电子处方警示系统减少门诊重复用药:以台湾289家医院为例

Effect of medication alert systems on reducing the outpatient duplicated prescriptions:An empirical analysis of 289 hospitals of Taiwan

目的:探讨台湾医院门诊应用电子处方警示系统的效果。方法:采集1998-2009年的医保数据库,纳入各年均有数据库数据的259家医院进行分析。根据台湾医院应用门诊电子处方警示系统的发展,12年分为4个阶段:1998—2000年(T1)、2001-2003年(T2)、2004—2006年(T3)、2007—2009年(T4)。重复用药率是计算每个时间段医院门诊重复用药处方数占全部处方数的比例。应用广义估计方程(Generalized Estimating Equation,GEE)分析4个阶段的重复用药率改变。结果 :T1总体门诊重复用药率11.7%,T2减少到10.4%,但T2-T4维持在10. 5%上下。GEE分析发现重复用药率如期呈现下降,但降幅逐渐减小(T2:b=-2.44; T3:b-3.20;T4:b=-3.30;P<0.001)。结论:医院门诊重复用药率随电子处方警示系统应用趋势呈现递减后维持平稳,表示系统虽然有效,但仍有需要持续改善之处。

Objective: The goal of this study is to evaluate the effect of medication alert systems (MAS) in outpatient service of hospitals in Taiwan. Methods: This paper collects the Taiwan-NHI data from 1998 to 2009 and selects 259 hospitals with data in each year for analysis. Based on the adoption trend of medication alert systems in Taiwan, the 12-year period is divided into four phases: 1998-2000 (T1), 2001-2003 (T2), 2004-2006 (T3), 2007-2009 (T4). The recurrence rate of duplicated prescriptions is the ratio of the average proportion of prescriptions with duplicated prescriptions over the total number of prescriptions of outpatients per period. The changes in duplicated prescriptions rate in the four phases are analyzed using the generalized estimating equation (GEE). The control variables included the hospital s characteristics and hospitals ranking for the average number of drugs which are prescribed to outpatients per period. Results: The rate of duplicated prescriptions in T2 is 1.3% less than 11.7% in T1, but is maintained around 10.5% from T2 to T4. After other factors are adjusted using the GEE, the rate of duplicated prescriptions gradually decreases as expected along with the time (T2: b=-2.44;T3: b=3.20;T4: b=-3.30;P <0.001). Conclusions: The rate of duplicated prescriptions has decreased with the application trend of electronic alert systems in hospitals outpatient services in Taiwan. The results may provide implications for both health insurance institutions and hospitals to consider the application of medication alert systems to minimize the inappropriate use of outpatient medication.