| Summary: | 碩士 === 長庚大學 === 醫務管理學研究所 === 94 === Abstract
The purpose of using drugs is to get patients receiving effective treatments. Pharmaceutical therapies are one of the most cost-effective and least invasive interventions among various medical treatments. However, with its potential adverse drug reactions (ADR), drugs could cause harm, death, degradation in quality of life, which increase medical consumptions and detriment to quality of medical care.
According to medical literatures, there are many factors related to ADRs including gender, age, comorbidity, clinical department, item of drugs prescribed, alcoholism, and body weight. The issue of how to avoid occurrence of ADR while considering those mentioned risk factors as intervention tools is everybody’s concern.
The study analyzed data from in-patient medical charts integrating on-line report system for ADR and ICD-9-CM E-codes 930-949 as cases of ADR in this thesis. The setting was a medical center in northern Taiwan. The adoption of multi-variable regression model was to investigate medical consumptions caused by ADRs.
The results have demonstrated that overall incidence of ADRs in this hospital was 1.28%. The leading cause of drugs according to therapeutic class were 1) antineoplastics and immunomodulating agents (29.56%); 2) antiinfectives for systemic use (19.18%); 3) nervous system (14.04%); and 4) cardiovascular system (10.82%). The most frequently found ADRs by organ systems were 1) digestive system (21.45%); 2) skin and appendages (19.03%); 3) nervous system (14.18%); 4) whole body (13.02%); and 5) hematic and lymphatic system (12.49%). Females were prone to have ADRs compared to males, with odds ratio= 1.25 and 95% confidence interval= 1.13-1.39. Patients with ischemic heart diseases (OR= 1.90; CI= 1.40-2.60), cerebrovascular diseases (OR= 1.56; CI= 1.20-2.02) and diabetes (OR= 1.34; CI= 1.11-1.63) were likely to have ADRs as well. Comparing to gynecology department, patients in some departments are in good chance of occurring ADRs, such as hematology and oncology department (OR= 63.42; CI= 40.11-100.27), infectious department (OR= 38.07; CI= 23.75-61.02), renal department (OR= 34.66; CI= 21.57-55.71), neurological department (OR= 33.07; CI= 20.44-53.48), and immunologic department (OR= 31.16; CI= 17.62-55.11). The medical expenses acquired from treating ADRs were NT$ 43,816~59,355 on average for each ADR hospitalization incidence, and the length of stay was 9.39~10.30 days. An average of NT$ 19,629 and excess length of stay of 4.39 days for each ADR case occurring during hospitalization were observed, which come up to a total cost of NT$ 89.65~98.20 millions (or 0.47~0.52% of the overall cost of hospitalization) per year. The study has also calculated the total length of stay and percent of hospital bed occupancy coming about 8,965~9,820 days per year and 0.77~0.84% of the year, respectively.
A special caution of medical procedure is warranted for high risk groups in ADRs. The study has suggested that information systems and practice guidelines for preventing ADRs from occurring are to be adopted in the future. Meanwhile, hospital administrators should propose a way to identify highly risk groups with portable indicators to ensure quality of medical care, hence reducing the total medical consumptions.
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