為探討中央健康保險局在90年2月1日起增訂:「上呼吸道感染病患」,如屬一般感冒或病毒性感染者不應使用抗生素,及91年7月中央健康保險局「總額預算制度」,對門診使用抗生素之影響而進行此研究。本研究分兩階段分別比較上述政策實施前、後之改變:(一)89、90年3-4月(二)90、91年11-12月;監測與上呼吸道感染相關診斷碼使用之人次及所佔比例、使用上呼吸道感染相關診斷之抗生素處方使用率、及不分診斷之門診抗生素佔率。結果顯示限制五項與感冒相關之診斷不能開立抗生素處方後,該診斷碼之使用率由6.61%降至5.42%,原本預期限制某些診斷不得使用抗生素,可能會使得其他上呼吸道感染但可用抗生素的診斷碼增加;但有趣的是,大部分與上呼吸道感染相關診斷碼的開立,比較兩階段反而都有比率下降趨勢(一、二階段降低分別爲0.81及0.49個百分點),而不分診斷之門診抗生素佔率,第一階段亦由15.0%降至12.8%,第二階段由11.6%降至7.9%。總而言之,健保使用抗生素的規定及總額預算制度,可以有效降低門診使用抗生素比率。
The Bureau of National Health Insurance issued a new policy in Feb. 1, 2001, to restrict antibiotic use in upper respiratory tract infections (URI). Global budget was also implemented since July 1. 2002. To achieve the goals demanded by those two policies, a series of regulations had been enforced at our medical center since then. The efforts included setting up computerized system for antibiotic prescriptions, to restrict antibiotic use in of some upper respiration tract infections. The antibiotic prescription rate was evaluated by reviewing: the number and the proportions of URI-related ICDs; URI-related antibiotics usage relative to all medications; and all outpatient antibiotic usage among the OPD medications. We noted a marked improvement in the OPD antibiotic usage (15% down to 7.9% OPD antibiotic usage rate among all medications) after our monitoring system has been implemented. Antibiotic regulation policy and global budget can reduce antibiotic prescription rate in the outpatient clinic setting.