| Summary: | 碩士 === 國立陽明大學 === 衛生福利研究所 === 92 === Abstract
The National Health Insurance Bureau (NHIB) encourages physicians to issue prescription refills for patients with stable chronic diseases. The payment policies of NHI have directly or indirectly affected the utilization of prescription refills. The objectives of this study were to explore the use of outpatient hypertension prescription refills and its impact on related medical utilization.
Secondary data analysis was conducted based on NHI Research Database (NHIRD) provided by National Health Research Institute (NHRI). We selected patients diagnosed with hypertensions in 2001 and have previously received antihypertensive medication in 2000. After excluding inpatients, a total of 8,251 patients were included for this study. There were 1,004 patients who used prescription refills, while 7,247 patients didn’t use prescription refills.
The proportion of the study subjects using prescription refills is 12.17% with an average of 4.54 prescription dispensing per person. Nearly all patients, except 16 patients (1.59%), have their prescription refilled in hospitals. Comparing the medication days, 42.02% of refill use group has medication days between 301~365 days while 24.95% of refill no-users has such medication days. Only 0.30% of refill use group received medication less than 60 days when compared to the group that didn’t use refills (19.82%), On the contrary, the patients who used refills used over 366 days of prescription were 19.52% in comparison to 8.93% of the refill non-user group.
Results of the multiple regression indicates that the patients who used refills have 2.6 medical visits less than their counterparts, but have 72 days more of medication. Regarding the medical expenditure, the patients who used refills have physician fees NT$522 and co-payment NT$842 less per person than their comparing group. But the patients using refill services resulted in an increment of pharmaceutical service fees NT$125 and drug fees NT$2,087 per person. Overall, the patients who use refills have NT$1,461 more medical expenses than their comparing group.
Our recommendations include responsible government authorities to collaterally use NHI IC card monitoring the repeated prescriptions, and to explore the opportunities of professional pharmacy services to provide follow-up services for better patient care. The establishment of guidelines regarding prescription refills for different diseases, and to encourage physicians-patients dialogue about prescription refills are also suggested.
Keywords: prescription refills, hypertension, medical utilization
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