老年人潛在不當處方用藥的醫療資源使用暨相關因素之研究─以Diphenhydramine為例

研究目的：台灣社會是高齡化迅速的國家，人口高齡化，使用藥物治療一般會增加，也增加了潛在不當處方用藥的風險。潛在不當處方用藥是一個值得正視的公共衛生問題，因為它可能會導致嚴重的醫療後果，同時對衛生保健系統施加相當程度的負擔。故本研究目的主要探討潛在不當處方用藥的相關影響因素，以及所造成的醫療資源耗用情形。研究方法：本研究架構以「全民健康保險學術資料庫」為研究工具，採回溯性研究設計；研究對象為年齡65歲以上的老年病患。根據2003年BEERS criteria來探討第一代抗組織胺藥物Diphenhydramine在老年人是否有發生潛在不當處方用藥，並利用病人的人口學特質、疾病特質、醫療提供者特質來探討潛在不當處方用藥之重要影響因素，以及造成的醫療資源耗用情形。研究結果：本研究結果初步發現，發生老年人潛在不當處方用藥的相關因素為：年齡愈大，發生潛在不當處方用藥的風險愈高(OR=1.03)；用藥顆數愈多，發生潛在不當處方用藥的風險也會增加(OR=1.02)；罹患心血管疾病者，發生潛在不當處方用藥的機率較高(OR=1.74)；罹患胃腸消化道疾病者，發生潛在不當處方用藥的機率較低(OR=0.62)；罹患精神方面疾病者，發生潛在不當處方用藥的機率較高(OR=72.17)；開立處方的醫師年資愈久，發生潛在不當處方用藥的風險愈低(OR=0.98)；和台北分局相比較，中區分局的醫療院所發生潛在不當處方用藥的風險較高(OR=1.35)；和醫學中心相比較，地區醫院和基層診所比較容易發生潛在不當處方用藥，OR值分別為2.00與1.37；相較於診療科別不是內科者，內科發生潛在不當處方用藥的風險較高(OR=1.29)；相較於診療科別不是耳鼻喉科者，耳鼻喉科發生潛在不當處方用藥的風險較高(OR=1.67)。另外發現到潛在不當處方用藥和住院費用、住院天數等醫療資源間有相關。結論與建議：老人潛在不適當藥物是一個值得關注的問題，不僅是關係到老年人的健康狀況，更可能對醫療資源造成沉重的負荷；在台灣這個高齡化且藥物使用如此頻繁的社會，醫療單位和政府衛生單位應好好的研究相關議題。

關鍵字

老年人；潛在不當處方用藥；醫療資源使用

並列摘要

Background：Taiwan is a rapidly aging country. The more population aging, the more medical utilization, may also increases the risk of potentially inappropriate medication. Potentially inappropriate medication is a serious public health problem that can lead to serious medical consequences and impose a considerable load on the health-care system. The purposes of this study are to explore the influencing factors of potentially inappropriate medication, and the consumption of medical resources. Method：The retrospective study used the National Health Insurance Research Database as research tools. The subjects of this study were elderly patients aged 65 years and older. According to 2003 BEERS criteria, the goal of this study was to explore whether there were potentially inappropriate uses of the first generation of antihistamine Diphenhydramine in the elderly population. We also explored the influencing factors of potentially inappropriate medication and the consumption of medical resources by using the demographic characteristics, disease characteristics and medical provider characteristics of those patients. Results：The preliminary finding of this study was to figure out the factors of the elderly potentially inappropriate medication. Those factors were：(1) The higher of age, the higher risk of potentially inappropriate medication (OR = 1.03). (2) The more numbers of drugs, the higher risk of potentially inappropriate medication (OR = 1.02). (3) Patients with cardiovascular diseases increased the risk of potentially inappropriate medication (OR = 1.74). (4) Patients with gastrointestinal diseases decreased the risk of potentially inappropriate medication (OR = 0.62). (5) Patients with mental disorders increased the risk of potentially inappropriate medication (OR = 72.17). (6) The more senior of prescribing physicians, the lower risk of potentially inappropriate medication (OR = 0.98). We also found that comparing with the Taipei regional, there was a higher risk of potentially inappropriate medication in the Central regional (OR = 1.35). Comparing with medical centers, local hospitals and primary care clinics were more likely to have a potentially inappropriate medication, with ORs 2.00 and 1.37, respectively. There were higher risks of potentially inappropriate medication in internal medicine (OR = 1.29) and otolaryngology medicine (OR = 1.67). In addition, potentially inappropriate medication abused medical resources, such as hospital costs and hospitalization days. Conclusions and suggestions：Potentially inappropriate medication of the elderly may influence their health status, and may cause heavy medical loading. Taiwan is an aging country with abounded medicine uses, those medical institutions and government health administration should concern those potentially inappropriate medication issues.

並列關鍵字

BEERS Criteria ； Diphenhydramine ； The elderly ； Potentially Inappropriate Medication ； Medical Utilization

參考文獻

中文參考文獻

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