Hygiene Pharmacy and Pharmacy Administration 公共衛生藥學暨藥事管理 精神專科醫院安眠藥品使用評估 衛生福利部桃園療養院藥劑科藥師鄭淑文 衛生福利部桃園療養院醫師陳質采 摘要 13 15% chisquare P 2010 7 12 100 53%47% 48.0 15.5 41-50 ( 27%) 38% 31% psychiatric hospital hypnotic drug utilization evaluation 壹 前言 200510% 40% 1 Johnson DSM-IV 1,014 13-16 11 10.7% 52.8% 2 (benzodiazepines, BZDS) (non-benzodiazepines) 藥學雜誌第 116 冊 133
公共衛生藥學暨藥事管理 Hygiene Pharmacy and Pharmacy Administration 13 15% 3 ( zolpidem) 2007 2007 (zolpidem) 2006 2003 2.17 4 31.4% 5 23.4% 6 6.2% 7 (2007) 2001 2004 (Defined Daily Dose DDD ) 27.19 40.48 BZD DDD zolpidem BZD 8 (physical dependence) 貳 研究方法 2010 7 12 100 chi-square P 參 研究結果 一 病人基本資料分析 100 53%47% 41-50 ( 27%)48.0 15.5 ( 47.51385 ) ( 29%) ( 28%) ( 57%) 1.2 59% ( ) zolpidem ( 37%) estazolam 32% ( ) 表一病人基本資料分佈 n % χ 2 value 病人性別 χ 2 (1) =0.36 47 47.0% 53 53.0% 年齡 ( 歲 ) χ 2 (4) =4.30 < 30 14 14.0% 31-40 20 20.0% 41-50 27 27.0% 51-60 20 20.0% > 61 19 19.0% 診斷 χ 2 (7) =64.16*** 29 29.0% 15 15.0% 28 28.0% 11 11.0% 5 5.0% 4 4.0% 2 2.0% 6 6.0% 身份別 χ 2 (3) =76.24*** 33 33.0% 57 57.0% 2 2.0% 8 8.0% 使用安眠藥品項數 χ 2 (2) =112.82*** 1 83 83.0% 2 14 14.0% 134 THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.3
n % χ 2 value 3 3 3.0% 使用安眠藥期間 χ 2 (6) =174.12*** 1-2 2 2.0% 2-3 2 2.0% 3-4 3 3.0% 4-5 12 12.0% 5-6 7 7.0% 6 59 59.0% 15 15.0% ***p < 0.001 for χ 2 -test 表二安眠藥使用頻次分析 n % 1 Zolpidem 37 37.0% 2 Estazolam 32 32.0% 3 Flurazepam 21 21.0% 4 Flunitrazepam 14 14.0% 5 Zopiclone 12 12.0% 6 Brotizolam 2 2.0% 7 Triazolam 1 1.0% 8 Zaleplon 1 1.0% 二 處方適當性評估 99% 50% WHO (DDD) 3% 100% 99% 17% ( ) 表三處方適當性 安全性及有效性評估結果 1. 處方適當性評估用藥合理性評估 () 99 99.0% () 1 1.0% 使用劑量合理性評估 27 27.0% ( WHO ) 50 50.0% ( WHO ) 23 23.0% 開藥日期合理性 () 97 97.0% ( ) 3 3.0% 用藥頻次 () 100 100.0% ( ) 0 0.0% 處方天數 ( ) 99 99.0% ( ) 1 1.0% 併用安眠藥 83 83.0% 17 17.0% 2. 安全性評估 告知病人 hypnotics 治療的 risk 及 benefit ( ) 69 69.0% ( ) 31 31.0% 病歷記載進行不良反應監測 83 83.0% 17 17.0% 16 94.1% 1 5.9% 副作用處理方式 (n=15) 1 6.7% 8 53.3% 1 6.7% 5 33.3% 指導病人主要的睡眠保健觀念 62 62.0% 38 38.0% 女性病人用藥前, 有否確定是否懷孕 (n=53) ( ) 46 86.8% ( ) 3 5.7% 4 7.5% 3. 有效性監測評估症狀療效評估 92 92.0% 8 8.0% 0 0.0% 停藥前是否減低劑量 16 16.0% 1 1.0% 2 2.0% 81 81.0% 三 安全性評估 31% 藥學雜誌第 116 冊 135
公共衛生藥學暨藥事管理 Hygiene Pharmacy and Pharmacy Administration l7% 38% 5.7% ( 53.3%) 33.3% ( 85.7%) 23.8% zolpidem 1 zopiclone ( ) 表四藥品不良反應症狀分析 n (%) 中樞神經系統 18 85.7% 5 23.8% 4 19.0% 1 4.8% 5 23.8% 1 4.8% 2 9.5% 心血管系統 1 4.8% 1 4.8% 泌尿道系統 1 4.8% 1 4.8% 其它 1 4.8% 1 4.8% 四 有效性監測評估 92% 8% 16% 1% 肆 結論與建議 參考資料 : 1. Roth T: Insomnia: Definition, Prevalence, Etiology, and Consequences. J Clinical Sleep Medicine 2007;3(5):S7 S10. 2. Johnson EO, Roth T, Schultz L, et al: Epidemiology of DSM-IV Insomnia in Adolescence: Lifetime Prevalence, Chronicity, and an Emergent Gender Difference. Pediatrics 2006;117(2):247-56. 3. 96, 2007 4. zolpidem - 2008;51(9):29-32. 136 THE JOURNAL OF TAIWAN PHARMACY Vol.29 No.3
