| Summary: | 碩士 === 國立陽明大學 === 藥理學研究所 === 98 === Peptic ulcer diseases (PUD) are the most common gastrointestinal (GI) diseases. The prevalence of chronic peptic ulcer was about 10% in the total population. Bureau of National Health Insurance (NHI) work out strict reimbursement guidelines due to anti-ulcer drugs are expensive. An NHI policy has changed for the prescription of anti-ulcer drug since October 1, 2003, in which an upper GI endoscopy must be done prior to prescribing anti-ulcer drugs with prices is above 4 NT dollars. The presented study used NHI outpatient claims database and examined the influences of this changing policy on prescription patterns with related problems of GI drugs in peptic ulcer diseases between January 2002 and December 2005. This study analyzed the level of hospital, registered divisions, and indications from these prescription items. Result: (1) The upper gastrointestinal endoscopy exams performed within in the PU drug prescriptions had increased 17% and the volume of H2RA which price is above 4 NT dollars group increased 8%. (2) Prescriptions containing anti-ulcer drugs with prices under 4 NT dollars were increased in district hospitals (43%) in 2004. Most the H2RA prescriptions (above 90%) were prescribed in physician clinics and dental clinics. (3) Defined daily doses were increased 54-60% in non-gastrointestinal clinics than in gastrointestinal clinics. DDDs of gastrointestinal and non-gastrointestinal clinics increased 66% and 15% from 2003 to 2004. (4) In the non-gastrointestinal clinics, most prescriptions contributive to DDDs were registered to rea-nose-throat clinics, and the increasing ratio of DDDs was contributed by chest medicine clinics. The amount of an anti-ulcer drug prescribed with indications increased 14.8% in 2004, and DDDs increased 32% in the lower price group (under NT 4 dollars). DDDs increased 13% in the off-label-use group, and 10% in the lower price group (under NT 4 dollars). (5) The more DDDs increased in regional hospitals the higher prevalence of potential drug-drug interactions (DDI) occurred with. Generally no matter drugs prescribed with indications or non-indications, DDDs increased due to the increasing DDDs in regional hospitals accompanied with higher prevalence of potential drug-drug interactions, health care authorities should clearly define the health insurance reimbursement guidelines for anti-ulcer drugs for off-label use. Health care authorities should also provide other H2RA (under 4 NT dollars) to avoid severe DDIs such as cimetidine, and promote to development of DDI-Intercept system for medication safety.
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