從健保申報資料探討中耳炎抗生素療程之合理性

Analyses of Antibiotic Treatment Duration on Otits Media Using NHI Claims

龐一嗚(I-Ming Parnn) ； 黃文鴻(Weng F. Huang) ； 謝曉菱(Hsiao-Ling Hsieh) ； 游素香(Su-Hsiang Yu) ； 吳欣蓉(Hsin-Jung Wu) ； 陳蕙玲(Huei-Ling Chen) ； 鍾進蘭(Chin-Lan Chung) ； 馬貴蘭(Kuei-Lan Ma) ； 李惠珠(Hui-Chu Lee)

《台灣公共衛生雜誌》 23卷2期 (2004/04) Pp. 141-149

https://doi.org/10.6288/TJPH2004-23-02-06

摘要

目標：瞭解健保特約醫療機構申報資料，在中耳炎使用抗生素的療程是否合理，分析可能影響用藥品質的指標值。方法：從民國九十年五月至十月之中央健康保險局台北分局門診申報資料，篩選ICD-9-CM代碼為3810、3814、3820、3824、3829等五碼之中耳炎案件共計119,773件，以統計分析軟體SPSS及SAS等，進行中耳炎病患的整體描述性統計及療程歸戶分析。結果：中耳炎案件以“3829未明示之中耳炎”申報最多，病患年齡以5歲以下最多，主要看診科別為耳鼻喉科及小兒科，近七成的中耳炎病患選擇在基層診所就醫。藥物療程經歸戶後，僅醫學中心之每療程平均給藥日份10.73天符合中耳炎標準療程10-14天用藥，療程平均給藥日份差異在各層級間有顯著差異。符合合理中耳炎療程給藥日份之案件比率，醫學中心佔15.86%最高、基層佔3.04%最低。個別醫療院所中耳炎療程平均給藥日份僅不到二成符合臨床規範；給藥療程合理案件佔中耳炎總案件之比率亦僅有22.18％；小兒科和耳鼻喉科的療程給藥日份合理之件數比率較高。在醫院層級以耳鼻喉科的合理比率最高；在基層則為小兒科合理比率最高。結論：本研究所探討的合理中耳炎療程，符合研究所界定的標準僅約二成左右。如對應院所個別分析資料，可加強院內自我管理，達到合理用藥之目標。

關鍵字

中耳炎 ； 抗生素 ； 合理療程

並列摘要

Objectives: This study analyzes the rational duration of antibiotic treatment on otitis media among NHI contract institutions. It explores potential indicators that may affect rational drug therapy in order to improve the quality of drug treatment. Method: The material for this study was based on the claimed data files dating May 1st ~October 31st, 2001 from the Northern Branch Office of NHI Bureau. A total of 119,773 cases diagnosed with otitis media by ICD-9-CM codes 3810,3814,3820,3824 and 3829 were screened for analysis using software programs of SPSS and SAS. Descriptive and analytical analyses were performed for selected otitis cases. Results: The number of otitis media by ICD-9-CM 3829 “unclassified otitis” ranked the highest among five ICD-9-CM codes. The patient group≦ 5 years old was the largest group, and ENT and the pedestrian departments were two most utilized specialties. There were nearly 70% of otitis patients choosing primary clinics. After the data files were classified by individual ID number, only medical centers with an average drug regiment of 10.73 days met the rational therapy criterion. There were significant differences among different levels of institution in terms of the average number of drug regimen days. The medical centers had the highest percentage (15.86%) meeting the rational antibiotic therapy criterion, the primary clinics the lowest (3.04%). There were less than 20% of institutions meeting rational antibiotic therapy criterion. The figure for physicians was 22.18%, while a higher percentage of rational antibiotic therapy was found in pedestrian and ENT departments. The ENT department ranked as the highest percentage for rational antibiotic therapy in the hospital segment, and pedestrian department the highest of the primary clinics. Conclusion: There were only around 20% of cases receiving rational antibiotic therapy regardless of the type of institution, physician, or clinical department. The results may be compared to the profile of an individual institution for better drug therapy management.

並列關鍵字

Otitis media ； antibiotic treatment ； rational therapy

參考文獻

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