醫院卓越計畫對精神分裂症門診病患換藥行為之影響

To explore whether the Center of Excellence Initiative (CEI) for hospitals implemented in 2004 had any influence on providers' prescribing patterns of antipsychotics for outpatient schizophrenia patients.
Methods: We applied a pre-test/post-test control group design and compared the change in medication switching behavior between hospitals that implemented the CEI and those that did not (control group). Using the National Health Insurance claim data from 2002 to 2004, we based our analysis on patients who regularly sought care from a hospital between 2002 and 2003. Medication switching behavior was defined as either switching from second generation antipsychotics (SGA) to first generation antipsychotiocs (FGA) or reducing dosages on SGA. The dosage of prescribed antipsychotics was measured by the prescribed daily doses (PDD). We applied the difference-in-differences (DID) approach and the generalized estimating equation (GEE) model to conduct the analysis.
Results: Among the 35,441 schizophrenia patients, 50.38% of them were from hospitals that participated in the CEI. Medication switching behavior was more likely to occur in hospitals that implemented the CEI compared to the control group (OR=1.19, 95% C.I. 0.69-2.07); however, the result was not statistically significant. The effects of CEI varied among hospitals with different characteristics or in different regions. Hospitals in the Taipei sub-bureau were more likely to display medication switching behavior than hospitals in the Kao-Ping sub-bureau. Military/veterans/non-profit proprietary hospitals were significantly less likely to display medication switching behavior than private hospitals. Metropolitan/community and mental hospitals were significantly less likely to switch medications than local community teaching hospitals.
Conclusions: The impact of CEI on prescribing patterns of antipsychotic for outpatient schizophrenia patients differed among hospitals in different regions, with different ownerships, and accreditation levels.