照護連續性與潛在不適當用藥相關性探討

Abstract

研究背景 隨著公共衛生的發展使得人口的平均餘命增加，台灣老年人口的比例逐年增加，這群老年族群大多身體機能退化，吸收代謝的功能變差，用藥可能造成的不良反應以及藥物交互作用，更容易在這群人發生，且這群人大多罹患多重慢性疾病，同時會接受多個專科醫師的照護，台灣全民健保在民國84年開始施行，民眾的就醫可近性以及可負擔性大大提升，民眾對於本身罹患的疾病常常會為了尋求第二專業意見，多次重複就醫的情況時有所聞，此外為了治療相關的疾病，同時可能會併服多種藥物，在使用多重藥物的情況下，更容易遭遇到用藥相關的問題，例如重複用藥或是使用潛在不適當用藥。 研究目的 希望瞭解照護連續性，與不適當用藥可能的相關性。進而建議在台灣家醫制度並沒有完全落實的現況下，是否應該進一步加強建構整合全人的醫療服務，以提供老年族群安全用藥的醫療照護，進而提升整體的照護品質。 研究方法 本研究為一橫斷性研究，使用｢全民健康保險研究資料庫｣，2005年之百萬歸人檔，另外建構出每個藥品對應之ATC碼，針對研究的當年度為65歲以上的老年人為研究對象，以Beers criteria以及重複用藥作為使用藥品適當性的評估，分析照護連續性與有無使用Beers criteria表列之潛在不適當用藥以及重複用藥的相關性，照護連續性所用的指標為Continuity of Care Index(COCI)以及Usual Provider of Care(UPC)，使用羅吉斯回歸的方式進行多變項分析。 研究結果 使用UPC測量照護連續性較佳的個案相較於照護連續性較差的個案，他們有較低的危險使用潛在不適當用藥以及重複用藥，OR值分別為0.51以及0.29，統計檢定達到顯著差異（p<0.001）；而使用COCI測量照護連續性較佳的個案相較於照護連續性較差的個案，有較低的危險使用潛在不適當用藥以及重複用藥OR分別為0.55以及0.29，統計檢定亦有達到顯著差異（p<0.001）。 結論 這群老年病患假如有較佳的照護連續性，可以降低Beers criteria表列之潛在不適當用藥以及重複用藥的使用，減少暴露在相關的用藥危險當中。

Background The Taiwan Department of Household Registration Affairs reported aging ( > 65 year-old) population significantly increased during the past decade. Key characteristics of this population are having multiple medical conditions. They consume significant proportion of medical resources in Taiwan which is around 30% of total national health insurance expenditure. Under this atmosphere, the risk of potential inappropriate medication utilization can be increased when shifting the physicians or the health care resources overuse under this open access system. Objective This primary objective of this study is to understand the relationship between continuity of care and potential inappropriate medication utilization under this national health insurance system. Method This database contains all of the original claim data of one million beneficiaries, who are randomly enrolled from the total registry beneficiaries in year 2005. We choose two indices to measure the continuity of care among elderly patient included in this study. First, this study applied usual provider of care (UPC) index and the second is Continuity of Care Index(COCI). Result The results revealed that patients with high COCI score were less likely to receive a potential inappropriate medications (odd rations [OR] 0.55, 95% confidence interval [CI] 0.53-0.57) or duplicated medication (OR=0.33, 95% CI 0.31-0.35) compared with patients in the low COC group. The similar findings can be noted when we adapted UPC as the indicator of continuity of care. Patients with high UPC score were less likely to receive a potential inappropriate medications (odd rations [OR] 0.51, 95% confidence interval [CI] 0.48-0.53) or duplicated medication (OR=0.29, 95% CI 0.28-0.30) compared with patients in the low UPC group. Conclusion Better continuity of care among this geriatrics population can improve the utilization of potential inappropriate medication and duplicated medications. Improvement of continuity of care is crucial to avoid relevant complications due to medication not be used properly.