| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所 === 96 === Abstract
Background
The chronic kidney disease is a world-wild public health problem. It is also related to complex co-morbidities. No matter what are the causes of disease, partial of the patients will progress to the End-Stage Renal Disease in the end. The ESRD incidence and prevalence increases continually and it also becomes a global common tendency. The ESRD incidence in Taiwan is the highest of the world. The prevalence, which is inferior to Japan, takes second place in the world. Futhermore, the prevalence and incidence of the middle and old-aged population, people who is older than 45 years old, is the highest of the world. It can tell how the kidney disease prevails in Taiwan apprently.
CKD patients can improve the kidney functions through controlling the hypertension earlier, taking the Angiotensin-Converting Enzyme Inhibitors (ACEI) or Angiotensin II Receptor Blockers (ARB), and controlling the blood sugar and the limit protein. The antihypertensive drugs are the most important one since controlling hypertension can help reducing the cardiovascular complications. The goal of this study is proved through calculating the pharmaceutical expenditure of the CKD patients and analyzing the tendency of drug utilization. Hope the information and results can be a reference resource for health policies making department and also can help reducing the medical resources utilization.
Method and Materials
This study applies the Retrospective cross-sectional study to look into the influenced factors (age, sex, co-morbidity) in drugs expense, and also applies the Anatomical Therapeutic Chemical Classification system to analyze the tendency of drugs utilization of the sample, which are patients who defined by NHI Research Database from 2000/1/1 to 2004/12/31 in the CKD group. Moreover, it will discuss the fluctuation of drugs utilization and expense by hospital level.
Results
The average cost of CKD outpatient and drugs a year per patient from 2000 to 2004 is increasing apparently. Furthermore, the CKD patient will have distinct outpatient and drugs expense from different age or sex combining with different disease, such as diabetes, congestive heart failure, and hypertension. In addition, age, sex and co-mboridity are the most noticeable factors in forecasting the cost. The frequency of medicine utilization in alimentary tract and metabolism, respiratory system and cardiovascular system took the first three places in 2000. The cost of cardiovascular system drugs has been increased remarkably in the term of 2000-2004.
The ARB utilized frequency is rising year by year; however, ACEI has been decreasing recently. There is significant difference between different levels of health care organizations. Moreover, ARB has kept replacing ACEI. The higher the hospital level is, the faster the replacing speed. By using the multinomial logistic regression, it also shows that CKD patients, who are elder or have diabetes, hypertension or congested heart failure, have more ACEI and ARB usage opportunities.
Conclusion
The frequency of CKD patient in ACEI, ARB usage has been higher year by year. Nevertheless, the investigation shows that medical centers have the highest prescription frequency. In order to increase the knowledge in the effects and the directions of drug usage, physicians should take education training continuously in the future. The cost of drugs has risen year by year during these five years. The health policy department could control the drugs charges by focusing on controlling those high price or high usage of drugs.
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