研究目的: 探討醫療過程中門診抗生素的處方型態,以中耳炎門診為例,探討抗生素使用品項、劑量、療程,及其處方型態影響再就診及費用的醫療結果。 研究方法: 利用2003年中央健康保險局全國門診的申報資料中,篩選ICD-9-CM代碼381.0、381.4、382.0、382.4、382.9五碼的中耳炎案件,以臨床指引作為判斷其使用抗生素處方型態符合與否的依據,利用統計軟體SAS進行整體描述性的統計及相關分析比較。 研究結果: 中耳炎案件中,以未滿12歲的患者最多,多就診於耳鼻喉科及小兒科,且多數選擇就診於私立基層診所,就診次數大多為一次或是一次療程。 抗生素處方型態中,品項符合臨床指引建議的佔所有使用抗生素就診人次的65.6%,將抗生素品項符合指引的就診次歸為療程後,抗生素劑量療程符合臨床指引建議的只佔所有使用抗生素符合指引品項療程的5.5%,主要都是劑量不足。 研究結論: 本研究探討抗生素的處方型態,極低比例的抗生素療程使用的劑量符合指引建議的治療天數,顯示台灣單次的就診無法接受完整的抗生素治療療程,建議進行病患用藥教育之外,也應訂定相關感染性疾病的抗生素給付用藥標準,以提高療程的完整治療率及減低抗藥性的問題。
Objectives: This study analyzes the patterns of antibiotics prescription on otitis media, explores the indicators that may affect the prescriptions of antibiotics’ ingredient, doses, duration, and identifies the factors contributing to the treatment expenses and recurrent of the disease. Methods: Data of this study was based on outpatient claim database in 2003 from the Bureau of National Health Insurance. Diagnoses of otitis media was defined as ICD-9-CM codes 381.0, 381.4, 381.0, 382.4 and 382.9. The study uses “Clinical Guidelines” to examine the adherence of antibiotics’ prescription and performs descriptive and analytical comparisons by using SAS. Results: The otitis media patients was mostly 12 years old or youger, and visited private otolaryngological and pedestrian clinics most frequently. The overall guideline adherence rate of the antibiotics’ ingredient was 65.6%, and only 5.5% of the prescriptions reached the recommendations of the antibiotics’ dose duration in one episode. Conclusions: The very low rate of adherence to antibiotics’ recommended doses reveals that patients can’t get sufficient antibiotics in one visit. The results indicate that patient education is needed, in addition health agencies should establish a new antibiotics’ payment scheme for infectious diseases to improve the treatment completion rate and solve the problem of drug resistance.