台灣地區多重用藥與醫療資源耗用關聯性之探討—以50歲以上世代追蹤為例

The Correlation between Polypharmacy and Medical Utilization for people older than 50 in Taiwan

李季紋(Ji-Wen Li)

指導教授 ： 李易蓁

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士班/碩士(2014年)

https://doi.org/10.6832/KMU.2014.00024

摘要

近年來，老年人口逐年增加，負向的健康功能問題日益嚴重，導致醫療費用急遽攀升。本研究目的係為瞭解台灣地區50歲以上之中老年人多重用藥與醫療資源耗用之變化趨勢，並進一步探究其間之關聯性。
研究工具為國民健康署的外釋檔案「中老年人身心社會生活狀況調查研究」，以西元1999年、2003年、2007年均接受追蹤訪視的世代為樣本，共計有2813人。統計分析方法為t-test, one-way ANOVA、卡方、廣義估計方程式 (Generalized estimating equation, GEE) 等方法。
結果顯示台灣中老年人的平均用藥種類數有逐年增加的趨勢，多重用藥的比例亦是逐年攀升。控制時間因素後，多重用藥程度愈嚴重，醫療資源耗用的風險也會增加。用藥種類數五種以上者，住院次數增加(RR＝3.91)，住院天數較長；用藥種類數2種以上者，急診次數增加(RR＝1.38)；用藥種類數愈多，中、西醫門診次數愈多(RR＝1.14v.s.1.11)；用藥種類數6種以上者，看牙醫次數增加(RR＝1.22)；用藥種類數2種以上者，到一般藥局的次數較多(RR＝1.35)。
因應高齡化社會來臨，健康功能逐漸退化的趨勢不能輕忽，因此中老年人的多重用藥問題更應特別關注。加強用藥宣導、提供整合照護服務等措施，避免多重用藥所帶來的負面影響，以期降低中老年族群健康功能之惡化，減緩醫療費用上升的趨勢。

關鍵字

中老年人 ； 多重用藥 ； 醫療資源耗用 ； 廣義估計方程式

並列摘要

Objective
As population become aging, chronic diseases are common among the elderly people in Taiwan. The use of the multiple medications, generally in the older people, has increased negative consequences, such as higher costs of medical utilizations . The objective of this study is to explore the correlation between the use of the multiple medications and medical utilizations in the elderly people aged over 50 in Taiwan. Methods
This study is derived from the secondary dataset ‘Survey of Health and Living Status of the Middle Aged and Elderly in Taiwan (years of 1999、2003 and 2007). Total samples are 2813 persons. The statistics used in this study include t-test, one-way ANOVA, chi-square, liner regression and GEE methods.
Results
The results indicate that the average number of the use of medications was increased by the growth of years. The proportion of 〝polypharmacy〞is appeared as the same trend. After adjusting the factor of time, more seriously the degree of polypharmacy is, more the medical utilizations are.
Conclusion
With the ageing population, it is very important to be aware of the risks of polypharmacy in the elderly people in Taiwan. Regarding the aspect of preventing the negative consequences of multiple medications and reducing the medical utilizations, this study suggests that health caregivers should carefully monitor the use of medications in the elderly people in order to decline the negative consequences of polypharmacy.

並列關鍵字

middle aged and elderly ； polypharmacy ； medical utilization ； GEE

參考文獻

中文文獻

衛生福利部國民健康署. (2014). 中老年身心社會生活狀況長期追蹤調查系列調查簡介, from http://www.hpa.gov.tw/Bhpnet/web/HealthTopic/TopicArticle.aspx?No=200712270015&parentid=200712270002

行政院衛生福利部國民健康署. (2010). 老人健康促進計畫(2009-2012),

from http://www.hpa.gov.tw/BHPNet/Web/Index/Index.aspx

謝美芬, & 顏兆熊. (2009). 老人多重用藥. 家庭醫學與基層醫療, 24(10), 351-355.