醫師特質與低價值處方的相關性探討─以抗生素、抗精神病藥物、鎮靜安眠藥為例

Abstract

研究背景：隨著醫療科技進步與人口高齡化的現象，各國醫療費用成長快速。台灣健保門診藥費從1998年至2016年也成長了178.7%。開立處方治療為低單價而使用頻率高的治療方法，比起高單價的處置，在總體成本上支出佔比更高。 研究目的：本研究在探討醫療提供者特性與低價值處方開立的相關因素，針對「急性鼻竇炎使用抗生素」、「上呼吸道感染使用抗生素」、「失智症患者使用抗精神病藥物」、「老年人失眠症狀使用鎮靜安眠藥物」四項低價值處方進行研究。 研究方法：本研究為橫斷性研究，使用2010年至2014年全民健保學術研究資料庫全人口之申報資料進行分析。研究對象分別為罹患急性鼻竇炎或上呼吸道感染、失智症20歲以上成年患者，以及有失眠躁動或譫妄症狀之65歲以上老年患者，分析2011年至2014年期間醫師對上述病患開立低價值處方的相關因素。 研究結果：2011至2014年期間，低價值抗生素使用發生在急性鼻竇炎與上呼吸道感染患者的比率分別為58.30%與6.80%；失智症患者首選藥物期間有19.91%的就診人次被處方抗精神病藥物；而因失眠、躁動、譫妄的老年人在首選藥物期間則有73.32%的鎮靜安眠藥物使用情形。經控制其他相關影響因素後，發現除上呼吸道感染使用抗生素項目，其他三項低價值處方以女性醫師的開立比率較低。醫師年齡與低價值抗生素及鎮靜安眠藥物處方開立呈現正相關，但與抗精神病藥物則呈負相關。不同科別的醫師給予處方有顯著差異。醫師藥費佔總門診費用比率中僅低價值鎮靜安眠藥項目呈現負相關；開立藥物佔總看診人次比率上所有項目均呈現正相關；每張處方箋藥品品項數部分，上呼吸道感染使用抗生素及失智症患者使用抗精神病藥物呈正相關，其餘兩項目呈負相關。 結論：本研究納入的四項低價值處方在臺灣十分普遍，並且與醫師特質息息相關。整體而言，醫師的性別、年齡、科別、開立該項藥品處方比率、藥費佔比、平均開立之藥品品項數均與醫師給予其患者低價值用藥之間具有相關性，但不同項目之間有些許差異。

OBJECTIVES: With the advancement of medical technology and the aging of the population, medical expenses grown rapidly in various countries. The health insurance’s outpatient drug fee increased by 178.7% from 1998 to 2016 in Taiwan. Prescribing drug is a relatively low-priced, high-frequency treatment, which accounts for a higher proportion of total cost than a high-priced treatment. PURPOSES: This study aims to explore the relationship between of low-value medication used and physician’s characteristics. Using “antibiotics for acute sinusitis”, “antibiotics for upper respiratory tract infections”, “antipsychotic drugs for patients with dementia” and “benzodiazepines or other sedative-hypnotics for insomnia elderlies” four low-value cares as example. METHODS: This study is a cross-sectional study using 2010-2014 Health Insurance Population Database. The subjects are adult patients with acute sinusitis, upper respiratory tract infection, dementia, and elderly patients with insomnia, agitation, or delirium symptoms, analyzing the relationship of physician’s characteristics. RESULTS: During the study period, the incidence of low-value antibiotics in patients with acute sinusitis and upper respiratory tract infection was 58.30% and 6.80%, respectively; 19.91% of patients with dementia were prescribed antipsychotic drugs; and 73.32% insomnia, agitation, or delirium elderly got benzodiazepines or other sedative-hypnotics. After controlling relevant influencing factors, it is found that in addition to the upper respiratory tract infection using antibiotics, the other three prescriptions have lower low-value medication used from female physician. There are significant differences in prescriptions given by physicians in different age groups and disciplines. Physician’s age is positively correlated with the prescription of low-value antibiotics and benzodiazepines, but negatively correlated with antipsychotics. Prescribing fees of the total outpatient expenses is only negatively correlated with low-value benzodiazepines. When physicians have the habit of prescribing antibiotics/antipsychotic drugs/benzodiazepines, they are more likely to give patients low-value prescriptions. Item of antibiotics for upper respiratory tract infections and antipsychotic drugs for patients with dementia are positively correlated with average number of drug items. CONCLUSION: The four low-value care included in this study are very common in Taiwan and closely related to physician characteristics. There are correlations between physician characteristics and low-value medication used, but slightly varied between different prescriptions.