台灣地區polypharmacy之流行病學研究

背景所謂的polypharmacy是指同時使用多樣藥物進行治療。併用多種藥物進行治療時，發生副作用的機率會提高，產生藥物交互作用的機率會增加，並且造成病患遵醫囑性的下降。隨著台灣人口的老化，以及慢性病盛行率的上升，併用多種藥物進行治療的情形是值得探究的，然而關於這方面的研究，在台灣是缺乏且不甚完備的。目的使用全民健康保險資料庫，以分析歷年門診polypharmacy的盛行情形，以及polypharmacy與性別、年齡、藥物、都市化程度，和疾病之間的關聯性。方法 Polypharmacy的定義是處方箋中含有五種以上的藥物。資料係以全民健保資料庫之門診處方及治療明細檔、門診處方醫令明細檔和醫事機構基本資料檔為來源，將ICD-9 CM及A code等疾病碼整合，並利用世界衛生組織藥物統計方法整合中心(WHO Collaborating for Drug Statistics Methodology)，所制定的解剖治療分類系統(Anatomical therapeutic classification, ATC )，來進行處方藥物的分類。採用民國86-90年中每一年之任一天為觀察期，以觀察歷年來門診polypharmacy之盛行情形。使用SAS套裝軟體8.2版進行統計分析。結果 86-90年任一天的polypharmacy盛行率皆超過30 %且無性別的差異，但其盛行率有逐年下降的趨勢。都市化程度與polypharmacy的盛行率成反比。呼吸道疾病是門診治療時最常出現的疾病診斷。呼吸道疾病(53.01%)、循環系統疾病(7.14%)、骨骼肌肉系統及結締組織之疾病(6.58%)、消化系統疾病(5.79%)和皮膚及皮下組織疾病(5.05%)，都常以 polypharmacy的方式進行治療 (p<0.0001) 。而polypharmacy老人最常被開立的藥物則依序為消化道類、神經系統類以及呼吸道類用藥。結論台灣地區門診polypharmacy盛行率相較於其他國家為高，且小於九歲和大於80歲的民眾，有半數以上是以多重藥物的方式進行治療。因此，醫療人員應對這些使用多重藥物的民眾，給予重點式衛教，以降低發生藥物不良反應的機率。

關鍵字

盛行率； polypharmacy

並列摘要

Background Polypharmacy (concomitant use of more than 5 drugs) is associated with health related problems, such as adverse drug reactions, drug interactions, poor compliance and increased risk of hospitalization. But the research about polypharmacy is scarce in Taiwan. Objective Not only to analyze the annual prevalence of polypharmacy in ambulatory visits in Taiwan and the effect of urbanization on polypharmacy but also to identify the individuals who are exposed to polypharmacy. Methods The NHI Research Databases for the years of 1997-2001 was used as the study material including only the claim data form ambulatory services. In order to observe the annual prevalence, a random day was chosen within a year. The anatomical therapeutic classification was applied for coding the prescription drugs. SAS for windows 8.2 was used for data management and statistic analysis. Results On a random day within a year from 1997-2001, at least 30 % of the people were exposed to polypharmacy. The sex did not differ in the prevalence of polypharmacy. And urbanization had slightly negative relationship with polypharmacy. Over half of the people in 0-9 yrs or over 80yrs were exposed to polypharmacy. Diseases about respiratory (53.01%), circulatory (7.14%), musculoskeletal system (6.58%), digestive system (5.79%), skin and subcutaneous tissue (5.05%) were often treated with polypharmacy. (p<0.0001) Digestive drugs, nervous system drugs, and respiratory drugs were often involved in polypharmacy among the elderly. Conclusion Polypharmacy is widespread in Taiwan, especially existed in people < 9 yr or > 80 yr. Respiratory disease not only the most common diagnosis, treated most with polypharmacy as well. Clinicians who are responsible for quality care programs should intensify their surveillance of the groups most prone to polypharmacy.