Therapeutic Duplication in Taiwan Hospitals for Patients With High Blood Pressure, Sugar, and Lipids: Evaluation With a Mobile Health Mapping Tool (Preprint)

Abstract

BACKGROUND Cardiovascular disease (CVD) causes approximately half of all deaths in patients with type 2 diabetes. Duplicative prescriptions (DP) of medication in patients with high blood pressure (hypertension), high blood sugar (hyperglycemia), and high blood lipids have attracted close attention in relation to the abuse of healthcare resources and preventive measures for such abuse. DP may occur through duplicative prescriptions by which patients receive redundant medications for the same condition from two or more sources such as doctors, hospitals, and multiple providers, or as a result of the patient’s wandering. OBJECTIVE We evaluated the degree of DP in Taiwanese hospitals for outpatients with the three types of redundant medications, and then used an online dashboard using mHealth on Google Maps to determine whether the situation has improved in the recent 25 fiscal quarters. METHODS Data on duplicate prescription rates of drugs for the aforementioned diseases from the third quarter of 2010 to the third quarter of 2016 were downloaded from the website of Taiwan’s National Health Insurance Administration (TNHIA). For the three types of drugs, 408, 414, and 359 hospitals with complete data were included in the study. We used scale quality indicators to (1) assess the attributes of the study data using scale quality indicators, (2) create a dashboard that can be traced using mHealth, and (3) select the hospital levels that perform better in performance improvement on the three types of drugs using the weighted scores across types of hospital and percentages of performance on Google Maps. We used Kendall’s coefficient of concordance (W) to evaluate whether the performance rankings are unanimous. RESULTS We found that (1) data quality is acceptable and effectively shows reliability and construct validity, (2) an online dashboard using mHealth on Google Maps allows easy and clear interpretation of DP medications regarding hospital performance using multidisciplinary functionalities and show the significant improvement of trends in the reduction of DP medications among all types of hospital, and (3) medical centers and regional hospitals gain a performance improvement in the three types of DP medications better than the disctrict hospitals do. Kendall’s W = 0.78, indicating all the performance rankings, is not unanimous ( = 4.67, d.f. = 2, p = 0.10). CONCLUSIONS The demonstration of a dashboard using mHealth on Google Maps can inspire 42 other quality indicators of TNHIA to be used by hospitals in the future. CLINICALTRIAL Not available