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題名：新制醫院評鑑、處方警示系統、以及門診重複用藥率的相關性探討
書刊名：臺灣公共衛生雜誌
作者：郭昱君／鄭守夏／楊銘欽
作者(外文)：Kuo, Yu-chun／Cheng, Shou-shia／Yang, Ming-chin
出版日期：2014
卷期：33:5
頁次：頁523-529
主題關鍵詞：新制醫院評鑑；處方警示系統；重複用藥；Hospital accreditation；Prescribing alert system；Medication duplication
原始連結：連回原系統網址new window
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  • 被引用次數被引用次數:期刊(4) 博士論文(0) 專書(0) 專書論文(0)
  • 排除自我引用排除自我引用:4
  • 共同引用共同引用:6
  • 點閱點閱:53
目標：探討新制醫院評鑑納入處方警示系統項目與門診重複用藥率的變化情形。方法：資料來源是2005年百萬承保抽樣歸人檔，擷取2003－08年各年有18歲以上病人西醫門診處方案件之地區級以上醫院320家。重複用藥係指病人在重疊日期接受院內不同醫師開立之處方含ATC（Anatomical Therapeutic Chemical）前四碼相同藥品，院內重複用藥處方率=（院內重複用藥處方數／院內重疊日期處方數）*100%。新制醫院評鑑處方警示系統項目施行時間分為實施前（2003－04年，T0）、試辦期（2005－06年，T1）、實施後（2007－08年，T2）；其他控制因素包括醫院層級別、權屬別、醫院所屬分局別。統計方法為描述性統計與廣義估計方程式（GEE）。結果：新制醫院評鑑實施前平均院內重複用藥處方率是46.28%，試辦期40.23%，實施後32.95%。院內重複用藥相關因素分析在控制其他變項後發現，2005－06年（T1）的院內重複用藥處方率減少6.08個百分點（p=0.0008）；而2007－08年（T2）則減少13.13個百分點（p＜0.0001）。結論：新制醫院評鑑處方警示系統和院內門診重複用藥的改善有相關。
Objectives: To understand changes in the medication duplication rate after implementation of a prescribing alert system as a new criterion for hospital accreditation. Methods: We studied 320 general hospitals that provided prescriptions for outpatients aged 18 and older in 2003-2008 from the longitudinal NHI dataset. Medication duplication was defined as ＂a patient received drugs with the same therapeutic effect (as defined by level 3 of the Anatomical Therapeutic Chemical system) with different prescriptions provided by different physicians from the same hospital within one treatment period＂. Medication duplication rate = (cases of medication duplication) / (total number of prescription provided in a hospital within same treatment period) x 100%. There were three observation periods: before the new criterion for hospital accreditation was implemented (years 2003-04, T0), the period of pilot implementation (years 2005-06, T1), and after the new criterion for hospital accreditation was implemented (years 2007-08, T2). The data were adjusted for accreditation status, ownership, and branch of BNHI, and descriptive statistics and GEE were used in the analysis. Results: The average rate of medication duplication in hospitals was 46.28% in years 2003-04 (T0), 40.23% in years 2005-06 (T1), and 32.95% in years 2007-08 (T2). After controlling for other factors, the medication duplication rate decreased by 6.08 percentage points (p=0.0008) in years 2005-06 (T1), and 13.13 percentage points (p＜0.0001) in years 2007-08 (T2). Conclusion: The addition of an alert system for duplicate prescriptions as a criterion for hospital accreditation was associated with improvement in the medication prescribing practices in hospital outpatient departments.
期刊論文
1.Lehmann, C. U.、Kim, G. R.(2006)。Computerized provider order entry and patient safety。Pediatric Clinics of North America，53，1169-1184。  new window
2.陳惠玉、許茜甯(20130300)。電子化整合處方系統對門診重複處方之改善。臺灣醫學，17(2)，111-124。  延伸查詢new window
3.Chu, H. Y.、Chen, C. C.(2012)。Continuity of care, potentially inappropriate medication, and health care outcomes among the elderly: evidence from a longitudinal analysis in Taiwan。Med Care，50，1002-1009。  new window
4.Hsu, M. H.、Yeh, Y. T.(2011)。Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart card in Taiwan。Int J Med Inform，80，18-19。  new window
5.Chrischilles, E. A.、VanGilder, R.(2009)。Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults。J Am Geriatr Soc，57，1000-1006。  new window
6.Kaushal, R.、Shojania, K. G.(2003)。Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review。Arch Intern Med，163，1409-1416。  new window
7.McCullough, J. S.、Casey, M.、Moscovice, I.(2010)。The effect of health information technology on quality in US hospitals。Health Aff，29，647-654。  new window
8.Poon, E. G.、Blumenthal, D.(2004)。Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals。Health Aff，23，184-190。  new window
9.Cheng, S. H.、Chen, C. C.(2014)。Effect of continuity of care on medication duplication among the elderly。Med Care，52，149-156。  new window
10.Bates, D. W.、Leape, L. L.、Cullen, D. J.、Laird, N.、Petersen, L. A.、Teich, J. M.、Seger, D. L.(1998)。Effect of computerized physician order entry and a team intervention on prevention of serious medication errors。JAMA，280(15)，1311-1316。  new window
11.陳世欽、蔡文正、黃昱瞳、謝儀靜、黃光華(20120200)。臺灣高血壓用藥之問題處方及其影響因素的研究。臺灣公共衛生雜誌，31(1)，31-42。new window  延伸查詢new window
12.全民健康保險爭議審議委員會(20070500)。不同科別重複用藥所涉及之爭議問題1(3)，74-81。  延伸查詢new window
13.蔡文正、游秋華、黃光華、謝淑惠、陳慧珊、廖家慧、吳守寶、詹勳政、龔佩珍(20090600)。健保IC卡對醫師診療之助益及其相關因素。臺灣公共衛生雜誌，28(3)，205-217。new window  延伸查詢new window
學位論文
1.邱千慈(2010)。某醫學中心臨床決策支援系統對重複用藥之影響(碩士論文)。臺灣大學。  延伸查詢new window
圖書
1.Hwang, H. G.、Chang, I. C.、Kao, C. S.(1995)。Investigation on the status of electronic medical records of medical institutions in 1995。Taipei：Ministry of Health and Welfare, R.O.C.。  new window
2.黃興進、張怡秋、高正雄、吳彬安、黃穗秋(2005)。衛生福利部九十四年度醫療院所病歷電子化現況調查。台北：衛生福利部。  延伸查詢new window
其他
1.衛生福利部醫事司。醫院評鑑基準，http://www.mohw.gov.tw/cht/DOMA/DM1.aspx?f_list_no=608&fod_list_no=895， 2013/06/25。  new window
2.衛生福利部中央健康保險署。全民健康保險醫院總額支付制度品質確保方案，http://www.mohw.gov.tw/cht/DOSI/DM1_Paspx?f_list_fod_list_r=43233， 2014/01/24。  延伸查詢new window
 
 
 
 
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