Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Medical Review and Pharmaceutical Benefits Division, National Health Insurance Administration, Ministry of Health and Welfare, Taiwan.
Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan; Population Health Research Center, National Taiwan University, Taipei, Taiwan.
Int J Med Inform. 2018 Aug;116:18-23. doi: 10.1016/j.ijmedinf.2018.05.004. Epub 2018 May 19.
Taiwan's single health insurer introduced a medication record exchange platform, the PharmaCloud program, in 2013. This study aimed to evaluate the effects of the medication record inquiry rate on medication duplication among patients with diabetes.
A retrospective pre-post design with a comparison group was conducted using nationwide health insurance claim data of diabetic patients from 2013 to 2014. Patients whose medication record inquiry rate fell within the upper 25th percentile were classified as the high-inquiry group, and the others as the low-inquiry group. The dependent variables were the likelihood of receiving duplicated medication and the overlapped medication days of the study subjects. Generalized estimation equations with difference-in-difference analysis were calculated to examine the net effect of the PharmaCloud inquiry rate for a matched sub-sample.
In total, 106,508 patients with diabetes were randomly selected. From 2013 to 2014, the medication duplication rate was reduced 7.76 percentile (54.12%-46.36%) for the high-inquiry group and 9.58 percentile (63.72%-54.14%) for the low-inquiry group; the average medication overlap periods were shortened 4.36 days (8.49-4.13) and 6.29 days (11.28-4.99), respectively. The regression models showed patients in the high-inquiry group were more likely to receive duplicated medication (OR = 1.11, 95% C.I. = 1.07-1.16) and with longer overlapped days (7.53%, P = 0.0081) after the program.
The medication record sharing program has reduced medication duplication among diabetes patients. However, higher inquiry rate did not lead to greater reduction in medication duplication; the overall effect might be due to enhanced internal control via prescription alert system in hospitals rather physician's review of the records.
台湾的单一健康保险公司于 2013 年推出了 PharmaCloud 药物记录交换平台。本研究旨在评估药物记录查询率对糖尿病患者药物重复使用的影响。
使用 2013 年至 2014 年全国健康保险理赔数据，采用回顾性前后设计和对照组进行研究。将药物记录查询率处于前 25%分位的患者分为高查询组，其余患者分为低查询组。将研究对象接受重复用药的可能性和重叠用药天数作为因变量。采用广义估计方程和差异分析计算差分式分析来检验 PharmaCloud 查询率对匹配亚组的净效应。
共随机选择了 106508 名糖尿病患者。从 2013 年到 2014 年，高查询组的药物重复率降低了 7.76 个百分点（54.12%-46.36%），低查询组降低了 9.58 个百分点（63.72%-54.14%）；平均药物重叠期分别缩短了 4.36 天（8.49-4.13）和 6.29 天（11.28-4.99）。回归模型显示，高查询组的患者更有可能接受重复用药（OR=1.11，95%CI=1.07-1.16），并且用药重叠天数更长（7.53%，P=0.0081）。
药物记录共享计划减少了糖尿病患者的药物重复使用。然而，较高的查询率并没有导致药物重复使用的减少更多；总体效果可能是由于医院处方警报系统加强了内部控制，而不是医生对记录的审查。