5. Busto UE, Ruiz Ines, Busto M, et al: A Benzodiazepine use in Chile: Impact of availability on use, abuse, and dependence. J Clin Psychopharmacol 1996;16:363-72. 6. Cuevas C, Mateos A: Prescribed daily doses and risk factors' associated with the use of benzodiazepines in primary care. Pharmacoepidemiology and Drug Safety 1999;8:207-16. 7. Zandstra SM, Zitman FG, Furer JW, et al:. Deferent study criteria affect the prevalence of benzodiazepine use. Soc Psychiatry Psychiatr Epidemiol 2002;37:139-44. 8.,2007 Drug Utilization Evaluation of Hypnotics in A Psychiatric Hospital Shu-Wen Cheng 1, Chih-Tsai Chen 2 Department of Pharmacy, Taoyuan Psychiatric Center, Ministry of Health and Welfare 1 Department of Child Psychiatry, Taoyuan Psychiatric Center, Ministry of Health and Welfare 2 Abstract Objective: In recent year, the usage of hypnotic drug has been increasing enormously. Based on the statistic of BNHI office, there is worth of 1.3 billion prescriptions of hypnotic drug in one year. In addition the reimbursement expenditure pays up more than 1 billion dollars with increasing expense rate of 15% every year. The purpose of this study was to observe the prescriptions of hypnotic drug in a psychiatric hospital and assess the drug usage, so there would be a more reasonable and better prescription guideline for patients in the future and clinical pharmaceutical service to ensure the safety of patient drug usage. Method: Giving a Psychiatric Hospital in northern Taiwan for example, the review of retrospective medical record was adopted. The study analyzed the rationality of hypnotic drug usage for patient in the period of July to December 2010 based on descriptive statistic and chi-square statistic of medical records to determine P value. Result: Among 100 subjects recruited in the study, 53% were female and 47% were male. The mean age of the subjects was 48.0 15.5 years old, and 27% of the subjects were between the ages of 41 to 50. The rate of reasonable drug usage and frequency was nearly 90%. However, outpatients who received education before usage was only 38% while patients who received warning of potential risk and benefit of hypnotic was only 31%. Conclusion: Repetitive receipt and overuse of hypnotics could cause addiction and trigger inappropriate drug usage and drug abuse. Therefore doctors, pharmacists and nursing staff should educate patients about drug usage and cognitive behavior in order to ensure drug safety, and to have a better and safer medical care for insomnia. 藥學雜誌第 116 冊 137