全民健保糖尿病門診問題處方之分析－以北台灣為中心之研究

Diabetic patients generally are users of multiple medications. This study explored potential inappropriate prescription problems of ambulatory diabetic patients in the National Health Insurance (NHI). Methods: This study applied secondary data analysis based on a claim database (September 1997~June 1998) provided by the Northern Branch of the NHI Bureau by selecting patients diagnosed with diabetes mellitus (DM) and DM complications ICD-9 codes. 35, 981 patients receiving hypoglycemic medications were included, and a total of 333,414 prescriptions with 17,795,911 medicines written in the prescriptions were identified. Results: The diabetic patients in this study had an average of 14.6 ambulatory visits per year, with average medical expenses of NT$11,822, 78.6% (NT$9,292) attributable to pharmaceuticals. The average days per prescription were 18.41 days, and there were 4.1 drugs per prescription. In the valid prescriptions, 4.7% of prescriptions had over-dosage problems, while 2.9% of prescriptions had duplicated hypoglycemic medication. Besides, 40.02% had moderate and 3.02% had severe adverse drug interactions. Overall, there were 45.28% of prescriptions that had one or more kinds of problem prescriptions. After controlling the patient characteristics and types of providers, there was statistical significance in term of odds ratio in written inappropriate prescriptions. The odds ratio varied from 1.09 (95% CI=1.06-1.13) of the other clinical departments versus family medicine to 8.39 (95% CI=7.56-9.30) of metropolitan hospital versus academic medical center. Prescriptions with over-dosage were more likely found among hospitals and clinics than academic medical centers with odds ratios ranging from 3.83 to 8.39. Comparing with public hospitals, the odds ratios were 3.93 (95% CI=3.66-4.26) for non-proprietary hospitals and 1.21 (95% CI=1.13-1.30) for private hospitals. Conclusions: The odds ratio of patients who receive inappropriate prescriptions were higher for females, patients with older age, and patients with DM complications. There were also various risks among different types of providers.