某醫學中心住院處方之分析研究：以治療單純性肺炎和肋膜炎(DRG90)為例

An Analysis of Prescribing Patterns for Treating Inpatients with Simple Pneumonia and Pleurisy (DRG90) in a Medical Center

錢慶文(Ching-Wen Chien) ； 童瑞龍(Jui-Long Tung) ； 盧彥樺(Yen-Hua Lu)

《醫務管理期刊》 4卷3期 (2003/09) Pp. 98-113

https://doi.org/10.6174/JHM2003.4(3).98

摘要

疾病的治療方式往往對醫療資源的耗用有相當的影響，尤其是我國是一個實施全民健保的國家，一種疾病治療的方式，不僅對醫療資源的耗用有直接的影響外，當然也會對其他的醫療服務產生排擠效果。所以對於疾病的治療方式，實有深入研究的必要。目前全民健保除了實施總額支付制度外，還計畫在未來數年內要所有的住院醫療服務完全的納入所謂的「診斷關係群」制度，所以研究造成疾病治療和處置上差異的因素在醫務管理上的重要性也隨之提高。有鑑於此，本研究以北部某醫學中心為例，選取符合DRG90「單純性肺炎和肋膜炎，沒有合併症或併發症且病人年齡大於17歲」的住院病患，分析在同一個醫院中不同單位，醫療專科，在照護相同疾病（「肺炎」）之病患在藥品資源的耗用（含處方型態上）上是否有顯著之差異？用「肺炎」作為研究主題是因為肺炎在臨床醫學、公共衛生和醫務管理上均有相當重大的意義。
在以台北市某醫學中心民國八十九和九十年符合DRG90（為單純性肺炎和肋膜炎，沒有合併症或併發症且病思年齡大於17歲）之案例407例為研究樣本。分析影響治療「肺炎」住院藥品費用及處方型態之因素，結果發現不同「醫療科別」和病患「年齡」在治療「肺炎」時會造成治療時用藥密度和藥品類別（以ATC藥理分類）上的差異。
本研究之結果建議醫院除了可以將其治療處置之方式列入臨床路徑管控之外，也應該將藥師納入醫療團隊，依據病患疾病嚴重程度、擬定用藥計劃來找出合理的醫療成本界限，編撰一套符合藥物經濟學的臨床藥物使用指引，以達到控制醫療成本、保障醫療品質的目標。

關鍵字

肺炎 ； 用藥方式 ； 資源利用

並列摘要

How to treat a disease has significant impact on medical and economical resource consumption. Since Taiwan has implemented the National Health Insurance (NHI) for seven years, different methods of treating a disease have different meanings to health policy-makers, doctors and hospital administrators. Especially when the NHI Bureau has adopt a global budget reimbursement system for reimbursing all the hospitals services, resource consumed by treating a disease will affect resources allocated for treating other diseases. In addition, the NHI Bureau has planned to adopt a Diagnosis Related Groups system for all inpatient services. Therefore, how a disease is treated, or how much resource can be used to treat a disease, is crucial to the success of the NHI. The main purpose of this study is to find and analyze factors which may cause different amount of source consumption for treating the same disease. Cases which were classified as simple pneumonia and pleurisy (DRG90) under Health Care Financing Administration (HCFA) DRG Manuel 18th version were selected for this study.
Drug and other resource consumed by 407 DRG90 cases from a medical center locating in Taipei over a two-year span were studied and analyzed. Medical department and a patient's age were found to have significant impacts on intensity and types of drug used to treat DRG90 inpatients. Results of this study suggest that pharmacists should be included in clinical teams so that they can assist doctors to integrate the amount and types of drugs used to treat DRG90 inpatients.

並列關鍵字

Pneumonia ； Prescribing pattern ； Resource consumption

參考文獻

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