社團法人臺灣臨床藥學會

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【原著】發展科學量表應用於醫學中心醫師用藥模式之研究
Developing a Scale for Distinguishing Physicians’ Approaches to Prescribing Drugs in a Medical Center
用藥模式、處方藥品屬性、關係承諾、健保及醫院政策、個人因素、Prescribing Behavior, Prescription Drug Attribute, Relationship Commitment, Health Care and Hospital Policy, Personal Factors
黃文君Wen-chun Huang1,2,* 、蔡義清Yih-Ching Tsaih2 、李宜勳I-Hsun Li1 、謝政智Cheng-Chin Hsieh1
1三軍總醫院臨床藥學部 、2銘傳大學企業管理學系
目的:藉由發展科學量表探討處方藥品屬性、關係承諾、健保及醫院政策及個人因素等四大構面,對於醫師處方意願的影響程度,繼而驗證醫師用藥模式,為醫院訂定藥政管理策略之所用。
方法:以因素分析法經Bartlett’s (sphericity) 檢定,經轉軸後結果萃取共同因素並根據因素負荷量 (factor loadings) 之特性命題。以集群分析 (cluster analysis) 方法,依據前述處方藥藥品屬性、關係承諾、健保及醫院政策與個人因素之因素得分做為集群分析之變數,從樹狀圖中研判適當的集群數為三群,再採用K-Means 方法來進行分析後將醫師用藥模式區隔分群。依據問卷受測者對處方藥藥品屬性、關係承諾、健保及醫院政策和個人因素四大構面滿意度給予評分後,進行統計分析。
結果:運用本研究量表可將某醫學中心不同用藥模式的醫師分為三個集群,分別為年齡36 歲以上,執業經驗超過10 年以上外科醫師;年齡35 歲以下執業經驗在5年以下醫師;及內科及其他科醫師,其特質詳述於本文內。
結論:運用本研究量表於某醫學中心,所得到的研究結果確實能將不同用藥模式的醫師正確分群。因此本研究量表可推廣於各醫院與院內實務相關結合應用,以擬訂最佳之藥政管理策略方案。

Objective: This study was aimed at exploring the following four factors by developing a scientific scale: the attributes of prescription drugs; relationship commitment; health insurance and hospital policies; and personal factors. In addition, we investigated the influence of these four factors on physician willingness to prescribe drugs and examined their approaches to prescribing drugs in order to set management strategies for hospital drug administrators.
Methods: Factor analysis was conducted prior to Bartlett’s test. Common factors were extracted after rotation and named according to factor loadingcharacteristics. The scores of the four factors then served as variables in cluster analysis, allowing us to identify three appropriate clusters. K-means clustering was subsequently performed to differentiate physicians’ approaches to prescribing drugs.
Results: The scale developed in this study categorized physicians from a medical center into three clusterson the basis of how they prescribed drugs: surgeons over the age of 36 years with more than 10 years of medical practice; physicians below the age of 35 years with less than 5 years of medical practice; and physicians of internal medicine or other departments. Their characteristics are described in detail in the main text.
Conclusions: The research results obtained using the proposed scale revealed that we could correctly divide physicians of the medical center into clusters according to their approaches to prescribing drugs. Therefore, the scale applied in this study could be widely used for relevant practical applications in hospitals.
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