The Strategies for Improving Antibiotic Usage under the Diagnoses of Upper Respiratory Infections and Its Impact in the Ambulatory Clinics in One Medical Centre in Taiwan

健保局為確保醫療服務品質，透過每季檢送相關監測指標狀況給各醫療機構以玆參考。其中本院「門診病人上呼吸道感染抗生素使用率」之指標值遠高於同儕值。有鑑於此，故研擬此計畫，期能透過相關對策提出與介入，降低門診病人上呼吸道感染抗生素使用率。於2004年10月至2005年9月間，相關科別陸續舉行會議，除研擬本院之合理使用指引，供臨床醫師診療參考，並說明正確書寫疾病碼之原則。亦利用政府機關及相關學會所製作之文宣品，向病人衛教正確使用抗生素之觀念。資料來源為本院之健保門診申報檔，向藥劑科進行追蹤。所有資料經分析，顯示在對策介入後，本院上呼吸道感染抗生素的使用率大幅降低。2004年第3季全院上呼吸道感染抗生素的使用率為28.6%，2005年第3季則下降至13.9%。值得注意的是，在計畫結束後，自2005年第4季至2006年第2季，使用率仍維持在9.7%-12.1%。本研究之結果顯示透過跨科別之會議召開，並針對相關資料定期檢討，對於改善抗生素的使用確有助益，且在提供實證文獻參考或人員教育訓練上亦有貢獻。然上呼吸道感染抗生素之使用為長久以來討論之議題，仍有待復續努力宣導及追蹤

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並列摘要

The Bureau of National Health Insurance (NHI) in Taiwan has provided quality indicators to all medical care providers each quarter to assure and evaluate the quality of medical service. This system highlighted a higher rate of antimicrobial usage in treating upper respiratory tract infections (URIs) in our ambulatory clinics than that in other tertiary medical care providers. Therefore, we aimed at developing effective strategies to reduce irrational antimicrobial usage in patients with URIs. Clinical practice guidelines were applied in a series of educational discussion meetings from October 2004 to September 2005. The principle of writing correct diagnoses was explained using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) codes, and educational materials were provided for patients during the ambulatory clinics. Data submitted to NHI were analysed by the Department of Pharmacy of Cathay General Hospital. Antimicrobial usage by patients with URIs decreased dramatically after the program had been implemented, i.e., from 28.6% in the third quarter of 2004 to 13.9% in the third quarter of 2005. It is noteworthy that even after the end of the study, the rates remained persistently low, i.e., 9.7%-12.1% from the fourth quarter of 2005 through the second quarter of 2006. The result of this study demonstrated the effectiveness of the strategies for promoting appropriate antimicrobial usage.

並列關鍵字

upper respiratory tract infections ； antimicrobial usage ； clinical practice guidelines ； implementation ； outpatient clinics

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The Strategies for Improving Antibiotic Usage under the Diagnoses of Upper Respiratory Infections and Its Impact in the Ambulatory Clinics in One Medical Centre in Taiwan

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