| Abstract: | Background and Objectives: There are limited studies up till now aimed at analyzing the clinical profits of the chronic illness refill prescription policy (CIRPP). Among these, there are only few research studies analyzing the impact of CIRPP utilization on medical resource utilization, while the majority of the studies compare the differences between with and without utilization of the CIRPP., The latter research method is less accurate and may lead to more biased results.. Therefore, this study intents to redefine the appropriateness of CIRPP and its impact on the health care system on the basis of diabetes mellitus (DM), to analyze the impact factors that affect the appropriateness of the prescription of chronic illness prescription refill slip (CIPRS) for diabetic patients, and to investigate whether the appropriateness of CIRPP for diabetics will affect medical usage or not.
Methods: This study involves secondary data analysis, which was based on the 2007 National Health Research Institute database. Patients who were prescribed to CIPRS three times are extracted as the appropriate group ; stable patients who continuously seek medical treatment for three months, consistently received the same medicine components and quantity treating DM for up to 84 days, should be prescribed to CIPRS but never received CIPRS prescription are extracted as the inappropriate group. These two groups are defined to analyze the factors affecting the appropriateness of the CIPRS prescription Subsequently, propensity score matching (PSM) method, issued by 1:1 matching the comparability of two groups of subjects, is used to compare whether the appropriateness of CIPRS prescriptions will impact the utilization of medical care or not.
Results: The impact factors for the appropriateness of the CIPRS prescriptions include patient age, existence of catastrophic illness, complications and medical institutions of the layer number of the level of ownership and the other branch. Even though, the appropriate group, who have received over three times CIPRS received 40 days more medications, NT$5,633 more drug fee per person, NT$111 more pharmaceutical service fees and NT$5,527 more apply expenses than the inappropriate group, they also had 2.55 times less doctors consultations per capita, NT$496 for physician fees, and NT$ 1,044 for co-payment. In the emergency department (ED) and hospitalization, the appropriate group could reduce the 0.078 visit, and 1,848 dollars in ED, 0.2 visit, 2.6 days, and 10,149 dollars in hospitalization, comparing with the inappropriate group. Overall (by and large), the total medical expenditures decrease 7,515 dollars.
Conclusions: The research result indicates that if only the impact of medical utilization of outpatient is concerned, implementation of CIRPP increases medical expense; however, if medical utilization of emergency and inpatient are included, the CIRPP apparently reduce the medical utilization to achieve the designed purpose. |
