健保IC卡實施對病人不同處方之同類藥物用藥日數重複之影響

The Impact of IC Cards Implementation on Repeated Same Medicines from Different Prescriptions

羅好芸(lo hao yün)

指導教授 ： 龔佩珍

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

研究背景與目的：全民健康保險開辦以來，降低了民眾就醫障礙、提高就醫的可近性，但醫療費用高漲及醫療資源浪費的問題一直存在，民眾因相同疾病重複取藥等不適當的就醫行為，不僅造成健保財務壓力及醫療資源浪費，也有用藥安全之虞。2004 年起健保IC 卡實施後，醫師可透過健保IC 卡了解病人的相關醫療訊息，做為臨床診斷上參考，提供正確的處置方案。 研究方法：本研究利用中央健康保險局2003 至2006 年每年十月份健保費用申報資料檔，探討健保IC 卡實施前後牙醫、西醫門診病人不同處方同類藥物用藥日數重複比例之差異，與各藥理有重複情形的族群特性。以開立醫令最多的五種藥理分類藥物為例，分別為制酸劑及吸附劑、抗焦慮，鎮靜及安眠劑、抗生素、抗組織胺劑，與開立比例第八名的止痛劑及解熱劑為例。 研究結果：顯示藥理重複情形以制酸劑類藥理重複最多，抗焦慮類藥物第二高、抗組織胺劑重複比例第三高，抗生素類藥理重複第四名，止痛劑類藥物重複比例佔最少。四年觀察期間此五種藥理的重複情形，以制酸劑及吸附劑與止痛劑及解熱劑有藥理重複的人次呈現減少的趨勢，其餘三種藥理重複情形皆呈現增加的趨勢，並以抗焦慮類藥物重複情形年平均成長幅度最大，抗組織胺劑重複情形成長幅度第二大。顯示並未因健保IC 卡實施，而有降低重複用藥的成效。但由健保IC 卡實施後來看，此五種藥理的重複情形，顯示整體有藥理重複的醫令筆數佔重複就醫總醫令筆數比例，有逐年降低的趨勢，整體有藥理重複的人次佔重複就醫總人次的比例，也呈現逐年降低的趨勢。 藥理重複情形之基本特性，男性與女性比例為47.04：52.96，年齡層分布以65 歲以上佔最多，慢性病患者比例為39.28%，藥理從重複情形其投保類別以第一類最多、第四類最少。就醫醫院特性評鑑等級越高有藥理重複情形就越低，權屬別以私立醫院佔開出藥理重複的處方最多(29.42%)、公立醫院最低(16.93%)，分局別以台北與中區分局最多(27.32%、25.3%)、東區分局最少(1.91%)。就醫科別以內科最多(25.84%)，疾病別以呼吸系統疾病與精神疾病有藥理重複的情形比例最多(22.07%、10.58%)。 結論：健保IC 卡實施前後未有明顯降低藥理重複情形，可能因健保局未稽核用藥醫令上傳使醫師可得資訊有限、醫師讀取率偏低所致。2004 年健保IC 卡實施後藥理重複情形比例呈微幅降低，是否為短暫政策效應抑或有持續改善重複用藥情形，再次檢視醫師的處方行為是值得探討的問題。 建議：政府機構應確實落實健保IC 卡的用藥醫令上傳動作，對基層醫療院所也應定期進行評鑑或對其開立的處方加強審查，以提升基層醫療品質。並加強宣導健保IC 卡的相關資訊，與民眾正確就醫及對用藥認知與安全的相關事項。醫事人員與醫療院所方面，應強健e 化程度並加強醫師與藥師對藥物知識的繼續教育，提高和病患溝通能力，以開立更安全的用藥處方。

關鍵字

健保IC 卡、處方型態、重複用藥

並列摘要

Background and objective: Since the national health insurance (NHI)implemented, the barrier of taking medical treatment was reduced and the patients’accessibility of medical treatment was improved. But the problems of medical cost raising and medical resource wasting have been existed a long term. The problem of duplicated prescription will cause financial pressure of the government, medical resource wasting and patients’ safety problem of using drug. Since the NHI IC card carried out in 2004, physician can acquire the related information of patients through the NHI IC card and provide the correct physician orders to patients.
Methods: This research discussed the changes of duplicated prescription problems in different prescriptions in dentist and western medicine before and after the NHI IC implemented. The files of declarative medical expenses in October from 2003 to 2006 were provided by Bureau of National Health Insurance. The study analyzed most five physician orders, which were Antacids and Adsrbents (6.7%), Anxiolytics, Sedatives and Hypnotics (5.1%), Antibiotics (4.3%), Antihistamine drugs (4.3%), and Analgesics and Antipyretics (3.0%). Results: The orders of duplicated prescription were (1) Antacids, (2 Anxiolytics, Sedatives and Hypnotics, (3) Antihistamine drugs, (4) Antibiotics, (5) Analgesics. During four years, the problems of duplicated prescription for Antacids, Adsrbents, Analgesics and Antipyretics decreased but another three prescriptions increased. The most two increased duplicated prescription were Anxiolytics and Antihistamine drugs. The results showed that the problem of duplicated prescription did not decrease while the NHI IC card was carried out. Because the prescription order is the main mission in second stage of NHI IC card program, the result before 2003 should be eliminated. After eliminating the results of year 2003, the duplicated prescription of physician orders and patients were decreased early.
The demographic characteristics of duplicated prescription were described as below. The proportion between male and female was close to 1 : 1 (47.04：52.96). The most age group was above 65 years old. The proportion of chronic diseases was 39.28%. The most cases sorted by category of the insured located in category one and the least was category four. The higher levels of hospitals had fewer cases of duplicated prescription. Private hospital had the most serious problems of duplicated prescription (29.42%) and public hospitals had lightest problems on it (16.93%). When comparing different branches of Bureau of National Health Insurance in Taiwan, Taipei branch and central branch had most duplicated prescription cases (27.32%、25.3%) and eastern branch had the least cases (1.91%). When comparing different departments and diseases in the hospital, medical department and respiratory tract infection and mental illness had highest proportion of duplicated prescription cases (22.07%、10.58%). Conclusions: The study showed that the problem of duplicated prescription was not decreased after the NHI IC card was carried out. The reasons may be that NHI did not audit the action of inputting physician order into NHI IC card or the lower usage of IC card information reading by physician. The problem of duplicated prescription was slightly decreased after 2004. Therefore, it is worth to discuss that the situation of slightly decreased after 2004 was the short term effect or the duplicated prescription problem did improved after NHI IC card implemented. Otherwise, the problem of physicians’ activities on duplicated prescription is still a problem for future studies.
Suggestions: Government should fulfill the actions of inputting physician orders into NHI IC card. Furthermore, examining the prescription orders from primary care clinics regularly to ensure the quality of health care is needed. Otherwise, government should educate patients about NHI IC card, drug usage safety issues and related information. In hospital and medical personnel aspect, they should reinforce the levels of computerizing and provide further education of drug to physician and pharmacist. The physician should enhance the ability of communicating with patient to ensure patients’ safety in prescriptions.

並列關鍵字

NHI IC card, Prescription patterns, Duplicated prescription

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