Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
Sleep. 2015 Jul 1;38(7):1039-44. doi: 10.5665/sleep.4806.
Although zolpidem is listed as a controlled drug in Taiwan, patients' behavior has not been restricted and has led to the problem of doctor shopping behavior (DSB), leading to overutilization of medical resources and excess spending. The National Health Insurance Administration in Taiwan has instituted a new policy to regulate physicians' prescribing behavior and decrease DSB. This retrospective study aimed to analyze the DSB for zolpidem by insomnia patients and assess related factors.
Data were extracted from the Longitudinal Health Insurance Database in Taiwan. Individuals with a diagnosis of insomnia who received more than one prescription of zolpidem in 2008 were followed for 24 mo. Doctor shopping was defined as ≥ 2 prescriptions by different doctors within ≥ 1 day overlapping in the duration of therapy. The percentage of zolpidem obtained through doctor shopping was used as an indicator of the DSB of each patient.
Among the 6,947 insomnia patients who were prescribed zolpidem, 1,652 exhibited DSB (23.78%). The average dose of zolpidem dispensed for each patient during 24 mo was 244.21 daily defined doses. The doctor shopping indicator (DSI) was 0.20 (standard deviation, 0.23) among patients with DSB. Younger age, chronic diseases, high number of diseases, higher premium status, high socioeconomic status, and fewer people served per practicing physicians were all factors significantly related to doctor shopping behavior.
Doctor shopping for zolpidem appears to be an important issue in Taiwan. Implementing a proper referral system with efficient data exchange by physician or pharmacist-led medication reconciliation process might reduce DSB.
尽管唑吡坦在台湾被列为管制药物，但患者的行为并未受到限制，导致了医生购物行为（DSB）的问题，导致医疗资源过度利用和支出过度。台湾全民健康保险署已制定新政策，以规范医师的处方行为并减少 DSB。本回顾性研究旨在分析失眠症患者的 DSB，并评估相关因素。
数据来自台湾的纵向健康保险数据库。2008 年被诊断为失眠症并接受超过一次唑吡坦处方的患者，随访 24 个月。医生购物行为被定义为在治疗期间的≥1 天内，由不同医生开出的≥2 张处方。每位患者通过医生购物获得的唑吡坦百分比作为每个患者 DSB 的指标。
在接受唑吡坦治疗的 6947 名失眠症患者中，有 1652 名患者出现 DSB（23.78%）。在 24 个月期间，每位患者开出的唑吡坦平均剂量为 244.21 日规定剂量。DSB 患者的医生购物指标（DSI）为 0.20（标准差为 0.23）。年龄较小、患有慢性病、疾病数量较多、保费较高、社会经济地位较高以及每位执业医师服务的人数较少，这些都是与医生购物行为显著相关的因素。
在台湾，唑吡坦的医生购物行为似乎是一个重要问题。实施适当的转介系统，通过医生或药剂师主导的药物调整过程实现高效的数据交换，可能会减少 DSB。
