- 學位論文
管制級數改變對Tramadol使用趨勢之影響
Effect of Schedule Change of Controlled Drug
摘要
研究背景：特拉嗎竇 (tramadol) 為合成中性樞性類鴉片疼痛解除劑，臨床上可治療急性中度至嚴重性疼痛及慢性疼痛。行政院衛生署於2007年2月16日將原第三級管制藥品tramadol，公告修正改列為第四級管制藥品。中央健康保險局對於疼痛解除劑之藥品給付規定，包括非類固醇抗發炎劑 (NSAIDs) 、tramadol及tramadol合併acetaminophen複方製劑。Tramadol管制級數改變後臨床醫療使用是否會取代NSAIDs？管制級數改變是否會造成醫療使用趨勢改變，屬值得深入研究及探討議題。 研究目的：本研究採用2005年至2007年中央健康保險局之全民健康保險研究資料庫之系統抽樣檔，欲了解tramadol管制級數改變前後之臨床醫療使用情形。 研究方法：本研究屬回溯性資料分析法，採用中央健康保險局之全民健康保險研究資料庫之系統抽樣檔；包含：醫事機構基本資料檔、藥品主檔、門診處方及治療明細檔、門診處方醫令明細檔、住院醫療費用清單明細檔及住院醫療費用醫令清單明細檔。分析tramadol管制級數改變前後於不同年齡層、性別、醫療院所層級及都市化程度..等之使用情形。 研究結果：NSAIDs及tramadol使用者在基本特質上有顯著的差異，NSAIDs廣為各年齡層使用，而tramadol則使用於老年患者居多。Tramadol管制級數後，tramadol使用人次在各年齡層皆呈現增加趨勢；NSAIDs使用趨勢並未明顯改變。Tramodol使用人次百分比五成以上集中於醫學中心，管制級數後地區醫院及基層院所使用人次呈現增加趨勢。 研究結論：當tramadol管制級數由第三級管制藥品改列為第四級管制藥品，其使用人次及使用量呈現增加趨勢。
並列摘要
Background: Tramadol is a synthetic, opioid-like, centrally acting analgesic. Tramadol provides effective analgesia in patients with moderate to severe acute pain and those with chronic painful conditions characterized by intermittent exacerbations of pain. Tramadol control schedule was changed from the schedule 3 to the schedule 4 on February 16, 2007. The central health insurance bureau pays the drugs for pain relief contain nonsteroidal anti-inflammatory drugs (NSAIDs), tramadol and tramadol plus acetaminophen. Tramadol may replace NSAIDs in clinical aspect after control schedule changed. Objective: The objectives are to evaluate the patients’ characteristics and the trends in prescription who received treatment of tramadol and NSAIDs from 2005 to 2007, duration of the tramadol control schedule changed. Methods: The data were sampling from the Taiwan’s National Health Insurance Research Database from 2005 to 2007 include ‘registry for contracted medical facilities’, ‘registry for contracted specialty services’, ‘monthly claim summary for inpatient claims’, ‘monthly claim summary for ambulatory care claims’, ‘registry for drug prescriptions’, ‘registry for drug prescriptions’, ‘ambulatory care expenditures by visits’ and ‘details of ambulatory care orders’. Gender, accreditation hospitals, age, quarter and extent of urbanization were analysis. Result:The oral and injection tramadol prescriptions were increasing with the age increasing. When tramadol control schedule changed from the schedule 3 to the schedule 4, oral and injection of tramadol prescriptions were increasing. Tramadol prescriptions were increasing in all age level. Oral and injection of tramadol prescriptions were increasing at local community hospitals and physician clinics. Patients age in the tramadol and NSAIDs prescriptions is differed significantly. The patients receiving the tramadol are older than whom receiving the NSAIDs. Conclusion: Tramadol prescriptions were increasing after tramadol control schedule changed from the schedule 3 to the schedule 4.