糖尿病糖尿病慢性病連續處方箋開立之適當性以及對醫療利用情形的影響

Analysis of The Appropriateness of Diabetes Refill Prescription's Impact Factor and Health Utilization

李昀珊(Lee Yun Shan)

指導教授 ： 張育嘉

亞洲大學/健康學院/健康管理研究所/碩士(2010年)

摘要

背景與目的：自慢性病連續處方箋(以下簡稱「慢連箋」)政策實施至今，少有研究分析其實施成效，且少數分析慢連箋政策對醫療利用情形之研究，多僅比較「有無」開立慢連箋之差異，此分類方式較為粗略，以至於分析結果可能會有所偏頗。因此，本研究以糖尿病為例，重新定義慢連箋開立之「適當性」後，分析影響糖尿病病患之慢連箋開立適當與否的影響因素，並探討糖尿病慢連箋開立適當與否對醫療利用情形的影響。

方法：本研究採用次級資料分析，主要利用2007年全民健保資料庫百萬歸人檔資料，擷取出有領滿3次慢連箋者為適當組；並以有連續就醫三個月、領藥天數84天以上、開立相同藥理分類之糖尿病用藥，且沒有改變劑量者為應開立卻未開立者(不適當組)，藉以分析開立慢連箋之適當與否的影響因素。隨後再利用傾向分數配對法(Propensity Score Matching, PSM) 按1:1的比例配對出具可比較性的兩組研究對象，比較開立慢連箋之適當與否對醫療利用情形的影響。

結果：影響慢連箋開立適當與否的因素包括病患年齡、有無重大傷病、併發症個數及醫療院所之層級別、權屬別與分局別。有領滿3次慢連箋之開立適當組相較於應開立卻未開立之不適當組，在門診醫療利用的部分，雖減少了2.55次門診就醫次數、496元診療費及1,044元的民眾部分負擔，但卻增加40天的用藥天數、5,633元用藥明細金額、111元藥事服務費及5,527元申請金額；在急診及住院方面，適當組比不適當組可減少0.078次急診、1,848元急診費用、0.2次住院、2.6天住院天數及10,149元的住院費用，整體而言，總醫療費用支出可減少7,515元。

結論：由本研究結果可以看出，若單純只看開立慢連箋對門診醫療利用情形的影響，則慢連箋的開立會增加醫療費用的支出，但若加入急診及住院的醫療利用後進一步探討，即可看出慢連箋政策的確可有效減少醫療資源的耗用，達到政策實施的成效。

關鍵字

糖尿病 ； 慢性病連續處方箋 ； 適當性 ； 傾向分數配對法 ； 醫療利用

並列摘要

Background and Objectives: There are limited studies up till now aimed at analyzing the clinical profits of the chronic illness refill prescription policy (CIRPP). Among these, there are only few research studies analyzing the impact of CIRPP utilization on medical resource utilization, while the majority of the studies compare the differences between with and without utilization of the CIRPP., The latter research method is less accurate and may lead to more biased results.. Therefore, this study intents to redefine the appropriateness of CIRPP and its impact on the health care system on the basis of diabetes mellitus (DM), to analyze the impact factors that affect the appropriateness of the prescription of chronic illness prescription refill slip (CIPRS) for diabetic patients, and to investigate whether the appropriateness of CIRPP for diabetics will affect medical usage or not.

Methods: This study involves secondary data analysis, which was based on the 2007 National Health Research Institute database. Patients who were prescribed to CIPRS three times are extracted as the appropriate group ; stable patients who continuously seek medical treatment for three months, consistently received the same medicine components and quantity treating DM for up to 84 days, should be prescribed to CIPRS but never received CIPRS prescription are extracted as the inappropriate group. These two groups are defined to analyze the factors affecting the appropriateness of the CIPRS prescription Subsequently, propensity score matching (PSM) method, issued by 1:1 matching the comparability of two groups of subjects, is used to compare whether the appropriateness of CIPRS prescriptions will impact the utilization of medical care or not.

Results: The impact factors for the appropriateness of the CIPRS prescriptions include patient age, existence of catastrophic illness, complications and medical institutions of the layer number of the level of ownership and the other branch. Even though, the appropriate group, who have received over three times CIPRS received 40 days more medications, NT$5,633 more drug fee per person, NT$111 more pharmaceutical service fees and NT$5,527 more apply expenses than the inappropriate group, they also had 2.55 times less doctors consultations per capita, NT$496 for physician fees, and NT$ 1,044 for co-payment. In the emergency department (ED) and hospitalization, the appropriate group could reduce the 0.078 visit, and 1,848 dollars in ED, 0.2 visit, 2.6 days, and 10,149 dollars in hospitalization, comparing with the inappropriate group. Overall (by and large), the total medical expenditures decrease 7,515 dollars.

Conclusions: The research result indicates that if only the impact of medical utilization of outpatient is concerned, implementation of CIRPP increases medical expense; however, if medical utilization of emergency and inpatient are included, the CIRPP apparently reduce the medical utilization to achieve the designed purpose.

並列關鍵字

Diabetes ； Chronic Illness Refill Prescription Slip ； Appropriateness ； Propensity Score Matching ； Health Utilization

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