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完整後設資料紀錄
DC 欄位 | 值 | 語言 |
---|---|---|
dc.contributor.advisor | 余峻瑜(Jiun-Yu Yu) | |
dc.contributor.author | Yi-Rou Lei | en |
dc.contributor.author | 雷沂柔 | zh_TW |
dc.date.accessioned | 2021-06-17T07:17:24Z | - |
dc.date.available | 2019-07-23 | |
dc.date.copyright | 2019-07-23 | |
dc.date.issued | 2019 | |
dc.date.submitted | 2019-07-11 | |
dc.identifier.citation | References
1. “Pediatric Drug Safety.” 台灣醫療改革基金會, 1 May 2016, www.thrf.org.tw/page/615 2. “您家寶貝吃的藥,是「兒童專用」的嗎?.” 兒童用藥守護神, issue.thrf.org.tw/child/questionary.htm#A03 3. “您家寶貝吃的藥,是「兒童專用」的嗎?.”現有兒童藥劑品項“ http://issue.thrf.org.tw/child/word/05.xls 4. “您家寶貝吃的藥,是「兒童專用」的嗎?.”提供兒童藥劑的醫療院所“ http://issue.thrf.org.tw/child/place.htm 5. “請重新研議診所開立原裝兒童口服液劑之給付方式與相關規定.”臺灣兒科醫學會, www.pediatr.org.tw/news/news_info.asp?id=222 6. World Health Organization. (2017). WHO model list of essential medicines for children: 6th list (March 2017, amended August 2017), 6th ed. World Health Organization (WHO) http://www.who.int/iris/handle/10665/273825 7. Ceci, A, et al. “Medicines for Children Licensed by the European Medicines Agency (EMEA): The Balance after 10 Years.” European Journal of Clinical Pharmacology, U.S. National Library of Medicine, Nov. 2006. 8. Crocetti, M, et al. “Fever Phobia Revisited: Have Parental Misconceptions about Fever Changed in 20 Years?” Pediatrics, U.S. National Library of Medicine, June 2001. 9. Esposito, Lisa. “Has Your Child Outgrown the Pediatrician?” U.S. News & World Report, U.S. News & World Report, health.usnews.com/health-news/patient-advice/articles/2014/05/15/has-your-child-outgrown-the-pediatrician. 10. Ghaleb, Maisoon Abdullah, et al. “Systematic Review of Medication Errors in Pediatric Patients.” The Annals of Pharmacotherapy, U.S. National Library of Medicine, Oct. 2006. 11. Ivanovska, Verica, et al. “Pediatric Drug Formulations: A Review of Challenges and Progress.” Pediatrics, American Academy of Pediatrics, 1 Aug. 2014. 12. Kai, J. “Parents and Their Child's Fever: Do as I Say, Not as I Do?” Family Practice, U.S. National Library of Medicine, Dec. 1998. 13. Augmentin tablets 375 mg, Package Insert https://tw.gsk.com/media/715636/augmentin-tablets-375-pi.pdf 14. AUGMENTIN Syrup 457 mg/5ml, Package Insert https://tw.gsk.com/media/718829/augmentin-syrup-457-pi.pdf 15. AUGMENTIN 1g F.C. Tablets, Package Insert https://tw.gsk.com/media/792723/augmentin-1g-fc-tablets-pi.pdf 16. The International Classification of Diseases, 10th Online Version, 2019. https://www.icd10data.com/ 17. Tobias, LD, and J Harkness. “Briefing Paper on Pediatric Medicines and Clinical Research.” Patients Organizations.org, www.patientsorganizations.org/paediatrics 18. Stroh, David Peter. Systems Thinking for Social Change: A Practical Guide to Solving Complex Problems, Avoiding Unintended Consequences, and Achieving Lasting Results. Chelsea Green Publishing, 2015. | |
dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/73098 | - |
dc.description.abstract | Drug formulation used in pediatric patients should be appropriate, safe, as well as be adapted to children’s needs. The use of inadequate drug formulation and the pulverizing medicine phenomenon are widespread in Taiwan. Many existing treatments are not suitable for children, which often leads to medical malpractice. Although the advocacy of pediatric drug safety from non-government organization, the improving regulations from government regarding current clinical situations remain stagnant. In order to evaluate the pediatric drug safety issue, this essay uses system dynamics approach to analyze the results that come from different prescribing behaviors. The analyses found out problems generated from pulverized medicine caused drug safety, drug efficacy, and cost issues, causing the decrease of the relative safety and efficacy of treatment, illustrated by balancing loops in the system dynamics. On the other hand, the reinforcing loops in the system dynamics generated from pediatric drug formulations created incentives to drive doctors to prescribe more pediatric drug formulations, leading to better drug safety and drug efficacy of treatment for children. Therefore, the system dynamics depicts the whole structure of pediatric drug safety issue came from different prescribing behaviors, letting us have a clear picture to address this problem. Four key issues that need to be addressed to stimulate the further improvement for pediatric drug safety in the medical system are identified: (1) building the network of medical institutions to promote pediatric safety; (2) set up online platforms and use of existing data to transmit more medication knowledge; (3) collect more clinical feedback and patients’ outcome to improve the development and the utilization of pediatric drug formulation (4) take the responsibility of saving more medical resources, helping government to save the cost in order to address drug safety and many other issues. | en |
