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作者:詹雅惠
作者(外文):Ya-Hui Chan
論文名稱:台灣門診泌尿道感染抗生素處方型態分析及其影響因素
論文名稱(外文):Analysis of Antibiotics Prescription Patterns and Influencing Factors for Outpatients with Urinary Tract Infection in Taiwan
指導教授:李偉強譚醒朝
指導教授(外文):Wui-Chiang LeeSing-Chew Tam
學位類別:碩士
系所名稱:醫務管理研究所
學號:39310007
出版年:95
畢業學年度:94
語文別:中文
論文頁數:74
中文關鍵詞:下泌尿道感染抗生素治療指引療程品質
外文關鍵詞:Urinary Tract InfectionAntibioticsGuidelinesduration of therapyQuality
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目的:
泌尿道感染發生頻率僅次於上呼吸道感染的感染症疾病,但國內研究尚無針對泌尿道感染進行抗生素療程分析之研究,希望透過本研究了解台灣下泌尿道感染病人使用符合指引抗生素療程的影響因素。

方法:
本研究利用全民健保承保抽樣歸人檔,分析台灣下泌尿道感染抗生素處方型態的種類以及療程,及探討相關影響的因素。本研究依「台灣地區泌尿道感染症抗微生物製劑之建議治療準則」為判斷依據,以2004年下泌尿道感染使用抗生素的15,799人次案例作為抗生素處方種類分析對象;以6,643個療程作為抗生素的處方療程分析對象,分為病人特質、醫院特質及醫師特質探討。

結果:
研究結果發現下泌尿道感染抗生素使用符合指引種類抗生素的比例為65.2%。在療程方面的研究結果發現,下泌尿道感染療程平均給藥日數為5.2天,使用符合指引抗生素療程比例為22.7%,療程不足比例為68.3%,療程過長比例為9.0%。利用羅吉斯迴歸控制其他因素後分析發現,就診醫院評鑑等級、醫院所在地區、醫院權屬別、醫師科別、醫師年齡是影響病人是否得到符合指引抗生素療程的因素,但病人特質及醫師性別並非有意義的影響因素。

結論:
研究結果顯示,台灣下泌尿道感染抗生素使用與指引符合情形並不高,基層診所明顯較醫學中心為不符合,建議主管機關應加強監督,醫療機構須提供醫師吸收資訊的機會,並提醒病人必須按照醫囑服藥及回診。
Objects:
Infections of the urinary tract are the second most common type of infection in the body which are only less than upper respiratory infection. There were not studies about duration of therapy with urinary tract infection in Taiwan.

Methods:
The study samples were selected from “Registry for beneficiaries” in National Health Insurance Research Database of 2004.The aim of this study was to analyze the appropriateness of prescription patterns of antibiotics used in adult patients with urinary tract infection in Taiwan. The judgment on appropriateness was based on the “Guidelines for antimicrobial therapy of urinary tract infections in Taiwan”. The appropriateness of prescription patterns were analyzed and compared among patients’, hospitals’ and physicians’ characteristics by two models. First model was judgment on appropriateness of medication with 15,799 visits and the second model was duration of antibiotic therapy with 6,643 cases.

Results:
The ratio of appropriate prescription was 65.2%. The average duration of antibiotic therapy in urinary tract infection was 5.2 days. The ratio of appropriate prescription and duration of antibiotic therapy was 22.7%; 68.3%underuse and 9.0% overuse. After controlling the confounding factors with multi-variate logistic regression, hospitals’ accreditation level, geographical area, ownership and physician s’ speciality, sex, age were significant factors influencing the results of appropriate duration of antibiotic therapy.

Conclusion:
Based on the study, the ratio of appropriate prescription was low. Primary Care Clinics were lower than medical centers. We suggested the health official government should intensify to control and medical organization should provide continuing staff training and physicians should increase the compliance of medication of patients.
目錄
第一章 緒論 1
第一節 研究背景及動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 泌尿道感染診斷與治療指引 4
第二節 國內抗生素分類及使用情形 17
第三節 抗生素處方型態及影響因素 20
第三章 材料與方法 24
第一節 研究架構 24
第二節 研究假說 25
第三節 資料來源與處理 26
第四節 研究變項操作型定義 30
第五節 資料分析方法 32
第四章 研究結果 33
第一節 研究樣本特質及其抗生素用藥情形描述 33
第二節 抗生素種類及抗生素療程影響因素分析 47
第五章 討論 57
第一節 下泌尿道感染抗生素使用情形 57
第二節 影響抗生素使用情形之因素 59
第三節 研究限制 65
第六章 結論與建議 67
第一節 結論 67
第二節 建議 69
參考文獻 71
《中文部分》


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《英文部分》
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