影響高血壓族群慢箋開立及領用的相關因素分析

Analysis of the impact factor of Hypertension Refill Prescription on Healthcare Utilization

李政倫(Zheng-Lun LI)

指導教授 ： 楊志良

亞洲大學/健康學院/健康管理研究所/碩士(2009年)

摘要

背景與目的：台灣地區因人口老化與生活型態的改變，疾病的型態由急性傳染病轉化成以老年人口為主的慢性疾病，且健保開辦以來門診次數始終偏高，因此健保局為降低不必要的門診量，鼓勵醫師可針對病情穩定的慢性病患開立慢性病連續處方箋，且病患若持慢箋分次調劑得免收藥品部分負擔，為實質醫藥分業邁出第一步。但目前慢箋開立率的計算方式是否正確、慢箋是否適用於日益增多的多重慢性病患者等問題仍有探討空間。
方法：本研究採用次級資料分析，主要利用2005年「全民健保學術研究資料庫」之100萬人承保抽樣歸人檔為觀察對象，並觀察其在2006年所有門診就醫資料，進行門診處方及治療明細檔（CD）、門診處方醫令明細檔（OO）、承保資料檔（ID）與醫事機構基本資料（HOSB）等檔案之個人歸戶串聯後，再將高血壓族群篩選出來後，先針對各影響因素間(ex：年齡、投保類別…)與慢箋開立及續用(再用)慢箋情形的相關性，最後再分析各影響因素(ex：性別)與慢箋開立及續用慢箋的相關強度。
結果：研究發現高血壓病患開立慢箋的比率有提升(28.78％)，但是持慢箋第二次調劑的比率僅佔原有開立慢箋的一半(47.33％)，而持慢箋第三次調劑的比率則更低(僅23.94％)，可見我國推行慢箋的成效不是很理想；另外再分析各影響因素與慢箋開立間及續用(再用)慢箋機率的關係也發現：
一、 在都市化程度方面，開立慢箋的機率會隨著都市化程度的升高而升高，但是續用(再用)慢箋的機率則是呈現相反的情形，會隨著都市化程度的升高而降低。
二、 在慢性病個數方面，開立慢箋的機率會隨著慢性病個數的增加而降低，而續用慢箋的機率不會受慢性病個數影響，但特別的是再用慢箋的機率亦會與開立慢箋一樣隨著慢性病個數的增加而降低。
三、 在就醫場所層級別方面，醫學中心開立慢箋的機率最高，地區醫院的機率為最低，而在續用(再用)慢箋的情形發現，則以地區醫院的機率明顯高於其它醫院層級別。
結論：由研究結果可見若要使慢箋的施行有更高的成效，不僅需提升醫師開立慢箋比率，還需民眾就醫習慣的配合，建議應繼續對民眾推廣慢箋的認知，以改善慢箋的使用情形。而本研究所分析的影響因素，也建議後續相關研究者可納入參考。

關鍵字

高血壓 ； 慢性病連續處方箋 ； 慢箋開立

並列摘要

Background and objectives: Because aging of population and change of lifestyle in Taiwan , the type of disease is transformed from acute infectious disease into a chronic disease, and ages fast of population structure. And the number of out-patient clinic has always been high since the Health Insurance starting, therefore the Bureau of National Health Insurance in order to reduce unnecessary out-patient amount, they encouraged physicians who treat chronic patients with stable condition can use chronic refill prescription, and if patients use re fill prescription, they have free of co-payment on drugs. It is the important step to promote the implementation of separation of dispensary from medical practice.
Methods: This study data files use the data analysis of secondary, in chief, it uses one million people as the objects of National Health Research Institute in 2005 . With the assistance of the Bureau of National Health Insurance, the researchers linked the Ambulatory care expenditures by visits data(CD), the Details of ambulatory care orders data(OO), and the Registry for beneficiaries data (ID)…
Results: The study found the prescription ratio of hypertension patients is raised (28.78%), but the prescription ratio of the second dispensed only occupies half of the original prescription (47.33%), while the third of percentage ( only 23.94 %) is the lowest, it shows the effect is poor that implementation of chronic refill prescription in Taiwan; Analysis of the relationship between the impact factors with the prescription and second dispensed (third dispensed) also found that:
(1) the degree of urbanization, we find the probability of the refill prescription will increase with the degree of urbanization to increase, but the second dispensed (third dispensed) shows the result is opposite, it will increase with the degree of urbanization is reduced.
(2) the number of chronic diseases, we find the probability of the refill prescription will reduce as the number of chronic disease is increased, but the second dispensed of the refill prescription will not be affected by the number of chronic disease, especially the third dispensed is the same as the probability of the refill prescription that will be reduced with the number of chronic disease is increased.
(3) at hospital-level, Medical Center has the highest probability for prescription of the refill prescription, and the ration of district hospitals is the lowest, and in the case of the second(third) dispensed of refill prescription found that the Probability of district hospitals are significantly higher than other hospital-level.
Conclusions: Our study concluded to enhance effectiveness of the implementation of refill prescription is not only physicians need to raise the ratio of the prescribing refill prescription but also patients need a good habit of medical treatment and recommended continuing to promote knowledge of refill prescription on people.

並列關鍵字

Hypertension ； chronic refill prescription, ； prescribe of the refill prescription

參考文獻

吳培滋（2007）。影響醫學中心醫師開立慢性病連續處方箋之因素探討。未出版之碩士論文，長榮大學醫務管理學研究所碩士，台南。

楊志良（1995）。健康保險。台北：巨流圖書公司。

廖文評、葉明功、柯景馨、羅慶徽、周稚傑 (2004)。台灣之高血壓藥物治療型態－1998年處方箋分析。台灣家醫誌，14(3)， 121-132。

郭信智、 楊志良（1994）。醫師目標收入理論之試證。中華衛誌，卷（2）， 149-155。

陳明進、黃崇謙（2001）。全民健保支付制度改變前後公立醫院與財團法人醫院服務量及醫療利益之比較。當代會計，2（2），169-194。