dc.description.provenance | Made available in DSpace on 2021-06-17T07:17:24Z (GMT). No. of bitstreams: 1 ntu-108-R06749077-1.pdf: 4163757 bytes, checksum: f89db39279fb05a6e639ff884c923a9d (MD5) Previous issue date: 2019 | en |
dc.description.tableofcontents | Table of Contents ii
List of Tables v List of Figures v 1. Abstract 1 2. Background 3 2.1 Safety Issues with Pediatric Medicine Treatment in Taiwan 3 2.2 Physicians Debate on Unpractical Policy Striving for Their Rights 5 2.3 Insufficient Healthcare Knowledge for Medications 5 2.4 Parent’s Medication Knowledge and Management of Their Children’s Ailments 6 2.5 Increased Risk of Medication Errors in Children 8 3. Current Situation 9 3.1 Improvement of Awareness Among Stakeholders in Pediatric Medication Safety..9 3.2 The Challenges in Developing Pediatric Drug Formulations 10 3.3 Attaching of Importance to Pediatric Medication Safety is Stagnant 11 4. Methodology 13 4.1 Behavior-Over-Time Graph 14 4.2 Stock / Accumulator 14 4.3 Flow / Rate 14 4.4 Core Variables and Stakeholders 15 4.5 Positive Arrow Signs and Negative Arrow Signs 15 4.6 Reinforcing Loop 16 4.7 Balancing Loop 16 4.8 Leverage Point Analysis 16 4.9 Definition of Specific Variables in This Essay 17 5. System Dynamics – Pediatric Drug Safety and Prescribing Behaviors 19 5.1 Behavior-Over-Time Graph 19 5.1.1 Number of Visitors 19 5.1.2 Under 18 Years Old Visit ENT Clinic Rate 20 5.1.3 The Reasons to Visit ENT Specialist in Children under 18 Years Old 21 5.1.4 Total Pulverized Rate in the ENT Clinic 23 5.1.5 Pulverized Rate in Children under 12 Years Old in the ENT Clinic 24 5.2 Stock-and-Flow Diagram 25 5.3 The Demonstration of System Dynamics Map 27 5.4 First Scenario: Prescribing Adult Drug Formulation to Children 28 5.4.1 Pulverized Medicine 28 5.4.2 Drug Safety Issues – Difficulty of Measuring Dose 29 5.4.3 Drug Safety Issues – Packaging Machine Contamination 30 5.4.4 Drug Efficacy Issues – Drug Palatability 31 5.4.5 Drug Efficacy Issues – Drug Storage Shelf-Life 32 5.4.6 Relative Safety of Treatment and Relative Efficacy of Treatment 33 5.4.7 Healthcare Quality 33 5.4.8 Parent’s Awareness of Drug Issues 34 5.4.9 Willingness to Prescribe Pediatric Drug Formulation 34 5.4.10 The Impact on the Number of Adult Drug Formulation Using on Children 35 5.5 Medical Malpractice 37 5.5.1 Prescription Error 38 5.5.2 Dispensing Error 39 5.5.3 Transcription Error 40 5.5.4 Administration Error 40 5.5.5 Off-Label Use 41 5.5.6 Medical Lawsuit 42 5.6 Second Scenario: Prescribing Pediatric Drug Formulation to Children 43 5.6.1 Medical Correctness – Precise Dosage Recommendation 44 5.6.2 Medical Credibility 44 5.6.3 Drug Safety Issues – Safe Excipients 45 5.6.4 Drug Safety Issues – Complete Package 46 5.6.5 Drug Efficacy Issues – Drug Palatability 47 5.6.6 Drug Efficacy Issues – Drug Storage Shelf-life 48 5.7 The Cost Between Adult Drug Formulation and Pediatric Drug Formulation 49 5.7.1 Medication Co-Payments Under National Healthcare Insurance System 51 5.7.2 Relative Cost of Treatment and Affordability of Medical Institution 52 5.7.3 Adjustment of Benefit Package 53 5.8 Development of Pediatric Drug Formulation 54 6. Leverage Point Analyses 57 6.1 Assessing the Role of Pulverized Medicine and Addressing its Impact on Medical System 59 6.1.1 Additional Variables Affect the Willingness to Prescribe Pediatric Drug Formulation 62 6.2 The Impact on Patient’s Awareness of Drug Issues 65 6.3 Medical Credibility – Long-Term Cooperation Between Clinical Workers and Patients 66 6.4 Medical Center’s Regulations to Improve Pediatric Drug Safety 67 7. Conclusions 68 8. Future Steps 69 9. Implications 70 10. Limitations 71 11. References 72 | |
dc.language.iso | en | |
dc.title | 臺灣兒童用藥安全與醫師開立處方行為之評估:系統動態學之觀點 | zh_TW |
dc.title | Evaluating Pediatric Drug Safety and Prescribing Behavior in Taiwan:A System Dynamics Approach | en |
dc.type | Thesis | |
dc.date.schoolyear | 107-2 | |
dc.description.degree | 碩士 | |
dc.contributor.oralexamcommittee | 孔令傑(Ling-Chieh Kung),蔡宜蓉(Yi-Jung Tsai) | |
dc.subject.keyword | 系統動態學,兒童用藥安全,醫師開方行為,小兒磨粉,兒童專用藥, | zh_TW |
dc.subject.keyword | System Dynamics,Pediatric Drug Safety,Pulverized Medicine,Prescribing Behavior,Pediatric Drug Formulation, | en |
dc.relation.page | 73 | |
dc.identifier.doi | 10.6342/NTU201901332 | |
dc.rights.note | 有償授權 | |
dc.date.accepted | 2019-07-12 | |
dc.contributor.author-college | 管理學院 | zh_TW |
dc.contributor.author-dept | 企業管理碩士專班 | zh_TW |
顯示於系所單位: | 管理學院企業管理專班(Global MBA) |
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