- 期刊
醫院卓越計畫對精神分裂症門診病患換藥行爲之影響
The Impact of Hospitals' Center of Excellence Initiative on Prescribing Pattern of Antipsychotics in Outpatient Schizophrenia Patients
摘要
目的：探討2004年七月全民健保醫院卓越計畫之實施，對醫院更換門診精神分裂症病患抗精神病藥品處方行爲之影響。 方法：採事前事後對照組比較研究設計，以2002-2003年皆固定在某醫院就醫的門診精神分裂症病患爲對象，利用2002-2004年健保門診申報資料之分析，比較有無加入卓越計畫醫院換藥行爲改變之差異。換藥行爲指「將第二代藥換爲第一代，或減少二代用藥量」。用藥量以醫師處方每日藥劑量(prescribed daily dose, PDD)計算。利用廣義估計方程式(generalized estimating equation, GEE)以差異中差異法(difference in differences)進行統計分析。 結果：35,441位病患中，在參與卓越計畫醫院就醫有50.38%。參與卓越計劃醫院於計劃實施後，換藥率較控制組高但不顯著(OR=1.19, 95% CI. 0.69-2.07)。但此效應因醫院特性而異，台北分局醫院換藥增加率顯著高於高屏分局；軍榮民及財團法人醫院顯著低於和立醫院；區域、地區及精神專科醫院顯著低於地區教學醫院。 結論：卓越計劃對醫院更換精神分裂症門診病患藥品行爲之影響因醫院特性而異。
並列摘要
Objectives: To explore whether the Center of Excellence Initiative (CEI) for hospitals implemented in 2004 had any influence on providers' prescribing patterns of antipsychotics for outpatient schizophrenia patients. Methods: We applied a pre-test/post-test control group design and compared the change in medication switching behavior between hospitals that implemented the CEI and those that did not (control group). Using the National Health Insurance claim data from 2002 to 2004, we based our analysis on patients who regularly sought care from a hospital between 2002 and 2003. Medication switching behavior was defined as either switching from second generation antipsychotics (SGA) to first generation antipsychotiocs (FGA) or reducing dosages on SGA. The dosage of prescribed antipsychotics was measured by the prescribed daily doses (PDD). We applied the difference-in-differences (DID) approach and the generalized estimating equation (GEE) model to conduct the analysis. Results: Among the 35,441 schizophrenia patients, 50.38% of them were from hospitals that participated in the CEI. Medication switching behavior was more likely to occur in hospitals that implemented the CEI compared to the control group (OR=1.19, 95% C.I. 0.69-2.07); however, the result was not statistically significant. The effects of CEI varied among hospitals with different characteristics or in different regions. Hospitals in the Taipei sub-bureau were more likely to display medication switching behavior than hospitals in the Kao-Ping sub-bureau. Military/veterans/non-profit proprietary hospitals were significantly less likely to display medication switching behavior than private hospitals. Metropolitan/community and mental hospitals were significantly less likely to switch medications than local community teaching hospitals. Conclusions: The impact of CEI on prescribing patterns of antipsychotic for outpatient schizophrenia patients differed among hospitals in different regions, with different ownerships, and accreditation levels.