藥物交互作用高度危象處方之探討 -- 以高高屏醫院門診為例

Drug-drug Interactions among High Risk Prescriptions -- Example of Hospital Outpatients in Kaohsiung-Pingtong Areas

黃梅珍(Mei-Chen Huang)

指導教授 ： 張永源

高雄醫學大學/健康科學院/醫務管理學研究所碩士在職專班/碩士(2006年)

https://doi.org/10.6832/KMU.2006.00016

摘要

摘 要
目的：
為提高醫療品質及病人用藥安全，探討醫院門診單一處方簽發生
高度危象藥物交互作用之醫院及病人特質差異性。並探討有無發生高度危象藥物交互作用處方之病人在住院醫療費用耗用及死亡之差異性。

方法：
高度危象藥物交互作用品項係指行政院衛生署「藥品交互作用資料庫管理資訊系統」中危象等級為一級、嚴重度為major且有相關文獻報告之藥物，共19組配對組合789個品項。以此分析探討9301-9412高屏分局醫院門診申報高度危象藥物交互作用處方其醫院及病人特質之差異，並進一步研究有無發生高度危象藥物交互作用處方之病人其住院醫療費用耗用及死亡差異性。

結果：
以Glim軟體做對數線性統計分析，顯示醫學中心是地區醫院的13-18倍，醫學院校附設醫院是署立醫院的4-7倍，高雄縣是澎湖縣的4-6倍，65歲以上是以下的2.5倍，男性是女性的1.5倍，外科是其他科的103-113倍，循環系統是神經系統的52-92倍。有無交互作用之病人其平均每人住院醫療費用差值為21.4萬元（P<0.01）、死亡比率差值為6.12%（P<0.01）。

結論與建議：
在層級別中以醫學中心發生比率最高，權屬別中以醫學院校附設醫院為最高，縣市別中以高雄縣為最高。65歲以上發生比率高於64歲以下，男性高於女性，外科及循環系統疾病發生比率為最高。有發生高度危象藥物交互作用之病人其平均每人住院費用及死亡比率均顯著高於無發生高度危象藥物交互作用之病人。故建議設立完善的院內用藥提示系統，推廣家庭藥師社區制度，IC卡增加同一病人藥物交互作用檢核功能及增列為健保局總額的品質指標，以提升病人用藥品質。
關鍵字：藥物交互作用、藥物不良反應、醫療品質

關鍵字

藥物交互作用 ； 藥物不良反應 ； 醫療品質

並列摘要

Abstract

Objective :
To improve quality of medical care and safely of patients taking
medication, we evaluated the high-risks drug-drug interactions in
clinics among hospitals and patients characteristics. We also search
for the difference of hospitalization fee and mortality rate in these
drug-drug interaction high risks patients.

Methods :
The definition of “high-risk drug-drug interactions” means the grade I, major severity and related publications support recorded in Department of Health drug-drug interaction database. There’re 19 pairs and 789 items in the database. And then analyze high-risk drug-drug interaction hospitals and patients among 9301-9412 Kaohsiung / Pingdong hospitals; and further evaluate the difference of hospitalization fee and mortality rate.

Results:
Through log linear analysis， we found that the medical center is 13-18 times than regional hospital; university subsidiary hospital is 4-7 times than government-owned hospital; Kaohsiung is 4-6 times than Penghu county; age over 65 is 2.5 times than under 65; male is 1.5 times than females; surgical department is 103-113 folds than other department; and circulation system is 52-92 folds than neurology system. Hospitalization cost among drug-drug interaction patients is more 214,000 NT dollors than non-drug -drug interaction patients (p<0.01), and the difference in mortality rate is 6.12% (p<0.01).

Conclusion and suggestion:
The possibilities of high-risk drug-drug interactions is higher in medical center, university subsidiary hospital and in Kaohsiung. Ages over 65, male, surgical department and circulation disease are also the high risk population. Furthermore, there’s significantly higher hospitalization coat and mortality rate in high-risk drug-drug interaction patients. We suggest that increase the IC card checking function and establish the community pharmacists system to ensure the good quality of patients taking medications.

Key word: Drug-drug interactions, adverse drug reaction, quality of medical care.

並列關鍵字

Drug-drug interactions ； adverse drug reaction ； quality of medical care

參考文獻

參考文獻

《中文文獻》

1. 王博彥；各層級醫療院所門診藥物交互作用分析 - 以全民健康保險學術研究資；臺北醫學大學/醫學資訊研究所；2003。

2. 王瑩玉；某教學醫院藥物不良反應之通報與評估；Formosa Journal of Clinical Pharmacy vol.12.No1 pp1-16；2004

3. 田俊雄、陳立奇、張豫立、鍾渙等；急診處方藥物交互作用之研究；醫院藥訊；1999。