title: Doctor Shopping Behavior for Zolpidem Among Insomnia Patients in Taiwan: A Nationwide Population-Based Study.
abstract: OBJECTIVE
  Although zolpidem is listed as a controlled drug in Taiwan, patients' behavior has not been restricted and has led to the problem of doctor shopping behavior (DSB), leading to overutilization of medical resources and excess spending. The National Health Insurance Administration in Taiwan has instituted a new policy to regulate physicians' prescribing behavior and decrease DSB. This retrospective study aimed to analyze the DSB for zolpidem by insomnia patients and assess related factors.
  
  
  METHODS
  Data were extracted from the Longitudinal Health Insurance Database in Taiwan. Individuals with a diagnosis of insomnia who received more than one prescription of zolpidem in 2008 were followed for 24 mo. Doctor shopping was defined as ≥ 2 prescriptions by different doctors within ≥ 1 day overlapping in the duration of therapy. The percentage of zolpidem obtained through doctor shopping was used as an indicator of the DSB of each patient.
  
  
  RESULTS
  Among the 6,947 insomnia patients who were prescribed zolpidem, 1,652 exhibited DSB (23.78%). The average dose of zolpidem dispensed for each patient during 24 mo was 244.21 daily defined doses. The doctor shopping indicator (DSI) was 0.20 (standard deviation, 0.23) among patients with DSB. Younger age, chronic diseases, high number of diseases, higher premium status, high socioeconomic status, and fewer people served per practicing physicians were all factors significantly related to doctor shopping behavior.
  
  
  CONCLUSIONS
  Doctor shopping for zolpidem appears to be an important issue in Taiwan. Implementing a proper referral system with efficient data exchange by physician or pharmacist-led medication reconciliation process might reduce DSB.
authors.affiliation: Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.|College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Tzu-Hsuan
authors.initials: TH
authors.lastname: Lu
authors.affiliation: Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.|College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: Yen-Ying
authors.initials: YY
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.|Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.|Department of Medical Humanities, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Hsin-Chien
authors.initials: HC
authors.lastname: Lee
authors.affiliation: Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.|College of Pharmacy, Taipei Medical University, Taipei, Taiwan.
authors.forename: You-Meei
authors.initials: YM
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual; D005260:Female; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D059065:Medication Reconciliation; D008875:Middle Aged; D010820:Physicians / Q000706:statistics & numerical data*; D000067490:Prescription Drug Overuse / Q000706:statistics & numerical data*; D011725:Pyridines / Q000600:supply & distribution* / Q000627:therapeutic use*; D012189:Retrospective Studies; D000068776:Sleep Aids, Pharmaceutical / Q000600:supply & distribution / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy* / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult; D000077334:Zolpidem
chemical_list: D011725:Pyridines; D000068776:Sleep Aids, Pharmaceutical; D000077334:Zolpidem
keywords: doctor shopping behavior; doctor shopping indicator; the National Health Insurance Research Database; zolpidem