抗微生物製劑管理計畫對醫院藥品使用及費用暨醫療品質之影響

Effect of Antimicrobial Manage Program in Antibiotic Consumption, Cost and Medical Quality

陳光銘(Kuang-Ming Chen)

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(2013年)

摘要

抗微生物製劑是治療感染症的重要藥物，亦常造成臨床不適當的濫用而造成費用的上升，故探討醫院實施抗微生物製劑管理計畫對抗微生物製劑及相關費用及醫療品質之影響。
本文是一回溯性研究，從2009年1月至2012年12月，收集一區域教學醫院實施抗微生物製劑管理計畫之成效，利用資訊系統設定限制抗微生物製劑之處方權限，配合感染科專科醫師實施事前審查機制，分階段逐步介入管理以達到減少抗微生物製劑之不適當使用及降低相關費用。資料分析包括該院病患特質、醫療服務量、醫療品質及藥品使用量與費用。統計分析利用SPSS 18.0統計套裝軟體，以描述性、單一樣本變異數分析F-檢定、複迴歸分析進行資料分析與驗證。
實施抗微生物製劑管理計畫後醫院抗微生物製劑各階段相關費用呈明顯下降之趨勢變化(p<0.001)。探查抗微生物製劑總藥費下降之顯著相關因素即為管理計畫介入時程(R2=0.816)。依總住院人日校正後每人日抗微生物製劑費用亦呈明顯下降之趨勢變化(p<0.001)。研究期間，各階段之粗死亡率、平均住院天數及14日再入院率等相關醫療品質指標無重大負面影響。
抗微生物管理計畫可有效減少抗微生物製劑之使用及降低相關藥費，對於醫療品質無負面影響。醫療機構可制定可行之抗微生物製劑管理計畫，以節省不必要之醫療支出。

關鍵字

抗微生物製劑管理計畫 ； 醫療資源耗用 ； 藥費 ； 醫療品質

並列摘要

Purpose
Antibiotic is the important medication for infective disease. Inadequate antibiotic use increase cost. This study to investigate the impact of antimicrobial consumption, cost and medical quality by antimicrobial manage program.
Methods
From January 2009 to December 2012, we collected antimicrobial consumption, cost and medical quality during implement an antimicrobial manage program in a regional teach hospital: We restricted the authority of antimicrobial agent prescription by computer system. Restricted antimicrobial agents should be prescribed by infection specifist pre-authorization approval. Four-steps intervention was implanted to decrease inadequate antibiotic using and associated cost. Data analysis included patient’s manifestation, medical ultilization, antimicrobial comsuption and cost.
Result
After intervention, antimicrobial cost in different stage showed a significant decrease trend(P<0.001). To investigate the factor of cost decrease and showed intervention stages are the major factor(R2=0.816). Adjusted by total hospitalized patient-days, the antimicrobial cost per patient-day in different stage also have a significant decrease trend(p<0.001).
During research peroid, medical quality factors like hospital mortaily rate, averger of hsopital-day and 14-day re-admission rate had no negative-effect.
Conclusion
Our result showed the antimicrobial manage program can reduce anti- microbial consumption and cost. In the same period, it had no any negative effect in medical quality. Medical organization can implant an structure and culture-fit programme to decrease inapporiate medical cost.

並列關鍵字

Antimicrobial manage program ； medical ultilization ； drug cost ； medical quality

參考文獻

Adriaenssens, N., Coenen, S., Versporten, A., Muller, A., Minalu, G., Faes, C., . . . Molenberghs, G. (2011). European Surveillance of Antimicrobial Consumption (ESAC): outpatient antibiotic use in Europe (1997–2009). Journal of antimicrobial chemotherapy, 66(suppl 6), vi3-vi12.

Al-Eidan, Fahad A, McElnay, James C, Scott, MG, Kearney, MP, Troughton, KEU, & Jenkins, J. (1999). Sequential antimicrobial therapy: treatment of severe lower respiratory tract infections in children. Journal of Antimicrobial Chemotherapy, 44(5), 709-715.

Al Naiemi, N., Duim, B., Savelkoul, P.H.M., Spanjaard, L., De Jonge, E., Bart, A., . . . De Jong, M.D. (2005). Widespread transfer of resistance genes between bacterial species in an intensive care unit: implications for hospital epidemiology. Journal of clinical microbiology, 43(9), 4862-4864.

Albrich, W.C., Monnet, D.L., & Harbarth, S. (2004). Antibiotic selection pressure and resistance in Streptococcus pneumoniae and Streptococcus pyogenes. Emerging infectious diseases, 10(3), 514.

Arias, C.A., & Murray, B.E. (2009). Antibiotic-resistant bugs in the 21st century—a clinical super-challenge. New England Journal of Medicine, 360(5), 439-443.