不同層級醫院三高處方用藥重複率改善結果的比較

Evaluation of Therapeutic Duplication of Medication in Patients with High Blood Pressure, High Blood Sugar, and High Blood Lipids between Local Hospitals, Regional Hospitals, and Medical Centers in Taiwan

王文芬(Wen-Fen Wang) ； 吳世望(Shin-Wang Wu) ； 錢才瑋(Tsair-Wei Chien)

《醫務管理期刊》 16卷4期 (2015/12) Pp. 279-293

https://doi.org/10.6174/JHM2015.16(4).279

摘要

目的：比較不同層級醫院三高藥品重複用藥日數比率及其改善情形。方法：擷取2011 年第1 季至2013 年第2 季衛生福利部中央健康保險署網路公佈各醫院的各季三高（即降血壓、降血糖、及降血脂藥物）給藥日數重複率。利用探索性因素決定因素的個數，以組間均方和換算出新座標權重比例。以單因子變異數分析檢定不同層級醫院間的的差異，並利用標準化迴歸係數檢測其間改善程度。結果：三高重複用藥日數的比率，呈現地區醫院不如醫學中心及區域醫院。其改善情形：在血壓用藥方面，呈現出區域醫院優於地區醫院；在血糖及血脂用藥方面，也呈現出區域醫院及醫學中心優於地區醫院。結論：三高藥品重複用藥日數比率呈現明顯的改善，重複用藥在大型醫院電腦系統的協助下較具成效。

關鍵字

重複用藥 ； 探索性因素分析 ； 高血壓 ； 高血糖 ； 高血脂

並列摘要

Objectives: We evaluated the degree of therapeutic duplication (TD) of medications in Taiwan hospitals for outpatients with hypertension, hyperglycemia, and dyslipidemia, and determined whether or not the clinical findings improved or became worse in the most recent 10 fiscal quarters. Methods: Data from the 1st quarter of 2011 to the 2nd quarter of 2013 of duplicate prescription rates of medications were retrieved from the Taiwan government-run National Health Insurance Department website. Exploratory factor analysis was used to determine the number of factors. Two periods of 3-type studied duplicate day ratios were used to construct a newly weighted and coordinated variable referring to the greatest ratio value of between-group to within-group in sum of mean squares of analysis of variance (ANOVA) to examine the differences between hospital levels. Standardized regression coefficients were used to investigate the data. Results: TD problems were significantly more serious in local hospitals than medical centers and regional hospitals. The reduction in TD for anti-hypertensive medications was significantly greater (p = 0.001) in regional hospitals than local hospitals. The reduction in TD for hypoglycemic and hypolipidemic medications was greater (p = 0.05) in medical centers and regional hospitals than local hospitals. Conclusions: Local hospitals did not improve as much as medical centers and regional hospitals, possibly because of differences in computerization.

並列關鍵字

duplicate medications ； exploratory factor analysis ； hypertension ； hyperglycemia ； dyslipidemia

參考文獻

王文中(1997)。測驗的建構：因素分析還是Rasch 分析？。調查研究－方法與應用。3，129-166。

王文中(2004)。Rasch 測量理論與其在教育和心理之應用。教育與心理研究。27(4)，637-694。

姚漢禱(2001)。負Alpha 信度係數指標在運動技能測驗之研究。體育學報。31，271-280。

陳世欽、蔡文正、黃昱瞳、謝儀靜、黃光華(2012)。台灣高血壓用藥之問題處方及其影響因素的研究。臺灣公共衛生雜誌。31(1)，31-42。

黃秀雅、周幸生、曾冠叡、顏秀芳、馮容莊(2011)。條碼給藥系統推行與全面品質管理策略之實務經驗。醫務管理期刊。12(2)，130-142。