taiwan

陳世欽(Shiu-Ching Chen) ； 蔡文正(Wen-Chen Tsai):黃昱瞳(Yu-Tung Huang) ； 謝儀靜(Yi-Chung Hsieh) ； 黃光華(Kuang-Hua Huang)

《台灣公共衛生雜誌》 31卷1期 (2012/02) Pp. 31-42

https://doi.org/10.6288/TJPH2012-31-01-04

摘要

目標：高血壓是心血管疾病的重要危險因子，不僅威脅民眾健康，更是公共衛生重要議題，本研究目的為利用全民健保資料庫分析，瞭解我國高血壓用藥之問題處方，並探討其影響因素。方法：資料來源為「全民健康保險學術研究資料庫」之2005年100萬人承保抽樣歸人檔。本研究分析2004至2008年之申報資料；採用ATC分類系統原則，進行健保藥品之藥理分類；擷取ICD-9-CM前3碼為401至405之高血壓門診個案為研究對象；問題處方分為重複用藥、交互作用及超量處方。結果：2004年至2008年共有161,003位高血壓患者，高血壓門診處方共有3,988,024人次。問題處方方面，重複用藥發生率為2.1%，交互作用高達33.41%，超量處方為12.39%。高血壓問題處方影響因素方面，在「公立及私立醫療機構」、「男性醫師」及「醫師年資越低」等特性之發生率較高。結論：本研究呈現台灣2004至2008年健保高血壓門診問題處方之現況結果，希望提供衛生政策決策者有效的資訊，以制訂用藥相關政策，俾利提升高血壓病患之用藥安全。（台灣衛誌 2012；31（1）：31－42）

關鍵字

高血壓 ； 問題處方 ； 重複用藥 ； 交互作用 ； 超量處方

並列摘要

Objectives: Hypertension (HTN) is an important risk factor for cardiovascular disease, and not only is a major health threat for the general population, but is also an important public health issue. Using National Health Insurance (NHI) claims data, this research investigated the inappropriate prescription of medications to treat hypertension under NHI in Taiwan. Methods: The data for 2004 to 2008 were collected from the National Health Insurance Research Database (NHIRD) published by the National Health Research Institutes. The dataset contains information about 1,000,000 beneficiaries randomly sampled from the year 2005 Registry for Beneficiaries of the NHIRD. The NHI Pharmaceutical Subsidy Anatomical Therapeutic Chemical classification system was used to extract the pharmaceutical classification records. The study subjects were identified based on major diagnoses of ICD-9-CM codes 401.xx-405.xx. Inappropriate prescriptions were defined as duplicate medications, drug-drug interactions, or over-dosage. Results: There were 161,003 patients with hypertension and 3,988,024 prescriptions from 2004 to 2008. For inappropriate prescriptions, the frequencies of over-dosage, duplicate medications, and drug-drug interactions were 2.1%, 33.41%, and 12.39%, respectively. The incidence of inappropriate prescriptions was considered high, and most were prescribed by public and private medical facilities, male physicians, and physicians with low seniority. Conclusions: This research demonstrated the inappropriate prescription of medications to treat HTN from 2004 to 2008 under NHI in Taiwan. It may provide useful information for policy-makers to enact relevant policies to ensure prescription safety for HTN patients. (Taiwan J Public Health. 2012; 31(1):31-42)

並列關鍵字

hypertension (HTN) ； inappropriate prescription ； duplicated medication ； drug-drug interaction ； over-dosage

參考文獻

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