驗證台灣醫院門診病人三高（抗血壓、抗血脂、抗血糖）重複處方間的關聯

Validation of the Relationship Between Medication Duplication for Hypertension, Hyperlipidemia, and Diabetes for Outpatients in Taiwan Hospitals

利用健康保險資料開放服務平台的台灣醫院三高（抗血壓、抗血脂、抗血糖）2023年4季病人用藥重複（天數）率的資料，驗證其假設：在各層級醫院、醫學中心、區域醫院、和地區醫院間具獨立性（即沒有關聯）。資料完整醫院共計421家，其中醫學中心19家、區域醫院86家、和地區醫院316家，納入R語言的驗證性因素分析。結果顯示：（1）全體三層級醫院的三高資料（即血壓/血脂、血壓/血糖、血脂/血糖）間皆具關聯（P<.05），其中於血壓/血脂間呈負向關聯；（2）醫學中心的血脂/血糖間具關聯（P<.05）；（3）區域醫院的血壓/血脂與血脂/血糖間具關聯（P<.05）；（4）地區醫院的三高資料（即血壓/血脂、血壓/血糖、血脂/血糖）間皆具關聯（P<.05），其中於血壓/血脂間呈負向關聯。研究假設（在各層級醫院、醫學中心、區域醫院、和地區醫院間具獨立性）未獲支持。台灣醫院中病人三高（抗血壓、抗血脂、抗血糖）的用藥重複率，在不同層級的醫院中存在不同程度的關聯。整體而言，所有層級的醫院中三高用藥重複率間均存在顯著關聯，並且在不同層級醫院中，這些關聯性具有其特定的表現形式。這些結果對於進一步優化用藥管理、減少重複處方、與瞭解資料間的關聯與獨立，具有重要的意義。

Using data from the Health Insurance Open Data Service Platform, this study examines the medication duplication rates (in days) for patients with three chronic conditions (hypertension, hyperlipidemia, and diabetes) in Taiwanese hospitals during the four quarters of 2023. The hypothesis being tested is that there is independence (i.e., no correlation) between different levels of hospitals (medical centers, regional hospitals, and local hospitals). A total of 421 hospitals with complete data were included in the analysis, comprising 19 medical centers, 86 regional hospitals, and 316 local hospitals. Confirmatory factor analysis was conducted using R. The results indicate: (1) there is a significant correlation (P<.05) between the data on the three conditions across all hospital levels, with a negative correlation specifically between hypertension and lipids; (2) there is a significant correlation (P<.05) between lipids and glucose in medical centers; (3) there is a significant correlation (P<.05) between hypertension/lipids and lipids/glucose in regional hospitals; (4) there is a significant correlation (P<.05) between the data on the three conditions in local hospitals, with a negative correlation specifically between hypertension and lipids. The hypothesis of independence between different levels of hospitals was not supported. Although significant correlations exist between the medication duplication rates for these conditions at all hospital levels, these correlations manifest uniquely within each hospital level. These findings are crucial for further optimizing medication management, reducing medication duplication, and understanding their associations in data attributes.