Impact of Implementing“Prescription monitoring program”on Specific Hypnotics: an Example of Public Hospital in Central Taiwan

• Main Authors: WANG, I-SHIANG, 王奕翔
• Other Authors: HO, CHIN-CHIH
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/kb7j4s

碩士 === 中臺科技大學 === 醫療暨健康產業管理系碩士班 === 106 === Background The abuse of hypnotics in our country is serious. National Health Insurance Administration, therefore, sets up the “Prescription monitoring program ”for those who use higher dosage of controlled drugs in order to cut down repeated prescription drugs or higher dosage of hypnotics so that patients can improve their quality of medical care and safety of medication use. Method The study uses retrospective study of medical record, selecting subjects from a public hospital in central Taiwan between 20~99 years old, from August 1st, 2014 to July 31st, 2016. Data collected included Flunitrazepam、Zolpidem、Midazolam、Estazolam and Zopiclone, total 5 kinds of hypnotics. There are about 14628 prescriptions in total. Descriptive analysis includes the number of prescriptions for individual drugs, total number changes of drugs, trends of the average daily dosage changes, and the patients' characteristics of taking those prescriptions. Inferential analysis uses simple linear regression to assess the fluctuation of the proportion of high-dose hypnotics "before" and "after" the implementation of the policy. Result This study indicates that under the supervision of “Prescription monitoring program ”,the amount of prescription of Flunitrazepam and Zolpidem, two important queried drugs, decreases, but amount of other hypnotics increases. Overall speaking, the amount of prescription of all hypnotics obviously decreases; however, the high-dose prescription of Flunitrazepam and Zolpidem is still worsening. The proportion of patients whose main diagnosis is substance dependence or abuse increases after intervention. Conclusion and Recommendation Implementing the policy of “Prescription monitoring program” can reduce the amount of prescription in Flunitrazepam and Zoplidem at the cost of increase the amount of prescription in other hypnotics. The total amount of all hypnotics is reduced. Moreover, for the patients who need the high-dose prescription, this policy cannot help them to reduce it effectively. Patients with substance dependence or abuse cannot be easily changed their habit of hypnotics. So if patients are on the list of "Prescription monitoring program”, this study suggests that they should be transferred to psychiatrists for evaluation and management and no being prescribed chronic continuous prescription. Also they should be limited in specific health facilities where sleep hygiene or cognitive behavioral therapy or addiction therapy can be provided. Keywords: Prescription monitoring program, high care list, hypnotics