糖尿病患者使用慢性病連續處方箋對門診醫療利用之影響

Abstract

近年來糖尿病已成為台灣地區主要死因的第四名，且國人糖尿病盛行率隨著年齡與年代的增加而升高，健保局為抑制醫療費用的成長，及降低不斷增加的就診次數，一再透過各種宣導管道，呼籲民眾及醫療院所如果病情穩定，民眾應儘可能請醫師開立慢性病連續處方箋，本研究目的在了解糖尿病患者的特性，並比較糖尿病患者是否使用慢性病連續處方箋的特性、藥品調劑場所及對門診醫療利用之影響。 本研究採用次級資料分析，利用國家衛生研究院所提供的全民健康保險學術研究資料庫的93年20萬承保抽樣歸人檔，針對93年期間符合本研究定義的糖尿病門診就診，且該年無住院紀錄的研究樣本，共有5,135人，曾經使用慢性病連續處方箋之病患1,820人，沒有使用慢性病連續處方箋之病患有3,315人，進行全年門診醫療利用的歸人分析。 控制其他變項後，以複迴歸分析觀察自變項對依變項的影響，研究結果如下： 1.糖尿病患者使用慢性病連續處方箋中，全由原醫療院所調劑的有4,106張，佔77.8%。而有藉由特約藥局後續調劑的處方箋有1,173張，佔22.22%，但糖尿病患者門診慢性病連續處方箋的實際開立率只有12.03%。 2.控制其他變項之後，使用慢性病連續處方箋患者的就醫次數比沒使用者少2.39次；給藥日份方面，使用慢性病連續處方箋的病患比未使用者多拿了61天的藥；用藥明細金額方面，使用慢性病處方箋的病患比沒使用者多4,140元；診療明細金額方面，使用慢性病處方箋的病患比沒使用者減少198元；診察費方面，使用慢性病處方箋的病患比沒使用者多84元。藥事服務費方面，使用慢性病處方箋的病患比沒使用者增加124元；醫療費用合計金額方面，使用慢性病處方箋的病患比沒使用者增加4,150元。部分負擔方面，使用慢性病處方箋的病患比沒使用者減少716元。 全民健康保險開辦至今邁入第13年，在保費收入不足以支應龐大的醫療費用之際，除了希望利用慢性病連續處方箋降低民眾就醫次數外，深入了解醫療費用是否增加，恐怕也是當務之急。然而，慢性病連續處方箋對糖尿病患者而言，不能全由就醫次數與金額來評估，慢性病連續處方箋開立與使用是否影響糖尿病病況的控制，建議衛生主管機關，應進行成本效益評估。

Diabetes is one of chronic diseases that threaten people’s health in Taiwan. Recently, diabetes not only has become fourth of main cause of death in Taiwan, but also has been prevailing as age increases. Because the expenses of medical treatment raise and the frequencies of seeing doctor increase rapidly, The Bureau of National Health Insurance (BNHI) tries to control these two causes go up. They encourage that if patients’ condition becomes stable, patients should use refill prescription of chronic illness instead. The objective of this study, including understand the characteristic of diabetes patients, contrast the impact of different ages and sexes after using diabetes refill prescription, and analyze what’s the effect of dispensing the prescription from hospital and pharmacy on healthcare utilization.

This study used secondary data analysis, which was based on National Health Insurance Research Database and provided by National Health Research Institute. We selected 5,135 patients who was diagnosed with 2 times or over diabetes medication and was not inpatients from two hundred thousand patients in 2004. There were 1,820 patients who once used prescription refill while 3,135 patients did not refill prescription in 2004.

Using the multiple regressions to observe what the relationship between independent variables and dependent variables is. The result of the proportion of the study subjects using refill prescription is 12.03% with an average of 2.9 prescriptions dispensing per person. About 77.78% of patients have their prescription refilled in hospitals, and there is 22.22% of them refilled from National Health Insurance（NHI）contracted pharmacy. Results of the multiple regression indicates that the patients who used refills not only have 2.39 medical visits less than the counterparts, but also get 61 days more of medicine. Regarding the medical expenditure of using refills, it has treat amount NT$198 and co-payment NT$716 less per person than the comparing group. However, the patients using refill services resulted in an increment of NT$84 of physician fees, NT$124 of pharmaceutical service fees, and NT$4,140 of drug fees per person. Overall, the patients who use refills have NT$4,150 more medical expenses than their comparing group.

National Health Insurance has been established for 13 years. It helps lots of patients to release the pressure of medical treatment expenses; however, the insurance revenue is deficit. NHIB encourages doctor to issue prescription refill for patients with stable chronic illness more often, so that it can reduce the frequency of going hospital. Additionally, they have to be very thorough in whether it diminishes the expenses of medical treatment. Yet, for diabetes patients, using refill prescription cannot depend on healthcare utilization, such as the money and the frequency of going hospital. It is more important for them to know the effect of using refill prescription to control the disease. Thus, we recommend that responsible government should use cost-effectiveness to analyze the refill prescription of diabetes.