執行「保險對象特定醫療資訊查詢」對於安眠藥物開立的影響──以台灣中部某公立綜合醫院為例

Influences of ''Specific Medical Information Query of the Insured'' on the Prescription of Hypnotics: Taking a Public General Hospital in Central Taiwan as an Example

臺灣中央健康保險署針對管制藥品用藥偏高病 人列為必須執行「保險對象特定醫療資訊查詢」， 希望藉此降低重複用藥或使用劑量過高等情形。本 研究即在探討執行「保險對象特定醫療資訊查詢」 前、後，安眠藥的處方箋及偏高劑量的開立量是否 降低。 本研究採取病歷回溯性研究，研究對象選 定中部某地區綜合醫院年齡大於20歲之精神科 門診病患，於2014年8月1日至2016年7月31日 取得Flunitrazepam、Zolpidem、Midazolam、 Estazolam、Zopiclone共五種安眠藥管制藥品的處方 箋，共有14,628張。以描述性統計、卡分檢定、簡 單線性迴歸進行統計分析。Flunitrazepam與Zolpidem開立量下降，但其他安眠 藥品開立量上升，安眠藥品總開立量下降。Zolpidem 與Flunitrazepam相比，下降比例更高。Flunitrazepam與 Zolpidem的平均每日處方劑量仍有上升趨勢。 執行「保險對象特定醫療資訊查詢」後對於 Flunitrazepam、Zolpidem的管控有部分幫助。（澄清 醫護管理雜誌 2020；16（4）：11-19）

Purposes Taiwan's National Health Insurance Administration has listed patients with highdose use of controlled medication as requiring ''Specific Medical Information Query of the Insured,'' in the hopes of reducing repeated medication or excessive dosage. This study aims to explore whether the number of prescriptions and high prescribed doses of hypnotics have been reduced following the implementation of ''Specific Medical Information Query of the Insured.'' Methods A retrospective study of medical records was conducted on psychiatric outpatients aged over 20 years from a regional general hospital in central Taiwan. From August 1, 2014 to July 31, 2016, we obtained a total of 14,628 prescriptions for five hypnotics, namely flunitrazepam, zolpidem, midazolam, estazolam, and zopiclone. Descriptive statistics, chi-square test, and simple linear regression were used for statistical analysis. Results The numbers of prescriptions for flunitrazepam and zolpidem had decreased, but the numbers of prescriptions for other hypnotics had increased, and the total number of prescriptions for hypnotics had decreased. Compared with flunitrazepam, zolpidem showed a higher decline rate. The average daily prescribed doses of flunitrazepam and zolpidem continued to show a rising trend. Conclusions The implementation of ''Specific Medical Information Query of the Insured'' was conducive to the control of flunitrazepam and zolpidem usage to some extent. (Cheng Ching Medical Journal 2020; 16(4): 11-19)