全民健保高診次民眾就醫行為改善方案
—藥事人員居家照護試辦計畫實施成效之探討

研究目的健保開辦後就醫可近性增加、民眾滿意度提升，但因醫療資源有限，如何妥善利用成為不可忽視的議題，健保局於民國99年實施藥師居家照護試辦計畫，針對門診高利用之保險對象中需輔導建立正確服用藥物觀念者，安排藥師進行居家訪視，期望藉由藥師的介入，導正病人用藥觀念，提升用藥安全，以期間接減少醫療資源之浪費。本研究主要欲探討此試辦計畫實施後的成效，了解藥師居家照護對於高診次民眾醫療利用的影響。樣本與方法本研究以健保局高屏業務組轄區門診高診次個案中，藥師有進行居家照護的456人為研究對象（實驗組），並同時取樣年齡與性別相同之個案做為對照組，而此對照組與實驗組於前側時，其就醫次數與醫療費用（藥費、藥服費、診察費及總醫療費用）沒有差異；實驗組每個個案於實驗介入期間，由藥師進行居家訪視照護1至8次。最後利用健保醫療費用申報資料庫，比較藥師居家照護執行前後醫療利用的差異。採用SPSS 17.0 for Windows套裝軟體進行描述性及推論性統計。結果本研究結果顯示加入試辦計畫者，其加入後醫療利用呈顯著下降，在就醫次數上有藥師介入實驗組從介入前每人每月平均 13.9±4.7次下降至8.3±4.4次，呈顯著之減少 (p<0.001)，就醫次數下降比例達 40.62%；藥服費從介入前每人每月平均379.3±180.3點下降至231.8±140.8點，呈顯著之減少(p<0.001)，藥服費下降比例達38.86%；診察費從介入前每人每月平均3275.7 ±1251.7點下降至1961.7 ±1120.8點，呈顯著之減少(p<0.001)，診察費下降比例達40.02%；診療費從介入前每人每月平均3252.5 ±4450.3點下降至2003.1 ±3836.4點，呈顯著之減少(p<0.001)，診療費下降比例達37.90%；總醫療療費用從介入前每人每月平均10354.6 ±20036.7點下降至7186.8 ±15631.9點，呈顯著之減少(p<0.001)，總醫療費用下降比例達30.44%。加入試辦計畫者在醫療利用中，「就醫次數」、「藥服費」、「診察費」、「診療費」、「總醫療費用」，比未加入試辦計畫者都呈現顯著下降的趨勢，顯示藥師介入訪視可有效下降病患之醫療利用。結論與建議由本研究結果顯示，藥師居家訪視對於高診次民眾的醫療利用具又顯著之影響，短期可有效降低門診就醫次數及醫療費用，因此，藥師居家訪視照護有助於提升高診次民眾的衛生教育，此政策值得繼續推行，建議鼓勵更多的藥師參與這項工作。然而，至於長期之效果是否仍然可以維持，值得再後續進行長期之研究。

關鍵字

高診次民眾；藥事人員居家照護；全民健康保險

並列摘要

Introduction With implementation of National Health Insurance, the issue of frequent hospital visiting raised attention in the healthcare management and discussed by scholars in public health. Bureau of National Health Insurance implemented an experimental plan of pharmacist home care to reduce the number of physician visit and subsequent medical cost. This study was performed to investigate the effects of pharmacist intervention on the frequent hospital attendant. Sample and methods A total of 456 cases with outpatient heavy users were enrolled for pharmacist’s home care project. 456 age, sex, and cost matched cases were selected as control group for intervention comparisons. In experiment groups, pharmacist’s home interview 1 to 8 times during the studying period was performed for each outpatient heavy users. Number of outpatient visit and cost including fee for physician, drugs, service, and laboratory test were recorded and analyzed. Statistical analysis using SPSS v17.0 was done to compare the parameters pre- and post intervention. Results The result revealed the number of physician visit was significantly decreased from: 13.9 ± 4.7 times before to 8.3 ± 4.4 times post pharmacist’s home visit (p <0.001). The decreasing rate was 40.62 %. No significant change of physician visit in control group. The medical cost including fee for drug service, physician, and laboratory test showed significantly decreased from the baseline, 379.3 ± 180.3, 3275.7 ± 1251.7, and 3252.5 ± 4450.3 to post pharmacist’s visit, 231.8 ± 140.8, 1961.7 ± 1120.8 and 2003.1 ± 3836.4, respectively. The total medical cost was significantly decreased from 10354.6 ± 20036.7 pre-intervention to 7186.8 ± 15631.9 points post pharmacist’s visiting (p <0.001). The decreasing rate was 30.44 %. Conclusion This study showed the pharmacists’ homecare interview had significant effects on reducing the number of physician visit and medical cost in those outpatient heavy users. The long term effect of pharmacists’ home visiting education in these patients needs further study.

並列關鍵字

Outpatient heavy Users ； Pharmacist’s Home Care

參考文獻

英文部分

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全民健保高診次民眾就醫行為改善方案 —藥事人員居家照護試辦計畫實施成效之探討

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