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  1. NTU Theses and Dissertations Repository
  2. 公共衛生學院
  3. 健康政策與管理研究所
請用此 Handle URI 來引用此文件: http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/58815
標題: 台灣民眾逛醫師尋藥行為之初探-以鎮靜安眠藥Zolpidem為例
A Preliminary Evaluation of Drug-seeking Behavior in Taiwan: The Case of Zolpidem
作者: Ming-Hua Yu
游明樺
指導教授: 鄭守夏
關鍵字: 尋藥行為,重複領藥比例,逛醫生,處方藥濫用,史蒂諾斯,
drug seeking behavior,doctor-shopping indicator,doctor shopping,prescription drug abuse,Zolpidem,
出版年 : 2014
學位: 碩士
摘要: 背景:
處方藥濫用是近年重要的公衛問題,其中,逛醫生(doctor shopping)被視為嚴重的處方藥物濫用行為,許多人可能會藉逛醫生重複領取同樣的藥物,也就是所謂的尋藥行為。而安眠鎮靜成份之一的Zolpidem,在台灣的成癮或濫用性逐年上升,因此,我們將利用重複領藥比例(DSI)計算民眾可能存在的Zolpidem尋藥行為。另一方面,照護連續性是測量民眾初級醫療利用很好的指標,所以我們也將分析照護連續性對於尋藥行為的影響。
目的:
探討台灣Zolpidem重複領藥的情形,並分析尋藥行為者的特質和相關影響因素,此外,比較非使用者、一般使用者和尋藥者其醫療利用的差異情形,和照護連續性對其的影響。
方法
本研究利用健保資料庫調查民眾領取Zolpidem的情形和尋藥行為,並計算使用者的重複領藥比例,其中我們也將利用傾向分數配對方法提高對照組和研究組的可比較性,藉由多元羅吉斯迴歸(Multinomial logistic regression)瞭解非使用者、一般使用者和尋藥者的差異,最後我們採COCI計算方式,分析照護連續性對使用者的影響。
結果:
2009年領取Zolpidem的盛行率為3.58%,重複領藥比例為7.54%,其中尋藥者重複領藥比例高達27.8%,影響青壯年和中年尋藥者的因子為,慢性病越多和投保薪資越低者其領取Zolpidem的機率也越高,而尋藥者在家醫科和內科的使用量皆比其他人高,老人方面的尋藥影響因素則是,慢性病越多和所在的醫師密度越高,其領取Zolpidem的情形越高,他們在內科和家醫科的利用則無達到統計上差異。最後,照護連續性對於尋藥者的影響程度,比起一般使用者對比無使用者的影響力更大,且隨著年齡越高,照護連續性對其的影響程度也越大,尤其是老年族群。
結論:
Zolpidem尋藥行為確實存在,且不同年齡層有不同的影響因素,而民眾在非精神專科的領藥比例也應加強重視,若能提高照護連性將有助於減少此行為的產生,建議有關單位應重視國內尋藥行為的現象,並進一步的做深入了解。
Background: Prescription drug abuse is one of the important problems in public health, and among which, doctor shopping is regarded as a serious behavior. Many people may get the same prescription drugs through different doctors repeatedly, which is called drug-seeking behavior. Zolidem, a prescription medication used for the treatment of insomnia, has been abused in Taiwan recently. This study aims to explore how drug-seekers get Zolpidem and the relevant factors associated with their consumption. We use a new method to estimate the relative parts of legitimate prescriptions and doctor shopping on the prescription database of NHI. Additionly, we also examine the connection between continuity of care(COC) and drug-seeking behavior.
Objective: We use doctor shopping indicator (DSI) to calculate the potential drug-seeking behaviors of Zolpidem in Taiwan. Besides, we want to understand the influence of COC on drug-seeking behavior.
Methods: We extract all the prescriptions of Zolpidem from National Health Insurance Registry of 2009. Moreover, we use propensity score matching (PSM) to reduce the bias between treatment and control groups on a large number of covariates. We profile the factors influencing non-users, users, and drug seekers with multinomial logistic regression.
Results: A total of 29,207 users are included in this study and the DSI is 7.54%. There are 2,420 persons who have drug-seeking behavior and their DSI is 27.8%. However, compared with people who don’t have this behavior, their DSI is only 0.5%. The result of logistic regression shows that Charlson comorbidity index and insurance degree are two factors significantly associated with the use of Zolpidem for the young and middle-aged drug-seekers. The drug-seekers of Family Medicine and General Medicine get more Zolpidem than other people. For elders, Charlson comorbidity index and density of doctors are two important factors significantly associated with the use of Zolpidem. Besides, higher COC indices are associated with lower prescription drug abuse, especially for the elders.
Conclusions: Drug-seeking behavior is increasing in Taiwan, which may cause serious prescription drug abuse problems. Health policymakers and the academic communities should begin to investigate the drug-seekers’ purposes and the possible effects of drug-seeking behavior on their health. Additionally, we should develop new regulatory guides and prescription monitoring programs for their abuse.
URI: http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/58815
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