臺灣地區上呼吸道感染門診病患之抗生素使用分析

Antibiotic Usage of Outpatients With Upper Respiratory Tract infection in Taiwan

目的：中央健康保險局於2001年2月1日起增訂「上呼吸道感染病患」，如屬一般感冒或病毒性患者不應使用抗生素。本研究在探討此政策實施多年後台灣地區上呼吸道感染門診病患抗生素的使用情形。方法：研究樣本來自全民健康保險資料庫之承保抽樣歸人檔（LHID2000，20萬人），針對2007年11至12月間所申報之上呼吸道感染門診病患就診84,396人次，進行分析上呼吸道感染處方抗生素之相關因子。結果：上呼吸道感染門診病患平均抗生素處方率有15.3%，抗生素處方率最多的變項分別是：台北分局，區域醫院，耳鼻喉科及18~40歲的病患。抗生素用藥金額佔上呼吸道感染門診口服藥物總金額之5.8%，平均每張處方的抗生素藥費較高的變項分別是：東區分局，醫學中心，小兒科及大於65歲的病患。而抗生素使用類別中以penicillins類最多，其次為cephalosporins類。結論：台灣地區上呼吸道感染門診病患抗生素處方率相較於其他感染仍偏高，應進一步監測抗生素的用藥情形，以改善處方的醫療品質。

Objectives: The Bureau of National Health Insurance (NHI) issued a new policy in Feb. 1st, 2001 to restrict antibiotic using in URI. The purpose of this study was to understand the antibiotic usage for outpatients with URI in Taiwan. Method: We analyzed data from November to December 2007 of National Health Insurance Research Database (LHID2000, 200,000 subjects). The total services of 84,396 in URI outpatients were identified to understand the associate factors of the antibiotic prescription. Result: The average rate of prescription of antibiotics for outpatients with URI was 15.3%. The antibiotic prescription rate was higher in the Taipei branch of NHI, in the regional hospital, in otolaryngology clinic and in the patient aged from 18 to 40 years old. Moreover, the cost of prescribing antibiotics consisted 5.8% of all cost of oral medicaments of outpatients with URI. The average cost of prescribing antibiotics was higher in the Eastern branch, in the medical center, in the pediatrics and in the elderly people aged above 65 years old. The largest consumptions among antibiotics were Penicillins, followed by cephalosporins. Conclusion: The rates of prescriptions of antibiotics were higher in outpatients with URI than in other infectious outpatients in Taiwan. We suggested to further monitor the antibiotics usage and to improve the quality of medication.