The analysis of D.M. prescribing pattern and inappropriate prescriptions in the different dispensing sites for the NHI contracted clinics

• Main Authors: Te-An Chang, 張德安
• Other Authors: 黃光華
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/07229276017711906325

碩士 === 中國醫藥大學 === 醫務管理學研究所 === 96 === Objective: In this study, prescription patterns and inappropriate prescriptions in treating diabetes mellitus (D.M.) under primary care setting at different dispensing types were investigated. Method: Secondary data analysis was applied in D.M. cases with the first three digits of ICD code 260 within years 2002-2005. The data were extracted from the database of National Health Research Institutes. The medications might be dispensed in three different types of pharmacies including medication dispensing divisions in clinics, gateway pharmacy, National Health Insurance (NHI) contracted pharmacy. Medication prescription patterns were characterized by four features including frequency, expense, administration duration and medication items. The administrated medications for treating D.M. are classified into five categories based on the anatomical therapeutic chemical (ATC) classification system. Inappropriate prescriptions refer to those with problems of over-dosage, duplicated medication, and drug-drug interaction. Result: The whole number of administrated medications is 58,705, including 25,040 with D.M. medications. The mean number of medications per prescription is 3.84 items; in which 1.64 are directly used for treating D.M.. Additionally, the averaged expense and duration of administration are NT$944.3 and 25.8 days, respectively, which demonstrates significant differences among different prescription types. The highest frequencies of D.M. medications used in different prescription types is Insulin Secretagogues. For inappropriate prescriptions, the frequencies of over-dosage, duplicated medication, drug-drug interaction, and whole inappropriate prescriptions are 4.2%, 2.7%, 19.4%, and 25.7%, respectively. But no significant differences were found in inappropriate prescription with regards to different prescribed types. Using Logistic Regression to control other variables, significant differences were found in inappropriate prescription with the characteristics of seeking medical consultations such as type of specify degree of urbanization, and the complication of patients. Conclusion: For different prescription types, significant difference was found in medication type, but not in inappropriate prescription for D.M. treatment. However, the percentage of inappropriate prescription for medication dispensing divisions in clinics is higher than gateway pharmacy and NHI contracted pharmacy.