資訊科技應用於改善多重慢性病人門診重複處方之分析

Implementing health information technology in an outpatient setting to reduce duplicate prescriptions among patients with multiple chronic diseases

目標：探討醫療資訊科技運用於門診藥事照護對門診多重慢性病人重複處方的影響。方法：南部某一醫學中心門診，於2012年10月至2013年6月期間，凡持1張以上慢性病連續處方箋之成年病人皆納入分析。門診藥事服務—科技化照護模式包括：（1）利用SAS軟體進行門診用藥重複處方篩選；（2）藥師審核重複處方、確立修改必要性、建立並預存電子建議提示；（3）電子提示融入電子醫囑輸入系統，在患者回診接受診療時，醫師將接到重新評估用藥或／與修改提示。病人與重複處方特性以描述性統計進行分析。結果：研究期間藥師共建議572筆處方（483人），重複處方常見於65歲以上（59％）、就診至少3個專科（80％）且用藥品項數大於10筆者（53％）。從完成處方修改的病人與處方分析發現（284人）：（1）高修改率藥品（大於80％）為用於心血管、新陳代謝和抗帕金森症的藥品；（2）相對於處方修改前6個月，修改後6個月的每月平均藥品費用減少47,325元；門、急、住診就診人次也分別相對下降5.7％、18.3％與13.8％。結論：門診藥事科技照護模式值得擴大規模執行以驗證其對減少重複處方發生率與醫療資源浪費的效果。

Objectives: To determine the effect of implementing health information technology in an outpatient setting on reduction of duplicate prescriptions among patients with multiple chronic diseases. Methods: Adult patients with at least 2 refillable prescriptions for multiple chronic diseases at a medical center in southern Taiwan between 1 October 2012 and 30 June 2013 were enrolled in the current study. The key design principles in the ambulatory pharmaceutical care model included (1) using the SAS Enterprise Guide to systematically screen potential duplicate prescription orders using pre-specified criteria, (2) hospital pharmacists performed medication reviews and provided electronic alerts for duplicate medications to physicians, and (3) medical alerts and recommendations were integrated into the natural workflow of practice to correct duplicate medications. Patient characteristics and patterns of duplicate medications were assessed using descriptive statistical analyses. Results: Of 572 notifications (n=483), the most common duplicate prescriptions occurred in patients > 65 years of age, had > 3 outpatient specialist visits, and were treated with > 10 medications. The correction rate for duplicate prescriptions was high for cardiovascular diseases, endocrinopathies, and Parkinson disease. Among patients who had corrected duplicate medications (n=283), the average monthly medication cost decreased 47,325 TWD during the most recent 6 months when compared to the 6 months preceding the correction. Furthermore, the outpatient clinic, emergency room, and hospitalization person-visits decreased 5.8%, 18.3%, and 13.8%, respectively. Conclusions: Implementation of advancing health information technology in the outpatient setting for a group of patients with multiple chronic diseases revealed a high propensity to successfully reduce duplicate medications in a large population.