台灣失能老人多重用藥之研究

Abstract

本研究之主要目的為呈現台灣失能老人多重用藥之盛行率，並探討其相關因素。研究樣本來自「全國長期照護需要評估」計畫資料中65歲以上之失能樣本，共11,788人，由調查檔中得到樣本之性別、年齡、教育程度、籍貫、心理健康、身體功能狀況、長期照顧模式等資訊，再連結其健保檔中的門診處方及治療明細檔（CD檔）及門診處方醫令明細檔（OO檔），以取得樣本在研究期間（2001年7月至2002年6月）的西醫門診就醫及用藥資訊共同分析。 台灣失能老人多重用藥(最大單日用藥種數在5種以上)的盛行率為81.0%，重度多重用藥(最大單日用藥種數在10種以上)的盛行率為38.1%。有將近三分之一的人(32.5%)有半年以上的時間，每天用藥5種以上；多重用藥天數平均值為122.5天，中位數為61天。 邏輯斯迴歸分析發現，發生多重用藥機會較高者為：年齡小於85歲、需部分負擔者、身體功能狀況為重度依賴或中度依賴者、共病症數目較多者及就醫傾向不固定(OR值7.147，95%CI 6.043-8.452)或中等者(OR值2.434，95%CI 2.122-2.792)。 發生多重用藥半年以上機會較高者為：年齡小於85歲、女性、外省人或福佬人、教育程度較高、有偶者、城鄉別在直轄市或省轄市者、需部分負擔者、居家且有請全職看護者、身體功能狀況之依賴程度較高者、共病症數目較多者、傾向至醫院就醫者及就醫傾向不固定(OR值1.696，95%CI為1.503-1.913)或中等者(OR值1.256，95%CI為1.102-1.430)。 在控制身體狀況之後，無固定就醫者發生多重用藥的機會非常的高，如何改進以減少多重用藥，進而降低因多重用藥而帶來的風險，是醫療體系制度改革應重視的議題。

The objectives of this study are to determine the prevalence and correlates of polypharmacy among disabled elderly in Taiwan. Eleven thousand, seven hundred and eighty-eight disabled people aged 65 years and above from the ‘Evaluation of Taiwan National Requirements for Long-Term Care’ were enrolled in the current study. Subject identification information was linked to the National Health Insurance claim database to obtain all prescription data from western medical ambulatory visits between July 2001 and June 2002. The prevalence of polypharmacy (defined as prescriptions of >=5 medications on the day of maximum numbers of medications prescribed during the study period) and major polypharmacy (>=10 medications) among disabled Taiwanese elders were 81.0% and 38.1%, respectively. Almost one-third (32.5%) of people were exposed to polypharmacy for more than 181 days during the study year. The average number of days of exposure was 122.5 days, and the median was 61 days. The tendency to usual healthcare sources was the strongest correlates of polypharmacy in multivariate logistic regression models. Compared to those with high tendency to usual healthcare sources, those with low tendency (OR= 7.147; 95%CI, 6.043 - 8.452) and those with intermediate tendency (OR=2.434; 95%CI, 2.122 - 2.792) were more likely to be exposed to polypharmacy. Other significant correlates of polypharmacy included younger age, requiring co-payment, and poor physical functioning. Significant correlates for exposure to polypharmacy for more than 181 days from multivariate were being under 85 years old, being female, being Mainlanders or Islanders, having higher education, being married, living in big cities, requiring co-payment, dwelling in community with a fulltime caregiver, being physically dependent, having more comorbidities, tending to seek medical advice from doctors in hospitals, and having low or intermediate tendency to usual healthcare sources. The prevalence of polypharmacy was extremely high in disabled Taiwanese elders. Lack of usual healthcare providers was one of the strongest correlates of polypharmacy. Our results suggested that policies to encourage elders to visit fewer healthcare providers may decrease the prevalence of polypharmacy and associated adverse outcomes.