高雄市立醫院抗生素處方之比較研究---以門診上呼吸道感染患者為例

本研究目的是在探討兩家高雄市立醫院在門診上呼吸道感染患者之抗生素使用情形之比較，包括抗生素處方率、抗生素藥理分類及抗生素醫療利用是否因為患者基本特質、不同醫院、不同看診科別及不同診斷別而有所差異。本研究之對象選自兩家高雄市立綜合醫院九十一年健保門診申報之所有普通案件（健保代號09案件，泛指開藥在14天之內之案件），不包括小兒科。再擷取門診醫令檔中主診斷前三碼460-466之呼吸道感染疾病患者共15,572人次，A醫院7,708人次，B醫院7,864人次。資料整理後，以SPSS for Windows 8.0統計軟體進行描述性及推論性分析比較。研究結果發現門診上呼吸道感染患者之抗生素使用情形，包括抗生素處方率、抗生素藥理分類及抗生素醫療利用均會因為不同醫院、不同看診科別及不同診斷別而有所差異；而患者基本特質部分，性別沒有顯著差異，而年齡則會有顯著差異。B醫院的抗生素醫療利用高於A醫院；耳鼻喉科之抗生素醫療利用最高；診斷為急性鼻竇炎及急性扁桃腺炎抗生素醫療利用比起其他常見上呼吸道感染診斷別之抗生素醫療利用要高。兩家市立醫院已於92年1月1日合併為同一家市立醫院，為提昇品質，對不同院區同科同診斷之醫療照護及處方一致應該是未來在經營方向上努力之目標，尤其是在抗生素之控管，益顯重要。

關鍵字

抗生素；處方；上呼吸道感染；醫療利用

並列摘要

The major purpose of this study was to compare overall antibiotics utilization for outpatients with upper respiratory infection between two Kaohsiung municipal hospitals. It was to examine whether there were any difference of antibiotics utilization among different hospitals, departments, diagnoses, and demographic variables of patients. The data source was derived from outpatient claim files of two Kaohsiung municipal hospitals in 2002, ICD-9 were 460-466, but exclude pediatrics. The total patients were 15,572, the hospital A was 7,708, and the hospital B was 7,864. Descriptive analysis and inference analysis were conducted by using SPSS for window 8.0. The study findings were summarized condensed as follow: there were significant differences of antibiotics utilization and classification among different hospitals, departments, diagnoses, and demographic variables of patients（except sex）. The antibiotics utilization of the hospital B was higher than the hospital A. The antibiotics utilization of ENT department was higher than others. The diagnoses of acute sinusitis and acute tonsillitis were higher than others. Since the two municipal hospitals had been merged by Jan 1,2003. We need to set up the unique standard antibiotics prescription to be followed. Especially, the same diagnosis had been made in the same department.