Department of Pharmacy, Chung Shan Medical University Hospital, Taichung 40201, Taiwan.
Department of Pharmacology, Chung Shan Medical University, Taichung 40201, Taiwan.
Int J Environ Res Public Health. 2021 Jul 8;18(14):7336. doi: 10.3390/ijerph18147336.
Due to the high-accessibility and low-copayment of healthcare system in Taiwan, the clinical visit frequency of people is relatively high, which often leads to an excessively high healthcare expenditure. The aim of this research was to explore the effectiveness of pharmaceutical home care for frequent users of outpatient service and to analyze the impact of pharmaceutical home care on medical utilization. The study was based on the Taiwan National Health Insurance Research Database. Patients with over 100 clinical visits during 2010 to 2012 were selected as subjects. Whether these patients participate the experimental plan of pharmaceutical home care in the following year and the medical utilization of the research subjects were analyzed to compare the difference between participating group and non-participating group in this plan. The generalized estimating equation was employed to examine the difference of medical utilization. A total of 3943 subjects were included in this study, including 591 patients (14.99%) participating in the experimental plan. The average number of physician visits during the following year of the participating group was higher than that of the non-participating group by 0.12 visits, and the outpatient medical expense was lower than the non-participating group by 18,302 points (1 point = 0.03 US dollars). After participating in the plan, the average number of clinical visits of frequent users of outpatient services was significantly reduced by 6.63 visits, and the outpatient expense was significantly decreased by 9871 points. After joining the experimental plan of pharmaceutical home care, the average number of outpatient visits decreased significantly and the medical expense was lower when compared with those who did not participate in the plan.
由于台湾医疗体系的高可及性和低自付额，人们的临床就诊频率相对较高，这往往导致医疗支出过高。本研究旨在探讨药剂师居家照护对门诊频繁就诊者的效果，并分析药剂师居家照护对医疗利用的影响。本研究基于台湾全民健康保险研究数据库。选择 2010 年至 2012 年期间就诊超过 100 次的患者作为研究对象。分析这些患者在次年是否参加药剂师居家照护的实验方案，以及研究对象的医疗利用情况，以比较该方案中参与组和非参与组之间的差异。采用广义估计方程检验医疗利用的差异。本研究共纳入 3943 例患者，其中 591 例（14.99%）患者参加了实验方案。参与组次年的医生就诊次数平均比非参与组多 0.12 次，门诊医疗费用比非参与组低 18302 点（1 点=0.03 美元）。参加该计划后，门诊高频就诊者的平均临床就诊次数显著减少 6.63 次，门诊费用显著减少 9871 点。参加药剂师居家照护实验方案后，与未参加者相比，门诊就诊次数明显减少，医疗费用降低。
