基層診所門診抗生素使用分析：以家醫科與不分科為例

Title: Antibiotic Use in Primary Care: Case Study of Family Physicians and General Practitioners

游翁斌(Weng-Ping Yu) ； 莊明憲(Mieng-Hsian Chuang) ； 柯景馨(Ching-Hsing Ke) ； 周稚傑(Chih-Chieh Chou) ； 陳永煌(Yeong-Hwang Chen) ； 羅慶徽(Ching-Hui Loh)

《中華職業醫學雜誌》 10卷3期 (2003/07) Pp. 185-194

https://doi.org/10.30027/CJOM.200307.0005

摘要

由於細菌抗藥性日漸增加，近年來抗生素之使用與管制更顯得重要，本研究之目的為探討第一線醫師，即基層醫療院所門診之抗生素使用現況。資料來源為健保局1998年一月所有家醫科與不分科之基層診所的申報資料，加以比較分析。經本研究估算，家醫科與不分科兩科的基層診所門診，一年的抗生素藥費共申報約新台幣一億四千萬元，每 2.63診次就有一次給予抗生素治療。其中罹患上呼吸道疾病之診次佔所有門診人次 30.2% ，但其使用抗生素金額佔所有診次抗生素金額之52.6%，且抗生素用藥金額佔其口服藥物總金額之20.7%，約每三次就診就有兩次給予抗生素治療。此時再利用複迴歸分析探討影響抗生素使用之因素，家醫科與不分科之給藥差異極小，但家醫科之抗生素用藥金額較低；患者之性別與年齡等因素亦不影響抗生素之使用；至於地區則以健保局台北分局與北區分局轄區使用抗生素頻率較高、東區分局使用頻率較低。

關鍵字

抗生素 ； 上呼吸道感染 ； 家庭醫師 ； 門診

並列摘要

Due to dramatic increase of drug resistant strains of bacteria, in recent years greater attention has given to the use and control of antibiotics. The target group of the present research is those consider primary users of antibiotics and the dispensing of it in clinics. The data comes from National Health Insurance's claim office and is based upon all the claims in the single month of January 1998, and selecting those records of family physicians by comparing it with general practitioners. Based upon the estimation of the present research of both primary care physicians and general practitioners, NT $140 millions worth of antibiotics on average were claimed per year. Antibiotics were prescribed once in every 2.63 visits. Patients with diseases of upper respiratory tract consists only 30.2% of ambulatory care, yet they claimed the cost of 52.6% for the use of antibiotics. Moreover the cost of prescribing antibiotics consists 20.7% of all oral medicaments. Meanwhile, two thirds of these visits, antibiotics were prescribed. By analyzing factors influencing the use of antibiotics by multiple linear regressions, there was trivial difference between family physicians and general practitioners. But the cost of prescribing antibiotics by family physicians was less. Patient' gender and age are not factors in the use of antibiotics. As far as the location of patient' residence, the percentage of prescribed antibiotics is much higher in the Taipei and Northern branches of NHI and less in the Eastern Branch.

並列關鍵字

Ambulatory care ； Antibiotic ； Family physicianns ； Upper respiratory tract infection