疾病診斷與藥物治療一致性之用藥安全調查：以口服降血糖用藥為例

Study of Medication Safety in Consistency between Disease Diagnosis and Pharmacological Therapy: An Example of Oral Hypoglycemic Agents

郭震群(Chen-Chun Kuo) ； 呂英豪(Ying-Hao Lu) ； 陳啟佑(Chi-Yu Chen) ； 黃耀斌(Yaw-Bin Huang)

《臺灣臨床藥學雜誌》 20卷1期 (2012/03) Pp. 11-24

摘要

Purpose:The purposes of the study were: 1) to use Taiwan's National Health Insurance Reseach Database (NHIRD) related to the presciptions of oral hypoglycemic agents (OHAs) for analyzing if medication therapy is consistent with diagnosis; 2) to explore the relationship between diagnosis and medication therapy in various professional levels; and 3) to investigate if inconsistency among medications is same.Material and Methods:A long-term retrospective study was implemented to use NHIRD between January 1998 and December 2007. The unit of analysis was each OHA prescription without diagnosis codes of diabetes mellitus (DM). The study observation was described as inconsistent prevalence.Results and Discussion:There were 5,221,072 outpatients' prescriptions collected in this study, and 2,557 inconsistent prescriptions in 238,768 OHAs prescriptions were observed. The mean inconsistent prevalence is 1.07%. The prevalence of clinic in general, internal medicine and special internal medicine was respectively 2.45%, 1.37% and 0.52% (P＜.0001). In special internal medicine, the prevalences of cardiology, gastroenterology, nephrology and endocrinology were 1.27%, 0.94%, 0.71% and 0.12% (P＜.0001), respectively. Endocrinology is the professional of DM, therefore it could be found more professional is more consistent between diagnosis and medication therapy. It also implied that potential medication errors were less happened in professional clinics. In OHAs, the prevalence was individually for biguanides 0.73%, sulfonylureas 1.62%, alpha glucosidase inhibitors 0.45% and thiazolidinediones 0.16% (P＜.0001). The sulfonylureas with higher risk of hypoglycemia provided higher inconsistent prescriptions among OHAs to assume more potential prescribing errors. For high-alert medications, the consistency between diagnosis and medication therapy should be carefully examined in the healthcare system.

關鍵字

疾病診斷 ； 藥物治療 ； 一致性 ； 用藥安全 ； 用藥疏失 ； 口服降血糖用藥

並列摘要

Purpose:The purposes of the study were: 1) to use Taiwan's National Health Insurance Reseach Database (NHIRD) related to the presciptions of oral hypoglycemic agents (OHAs) for analyzing if medication therapy is consistent with diagnosis; 2) to explore the relationship between diagnosis and medication therapy in various professional levels; and 3) to investigate if inconsistency among medications is same.Material and Methods:A long-term retrospective study was implemented to use NHIRD between January 1998 and December 2007. The unit of analysis was each OHA prescription without diagnosis codes of diabetes mellitus (DM). The study observation was described as inconsistent prevalence.Results and Discussion:There were 5,221,072 outpatients' prescriptions collected in this study, and 2,557 inconsistent prescriptions in 238,768 OHAs prescriptions were observed. The mean inconsistent prevalence is 1.07%. The prevalence of clinic in general, internal medicine and special internal medicine was respectively 2.45%, 1.37% and 0.52% (P＜.0001). In special internal medicine, the prevalences of cardiology, gastroenterology, nephrology and endocrinology were 1.27%, 0.94%, 0.71% and 0.12% (P＜.0001), respectively. Endocrinology is the professional of DM, therefore it could be found more professional is more consistent between diagnosis and medication therapy. It also implied that potential medication errors were less happened in professional clinics. In OHAs, the prevalence was individually for biguanides 0.73%, sulfonylureas 1.62%, alpha glucosidase inhibitors 0.45% and thiazolidinediones 0.16% (P＜.0001). The sulfonylureas with higher risk of hypoglycemia provided higher inconsistent prescriptions among OHAs to assume more potential prescribing errors. For high-alert medications, the consistency between diagnosis and medication therapy should be carefully examined in the healthcare system.

並列關鍵字

Diagnosis ； Therapy ； NHIRD ； Medication Safety ； Oral Hypoglycemic Agents