Influences of Patient Faithfulness and Physician Characteristics on Physicians’ Prescribing Behavior in Outpatient Settings

摘 要 目的：慢性病患長期由同一位醫師固定看診，又稱為忠誠就醫，被認為是較佳的門診照護模式，它不僅能建立醫病間的信任關係，也會增加病患對醫療品質的滿意度。然而，病患的就醫忠誠度是否促發了醫師的處方行為，其相關性的強度及變動趨勢為何，卻缺乏量化資料的驗證和支持。本實習計畫的目的，在考量醫師的人口學特質後，探究病患的就醫忠誠度與醫師處方行為間的關連性。 方法：本實習計畫採橫斷式研究法，以主診斷係「非特定原發性高血壓」的處方箋為例，來探究上述的關係。病患就醫忠誠度的測量，以其2009年1月至2010年12月期間，固定由同一位醫師看診的次數而定，總計包括80位看診醫師及所開立的27,128張處方箋納入分析，醫師的特性則依據其處方狀況及人口-社會特徵等變項來測量。本計畫運用SAS 9.2統計軟體，並採用卡方檢定、F檢定及多元羅吉斯迴歸等進行資料分析。 結果：女性及年長病患較少由同一位醫師固定長期看診，也就是就醫忠誠度較低。醫師開給高忠誠度病患的的處方箋藥品較少、次診斷較少、給藥天數較長，慢性病連續處方箋比率較高。整體而言，醫師年齡越大，處方行為較容易受到病患就醫忠誠度的影響，相反的，醫師職位等級越高，處方行為較不會因病患就醫忠誠度而有改變。另外，醫病溝通受醫師個人特質所主導，與病患的就醫忠誠度較無顯著關連性。 結論：當病患與個別醫師間建立起良好的就醫忠誠度，不僅醫師較能掌握病情，也能降低病患就醫頻率，減少用藥品項及開立較長天數的處方等，有助於提升醫療資源的使用效率，達到節約健保資源的成效。尤其以年長醫師或一般主治醫師的門診處方行為，受就醫忠誠度的影響較為顯著，然而病患長期由同一位醫師看診，卻未必能產生良好的醫病溝通結果。本實習計畫所獲致的相關結論，能提供政府日後持續推動病患忠誠就醫政策的重要參考。Abstract Objectives: Chronic patient visiting a physician with long-term continuity, also called patient faithfulness, is deemed a better healthcare model for outpatient services. It not only builds up trust between patients and physicians but also increases patients’ satisfaction with the quality of care. However, whether patient faithfulness contributes to physician’s prescribing behavior, and if yes, to what extent and in what way, which lacks quantitative data to validate and support. This study aims to investigate how patients’ faithfulness, by taking into account physicians’ characteristics, correlates with physicians’ prescribing behaviors. Methods: This study basically follows a cross-sectional design, using “non-specific essential hypertension” as the example to explore the above relationships. Patient faithfulness was measured by continuity of visiting a specific doctor from January 2009 to December 2010, a total of 80 physicians and their 27,128 prescription records during the above period of time were included in this study. Physician characteristics were measured by their prescribing practices and socio-demographic factors. Using SAS9.2, the data analysis was carried out by the methods ofχ2 test, F test, and multiple logistic analysis. Results: Patients who are female and with older age were less likely to visit physicians in a continuous basis, i.e., with lower level of faithfulness. To physicians with greater level of faithfulness, physicians tended to prescribe fewer drugs, give fewer sub-diagnoses, fill longer prescription days, and dispense Chronic Illness Prescription Slip. In general, physicians who were older in age were apt to influence by patients’ faithfulness. On the contrary, physicians holding higher positions were less influenced by patients’ faithfulness. Moreover, patient-physician communication depended more on physicians’ characteristics rather than patients’ faithfulness. Conclusions: Patient faithfulness leads to a greater control of disease, decrease visits, reduce total prescription items, and also increase prescription with longer period of time. As a result, patient faithfulness enhances the efficiency in NHI resource consumption. Particularly, patients’ faithfulness significantly affected physicians who were older and senior in practices. Notably, however, improved patient-physician communication might not be generated through visiting a physician with long-term continuity. Findings from this study can inform the government in the development of faithful patient policy