| 摘要: | 目標：本研究目的為探討西醫基層門診不同處方箋調劑類型之氣喘用藥型態及問題處方。方法：採次級資料分析，研究對象為全民健保2002至2005年西醫基層門診符合ICD-9前三碼為490-496之氣喘案件。處方箋調劑類型分為自行調劑、門前藥局及一般藥局；用藥型態包含處方頻率、用藥費用、給藥天數及藥品類別；氣喘用藥依ATC藥理分類分為六類；問題處方包括超量處方、重複用藥及交互作用。結果：本研究西醫基層氣喘處方有12,143張，每張處方平均總用藥品項數為4.72項，其中氣喘用藥1.65項，平均藥費為419.1元，其中氣喘用藥201.6元，平均用藥天數為11.6天，平均用藥類別數1.19項，在不同處方箋調劑類型皆具顯著差異；診所自行調劑處方數逐年下降(65.49%-->51.60%)，而門前藥局(25.03%-->31.57%)及一般藥局(9.48%-->16.83%)則逐年上升；氣喘藥品使用率方面，乙二型交感神經作用劑佔45.74%、茶鹼33.52%、吸入型類固醇16.10%；診所自行調劑之每張氣喘處方平均藥費為442.1元，大於門前藥局416.2元及一般藥局374.9元；問題處方中，超量處方箋1,144張發生率為9.42%、重複用藥1,142張(9.4%)及藥物交互作用902張(7.43％)；問題處方在處方箋調劑類型及就診特性之就診科別、登記型態、都市化程度、病患年齡等變項，皆具顯著差異。結論：本研究顯示氣喘處方在處方箋調劑類型，存在用藥型態及問題處方之顯著差異；各類問題處方比率，一般社區藥局均顯著低於自行調劑及門前藥局。
Objective: In this study, prescription patterns and inappropriate prescriptions in treating asthma under primary care setting at different dispening sites were investigated. Method: Secondary data analysis was applied in asthma cases with the first three digits of ICD code ranging from 490 to 496 within years 2002-2005. The data were extrated from the database of National Health Research Institutes.The medications might be dispensed in three different types of pharmacies including medication dispensing divisions in clinics, gateway pharmacy, National Health Insurance (NHI) contracted pharmacy. Medication prescription patterns were characterized by four features including frequency, expense, administration duration and medication items. The administrated medications for treating asthma are classified into 6 categories based on the anatomical therapeutic chemical (ATC) classification system. Inappropriate prescriptions refer to those with problems of over-dosage, duplicated medication, and drug-drug interaction. Result: A total of 12,143 prescriptions under the primary care setting were extracted and analyzed. The mean number of medications per prescription is 4.72 items, in which 1.65 items are directly used for treating asthma.The averaged expense is NT$419.1, in which NT$201.6 are directly used for treating asthma. Additionally,the duration of administration and medication items are 11.6 days and 1.19 items, respectively, which demonstrates significant differences among different prescription patterns. It was found that the prescription rate decreased from 65.49% to 51.60% for clinics, while it increased from 25.03% to 31.57% for gateway pharmacy and from 9.48% to 16.83% for NHI contrated pharmacy, respectively. Regarding the prevalence of prescribed medications for asthma treatment, 45.74% of them are belong to β2-adrenergic agonists, while it is only 33.54% and 16.10% for Xanthine and Corticosteroids, respectively. Mean expense for each prescriped at gateway pharmacy is NT$442.1 and is higher than both NHI contracted pharmacy (NT$416.2) and medication dispensing divisions in clinics (NT$374.9). For inappropriate prescriptions, the frequencies of over-dosage, duplicated prescription, and drug-drug interaction are 1,144 (9.42%), 1,142 (9.40%), and 904 (7.43%), respectively. Significant differences are found in inappropriate prescription with regards to different prescriped sites and characteristics of seeking medical consultations such as type of specity, type of registration, degree of urbanization, and age of patients. Conclusion: For different prescription sites, significant difference is found in medication type and inappropriate prescription for asthma treatment. Percentage of inappropriate prescription for general drug stores is significantly lower than medication dispensing divisions in clinics and gateway pharmacy. |
