門診非成癮性止痛藥之處方型態

The Prescription Patterns of Non-narcotic Analgesics in Outpatient Clinics

非成癮性止痛藥在世界上是廣泛被使用的藥品，但這類藥品在台灣的使用情形卻尚未能深入瞭解。本研究之目的在於分析台灣使用非成癮性止痛藥的處方型態。研究屬於回溯性的設計，研究樣本來自國家衛生研究院所提供之1997年健保門診申報資料抽樣檔，抽樣檔樣本數佔母群體的0.2%。抽樣檔中共篩選出134,726張非成癮性止痛藥品處方，我們再進一步分析不同醫院及病人特質之間這類藥品的使用情形。研究之主要結果如下：抽樣檔中含有非成癮性止痛藥品的處方佔所有處方的39.2%，而抽樣檔中含有非類固醇性抗發炎藥品的處方則佔所有處方的26.4%。非成癮性止痛藥使用量最大的變項分別是：不分科，上呼吸道疾病，基層醫療單位及私立診所。非成癮性止痛藥品使用最多的成份為acetaminophen。平均每張處方的非成癮性止痛藥費較高的變項是大於60歲組、骨科、骨骼肌肉系統及結締組織疾病、以及醫學中心。與非成癮性止痛藥合併使用最多的藥品是「制酸劑、治療消化道潰瘍及治發脹劑」。根據研究結果，建議未來研究者深入分析這類藥品處方所造成的副作用，以及這些副作用所造成的影響有多少。並建議有關當局應對這類處方建立藥品使用評估制度，以改善處方的醫療品質，而且也能保障病人的健康權益。

Non-narcotic analgesics are among the most widely used medicines, but their utilization has not been extensively explored in Taiwan. The objective of our study is to analyze the prescription patterns of non-narcotic analgesics in Taiwan. This study was retrospective and based on the claimed reimbursement sampling database of the ambulatory care of National Health Insurance Bureau (NHI) in 1997 from the National Health Research Institutes (NHRI). The prescriptions represent 0.2% of the national prescription survey. A total of 134,726 prescriptions with non-narcotic analgesics were available for analysis. We analyzed the prescription patterns of non-narcotic analgesics among different patient groups and hospitals. About 39.2% of total prescriptions include non-narcotic analgesics, and 26.4% of the total prescriptions were written with non-steroidal anti-inflammatory drugs. The most frequently prescribed non-narcotic analgesics were found in general practice department, diseases of the upper respiratory tract, primary care settings, and private clinics. Acetaminophen is the most often prescribed non-narcotic analgesic. The highest average drug fee of non-narcotic analgesic prescriptions claimed were found in the age group of 60 years old above, the orthopedic department, diseases of the musculoskeletal system and connective tissue, and medical centers. The drug category 'antacids, drugs for treatment of peptic ulcer and flatulence' was the most commonly prescribed category with non-narcotic analgesics. According to the findings, we suggest that researchers should endeavor to analyze the adverse effects caused by non-narcotic prescription, and the impact of their respective adverse effects. The authorities concerned should also establish an effective drug utilization review system to improve the quality of prescription, and then it will also be able to assure better quality of care to the patients.