研究目的:探討非類固醇抗發炎藥物(non-steroidal anti-inflammatory drug ; NSAID)常用者的就醫持續性與併用高風險藥物之相關情形。 研究方法:利用2005年的全民健保資料庫抽樣歸人檔進行分析,研究對象為參加全民健保且在2005年使用NSAID日數大於30天的病人。本研究高風險定義為危害等級較高,故發生不良藥物交互作用的風險較高,NSAID併用高風險藥物的定義為:採用行政院衛生署「藥物交互作用資料庫管理資訊系統」中之NSAID各成份併用危害等級在三以上之各種藥物成份。藥物併用定義為開立NSAID處方期間與開立高風險藥物處方期間重疊3天以上。計算就醫持續性則使用兩種指標,分別為照護持續性 (continuity of care, COC) 指標及經常提供者持續性(usual provider continuity, UPC) 指標。隨後以logistic regression控制病人性別、年齡、合併症數、就醫次數、平均用藥數、院所層級、院所地區、醫師性別及醫師年齡,以估計不同就醫持續性之NSAID常用者發生併用高風險藥物之勝算。 研究結果:一年內使用NSAID超過30天以上者共有52,010,占全民健保百萬歸戶樣本的5.2%,25人無使用高風險藥物,其中發生併用高風險藥物的比例達20.2%,以併用Beta blocking agents的比例最高,達8.79%,併用Preparations increasing uric acid excretion的比例最低(無併用發生)。中及高就醫持續性的NSAID常用者併用高風險藥物的勝算分別是低就醫持續性者的0.89倍(95%信賴區間[CI]:0.84- 0.94)及0.76倍(95%CI: 0.71-0.80)。 研究結論:本研究發現常用NSAID病人的就醫持續性越高,併用高風險藥物的勝算顯著較低,且於藥物併用次數及種類數的機率皆較低,如何提高該類患者的就醫持續性,以減少不同門診醫療服務院所用藥間產生藥物交互作用的風險,提高病患門診就醫的用藥安全,是未來政策努力的方向。
Abstract Purpose : This study aimed to examine the association between continuity of care and high risk concomitant medication in continuous non-steroidal anti-inflammatory drug (NSAID) users. Methods: National Health Insurance (NHI) Research Database’s Longitudinal Health Insurance Database 2005 (LHID2005) were used to conducted this study. NHI’s beneficiaries with NSAID prescription more than 30 days in 2005 were defined as continous NSAID user, and their concomitant medications were defined as significant drug-drug interactions (DDI) event according to Drug Interaction Facts. Continuity of care (COC) index and usual provider continuity(UPC) were used to measure the continuity of care for continuous NSAID users. Multiple logistic regression analysis was then applied to estimate the association between continuity of care and high risk concomitant medication in continuous NSAID users. Results: There are 52,010(5.2%) people use NSAID more than 30 days in a year. 25 not have uses the high risk medicine; 20.2% had concomitant high risk medication. Medium and high (v. low) levels of continuity of care with high risk concomitant medication (adjusted rate ratio [RR] 0.89, 95% confidence interval [CI] 0.84- 0.94, and 0.76, 95% CI 0.71-0.80, respectively). Conclusions: This research discovery commonly used NSAID patient had higher continuity of care, and high-risk drugs combinations with significantly lower odds. Improving continuity of care should be an important part of future healthcare reform.