Kan Wei-Chih, Kuo Shu-Chun, Chien Tsair-Wei, Lin Jui-Chung John, Yeh Yu-Tsen, Chou Willy, Chou Po-Hsin
Department of Nephrology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan.
JMIR Med Inform. 2020 Jul 27;8(7):e11627. doi: 10.2196/11627.
Cardiovascular disease causes approximately half of all deaths in patients with type 2 diabetes. Duplicative prescriptions of medication in patients with high blood pressure (hypertension), high blood sugar (hyperglycemia), and high blood lipids (hyperlipidemia) have attracted substantial attention regarding the abuse of health care resources and to implement preventive measures for such abuse. Duplicative prescriptions may occur by patients receiving redundant medications for the same condition from two or more sources such as doctors, hospitals, and multiple providers, or as a result of the patient's wandering among hospitals.
We evaluated the degree of duplicative prescriptions in Taiwanese hospitals for outpatients with three types of medications (antihypertension, antihyperglycemia, and antihyperlipidemia), and then used an online dashboard based on mobile health (mHealth) on a map to determine whether the situation has improved in the recent 25 fiscal quarters.
Data on duplicate prescription rates of drugs for the three conditions were downloaded from the website of Taiwan's National Health Insurance Administration (TNHIA) from the third quarter of 2010 to the third quarter of 2016. Complete data on antihypertension, antihyperglycemia, and antihyperlipidemia prescriptions were obtained from 408, 414, and 359 hospitals, respectively. We used scale quality indicators to assess the attributes of the study data, created a dashboard that can be traced using mHealth, and selected the hospital type with the best performance regarding improvement on duplicate prescriptions for the three types of drugs using the weighted scores on an online dashboard. Kendall coefficient of concordance (W) was used to evaluate whether the performance rankings were unanimous.
The data quality was found to be acceptable and showed good reliability and construct validity. The online dashboard using mHealth on Google Maps allowed for easy and clear interpretation of duplicative prescriptions regarding hospital performance using multidisciplinary functionalities, and showed significant improvement in the reduction of duplicative prescriptions among all types of hospitals. Medical centers and regional hospitals showed better performance with improvement in the three types of duplicative prescriptions compared with the district hospitals. Kendall W was 0.78, indicating that the performance rankings were not unanimous (Chi square=4.67, P=.10).
This demonstration of a dashboard using mHealth on a map can inspire using the 42 other quality indicators of the TNHIA by hospitals in the future.
心血管疾病导致约一半的2型糖尿病患者死亡。高血压、高血糖和高血脂患者的重复用药问题，引发了人们对医疗资源滥用的关注，并促使采取预防此类滥用的措施。重复用药可能是由于患者从医生、医院和多个医疗机构等两个或更多来源接受针对同一病症的多余药物，或者是患者在不同医院间辗转导致的。
我们评估了台湾地区医院门诊患者三种药物（抗高血压药、抗高血糖药和抗高血脂药）的重复用药程度，然后使用基于移动健康（mHealth）的在线仪表盘在地图上确定在最近25个财政季度中这种情况是否有所改善。
从2010年第三季度到2016年第三季度，从台湾地区国民健康保险管理局（TNHIA）网站下载三种病症药物的重复处方率数据。分别从408家、414家和359家医院获取了完整的抗高血压、抗高血糖和抗高血脂处方数据。我们使用量表质量指标评估研究数据的属性，创建了一个可通过mHealth追踪的仪表盘，并使用在线仪表盘上的加权分数选择在三种药物重复处方改善方面表现最佳的医院类型。使用肯德尔和谐系数（W）评估绩效排名是否一致。
数据质量被认为是可接受的，具有良好的可靠性和结构效度。在谷歌地图上使用mHealth的在线仪表盘，通过多学科功能能够轻松、清晰地解读医院绩效方面的重复处方情况，并且显示出各类医院在减少重复处方方面有显著改善。医学中心和区域医院在三种重复处方的改善方面表现优于地区医院。肯德尔W值为0.78，表明绩效排名不一致（卡方=4.67，P=0.10）。
这种在地图上使用mHealth的仪表盘展示，未来可能会启发医院使用TNHIA的其他42个质量指标。
