The impact of Antibiotic combination forms on uncomplicated acute pyelonephritis utilization and quality

• Main Authors: Jao-Hsien Wang, 王堯顯
• Other Authors: Herng-Chia Chiu
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/04767410347206797724

碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 97 === Purpose of the Study: To investigate uncomplicated acute pyelonephritis, its diagnosis by different specialist, the characteristics of patients, the types and forms of antibiotic use, in order to determine the factors that influence the utilization and distribution of medical resources. Method of Study: The study was based on the country’s National Health Research Institutes result on National Health Insurance Research Database. We analyzed the database of patients admitted for acute pyelonephritis from January 2004 to December 2006, with DRG code「321」: 「Kidney and Urinary Tract Infections, Age ≧ 18, without complications」, primary diagnosis (ICD-9 code) 「590.10」as well as female patients who were admitted and have received antibiotics treatment as targets of this study. Method of analysis: Chi-square test, analysis of variance (ANOVA), univariate and multivariate analyses, analysis of regression, logarithmic regression to analyze specific influences on the cause. Result of Study: 3 consecutive years of study based on diagnosis by different specialist, patients’ characteristics, types and forms of antibiotic use, the utilization of medical resources have resulted in no significant difference. Based on the type of hospital, the antibiotics expenses, total medical expenses, number of days of hospitalization, there was a significant difference between medical centers and regional and district hospitals (p<0.001); based on specialty diagnosis, there was a significant difference between infectious disease specialist compared to other specialty p(<0.05); based on patients’ characteristics, the age group >65 has a significant difference compared to age group 41-64 and 18-40 (p<0.05); those with diabetes mellitus showed more significant difference compared to those without (p<0.05). The most common combination of antibiotic use was cephalosporins and aminoglycosides (61.7%). The second most common is a single antibiotic use of cephalosporins (14.1%). The most expensive antibiotic is a single fluoroquinolones. Among the combination of antibiotics, the combined use of cephalosporins and aminoglycosides compared to single fluoroquinolones showed only a difference of 0.558 days (p<0.05). After multivariate analysis, we obtained 3 groups of regression where the square of R is 0.434、0.698 and0.134. Conclusions and Recommendations: Based on the utilization of medical resources, the medical centers clearly used up more compared with regional and district hospitals. Based on diagnosis by specialty, infectious disease specialist diagnosed more compared to other types of specialty. But with the same diagnosis using DRG code「321」, there was clearly a big influence among physicians in medical centers (p<0.001) and prescriptions by infectious disease specialist (p<0.001). Among patients’characteristics, the older age group (p<0.001) and those with diabetes mellitus (p<0.001) consumed more of the medical resources; there was also a big difference in the expenses incurred by any combination of antibiotics (p<0.001), but there was no difference in the number of days of hospitalization. Recommendations: the result of this study can be clinically used as reference by different levels of hospitals; this can also be used as an evidenced-based study to assess antibiotic use among physicians and a guide among different clinical specialists and medical associations and further study for future learning. As a basis for making policy in DRG payment of the department of health as a result of the study of patients’ use of medical resources and its cost.