運用資訊檢核系統提升藥物使用效益──以新型糖尿病藥物為例

Information Verification System to Enhance the Efficiency of Medical Prescriptions: A case Study with new Diabetes Medications

目的
美國醫學研究院提出健康資訊系統（Health Information Technology, HIT）是改善病人安全和提升醫療品質的重要策略，因此利用新增處方警示系統的藥品使用條件檢核功能，提升新進糖尿病藥物合理性使用的比率以及藥物費用支出的合理性狀況，以使醫療資源能有效的利用。
方法
運用回溯性的研究方式收集2021年7月至2022年6月新引進糖尿病複方製劑的病人用藥紀錄，以敘述性統計分析新設定的糖尿病藥品使用條件的檢核機制之藥品處方與藥品費用是否符合藥品使用規定的分布情形以及各科別使用本類藥品的狀況。
結果
綜合研究結果發現使用這兩種藥品的科別以家醫科、內分泌科及腎臟內科居多，而在導入糖尿病給付條件之處方檢核系統後，其處方不符合規定比率由27.2％降至9.9％，改善率63.6％，藥品的不合理費用則由14,329元/月降至6,167元/月，減少8,162元/月，整體改善率57％，每年可節省將近十萬元的不合理藥費，有效改善藥品使用狀況。
結論
結合資訊檢核功能的醫令系統，可促進醫師處方決策的適當性，應能協助醫院進行藥品費用之改善，除了促進醫院的整體性的醫療收支平衡外，亦可提升醫療品質與達到管控醫療費用之效益。

Purposes
According to the National Academy of Medicine of the United States, health information technology (HIT) is an important strategy for improving patient safety and healthcare quality. To enhance the effective usage of medical resources, this study used the Verification of Medication Usage Conditions (Conditions) for Health Insurance Coverage (Coverage) function in the newly added medication alert system to improve the rational utilization rate of newly introduced diabetes medications and the reasonability of medication expenses.
Methods
Medication records of patients newly introduced to combination medications for diabetes were collected via a retrospective approach from July 2021 to June 2022. We evaluated whether the prescriptions and costs of these new medications, under the newly established Conditions mechanism, conformed to the listed medication usage regulations, as well as their usage across various departments based on descriptive statistical analysis.
Results
Overall, the results indicated that family medicine, endocrinology, and nephrology were the departments most frequently using the two drugs. Following the implementation of the Conditions for Coverage system for diabetes, the rate of non-compliant prescriptions decreased from 27.2% to 9.9%, an improvement of 63.6%. Unreasonable medication expenses were reduced from NT$14,329 per month to NT$6,167 per month, a reduction of NT$8,162 per month, and an overall improvement rate of 57%. This could result in annual savings of nearly NT$100,000 in unreasonable medication expenses, which would significantly enhance the efficiency of medical prescriptions.
Conclusions
The integration of an information verification function into the computerized order entry system can promote the appropriateness of physicians’prescription decisions and assist hospitals in managing medication expenses more effectively. Its application can assist hospitals in achieving an overall financial balance in healthcare, enhance healthcare quality, and contribute to the regulation of medical expenses.