在台灣人民普遍的想法看病就是要拿藥,且一直習慣認為胃藥是一種領藥時的附贈品,也幾乎在很多處方中常常都會加開胃藥。所以在服藥時,常常都配上胃藥(制酸劑)併服。很多醫師開處方時,應病人要求,也喜歡加入制酸劑,胃藥---制酸劑反而變成了一種不是很確定病人醫療需求的一種型態。再加上健保給付胃藥的幾乎全不設限,更是推波助瀾了胃藥的使用。然而有些藥物是不宜和制酸劑併服的,因此藥物與制酸劑的交互作用存在於一些藥物治療中。而如果藥品所引起的腸胃不良反應,不是因為胃酸分泌因素引起的,使用制酸劑的幫忙有限,因此某些民眾認為藥品一定要加胃藥吃,有時是不當的心理作用與習慣。對醫療的生態、服藥的效果、病人的健康反而產生了重大的影響。 本研究就全國家衛生研究院提供的健保資料中的20萬人歸人抽樣檔中做分析,再以SAS軟體統計作資料之分析,研究發現在2,572,065 門診人次中,其中有822,537門診人次有處方胃藥中最被廣泛使用的制酸劑。其門診處方制酸劑使用率為31.97%,將近每三門診人次就有一門診人次有開制酸劑的處方。其中處方制酸劑門診人次中3年病史無潰瘍適應症而處方制酸劑者有325,031門診人次,佔總共開制酸劑的門診人次之39.52 %。而處方制酸劑門診人次中3年病史無潰瘍適應症且同一處方中無併開NSAID藥物而處方制酸劑者有107,331門診人次,佔總共開制酸劑的門診人次之13.05 %。 制酸劑的使用情形,如無適應症而使用,或過度使用而造成處方中的疑似交互作用等,與醫療院所的特質、病人的特質、醫師的特質都有相關。 希望此研究能幫助病患在用藥安全上能更進一份心力,也希望未來國家的健康安全照護政策能更完善的從病人醫療健康預防著手,一方面間少不必要的醫療浪費,一方面也更防範了病人因不必要的藥物產生之有礙健康之可能。
Abstract This study was intended to explore the prescription patterns and the problem of prescriptions containing Antacids in Taiwan, the results of this study may serve as the references for the decision making in health policy. The study was based on the sampling set of NHI claimed database of ambulatory care in 2002 from National Health Research Institutes. The prescription patterns and problems of prescription containing antacids were analyzed among various patient、hospital and doctor characteristics . The main findings of this study are described as followings: In terms of prescription patterns, 31.97% of total prescriptions contained antacids. In total prescriptions contained antacids, 39.52% of prescriptions contained antacids is no ulcer in last three years. 13.05% of total prescriptions contained antacids is no ulcer in last three years and no combine NSAIDs Factors related to higher use of antacids included male, 0~20 years old, the general clinic department, the dermatology department. Based on the findings described above, it is suggested that the causes of prescribing problems and the impact of prescribing problems should be further explored in the future. Meanwhile, the health authorities should establish an effective drug utilization review system in order to decrease antacids Keywords: Antacids, Ulcer, Overuse,Drug interaction