健保申料探 中耳炎抗生素程之合理性
一1 文2,* 菱3 游素香3 欣蓉3 蕙玲3 3 3 李惠珠3
I-Ming Parng1, Weng F. Huang2,*, Hsiao-Ling Hsieh3, Su-Hsiang Yu3 Hsin-Jung Wu3, Huei-Ling Chen3, Chin-Lan Chung3, Kuei-Lan Ma3, Hui-Chu Lee3
1 中央健康保局
Bureau of National Health Insurance, Department of Health, Executive Yuan, Taiwan.
2 立明大院生福利研究所，台北市立街二段155
Institute of Health and Welfare Policy, College of Medicine, National Yang Ming University, No.155, Li-Long St, Sec. 2, Taipei, Taiwan.
3 中央健康保局台北分局
Taipei Branch, Bureau of National Health Insurance, Department of Health, Executive Yuan, Taiwan.
＊通作者Correspondence author. E-mail: huang@ym.edu.tw
目：解健保特申料，在中耳炎使用抗生素的程是否合理，分析可能影用品的指值。方法：民九十年五月至十月之中央健康保局台北分局申料，ICD-9-CM代3810、3814、3820、3824、3829等五之中耳炎案件共119,773件，以分析SPSS及SAS等，行中耳炎病患的整描述性及程分析。果：中耳炎案件以“3829未明示之中耳炎”申最多，病患年以5以下最多，主要看科耳鼻喉科及小科，近七成的中耳炎病患在基所就。物程後，中心之每程平均日份10.73天符合中耳炎程10-14天用，程平均日份差在各有著差。符合合理中耳炎程日份之案件比率，中心15.86%最高、基3.04%最低。院所中耳炎程平均日份不到二成符合床；程合理案件中耳炎案件之比率亦有22.18%；小科和耳鼻喉科的程日份合理之件比率高。在院以耳鼻喉科的合理比率最高；在基小科合理比率最高。：本研究所探的合理中耳炎程，符合研究所界定的二成左右。如院所分析料，可加院自我管理，到合理用之目。(台2004；23(2)：141-149)
：中耳炎、抗生素、合理程
Analyses of antibiotic treatment duration
on otitis media using NHI claims Objectives: This study analyzes the rational duration of antibiotic treatment on otitis media among NHI contract institutions. It explores potential indicators that may affect rational drug therapy in order to improve the quality of drug treatment. Method: The material for this study was based on the claimed data files dating May 1st ~October 31st, 2001 from the Northern Branch Office of NHI Bureau. A total of 119,773 cases diagnosed with otitis media by ICD-9-CM codes 3810, 3814, 3820, 3824 and 3829 were screened for analysis using software programs of SPSS and SAS. Descriptive and analytical analyses were performed for selected otitis cases. Results: The number of otitis media by ICD-9-CM 3829 nclassified otitis?ranked the highest among five ICD-9-CM codes. The patient group ?5 years old was the largest group, and ENT and the pedestrian departments were the two most utilized specialties. There were nearly 70 % of otitis patients choosing primary clinics. After the data files were classified by individual ID number, only medical centers with an average drug regiment of 10.73 days met the rational therapy criterion. There were significant differences among different levels of institution in terms of the average number of drug regimen days. The medical centers had the highest percentage (15.86%) meeting the rational antibiotic therapy criterion, the primary clinics the lowest (3.04%). There were less than 20% of institutions meeting rational antibiotic therapy criterion. The figure for physicians was 22.18%, while a higher percentage of rational antibiotic therapy was found in pedestrian and ENT departments. The ENT department ranked as the highest percentage for rational antibiotic therapy in the hospital segment, and pedestrian department the highest of the primary clinics. Conclusion: There were only around 20% of cases receiving rational antibiotic therapy regardless of the type of institution, physician, or clinical department. The results may be compared to the profile of an individual institution for better drug therapy management. (Taiwan J Public Health. 2004;23(2):141-149)
Key Words: Otitis media, antibiotic treatment, rational therapy
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