實證醫學愈來愈受重視的此時，已有許多研究透過問卷的方式，討論實證醫學的結論無法轉化為臨床行為的因素。然而，在本研究初發表於國外期刊之前，尚未有研究探討當一個實證醫學證據發生後，是哪些特性的醫師實行了該實證，又需花多少時間才能落實。本研究即是透過健保資料庫，回溯性地探討，當2007年rosiglitazone一藥物被以最高等級的實證醫學證據的統合分析方法，發現使用的病患會有較高的心肌梗塞機率後的一年半內，此藥物被終止使用的情形。
使用資料庫研究的缺點之ㄧ為無法探知個案醫師的主觀實證醫學看法，故本研究設計了兩個模式來探討終止處方醫師的特性。在模式A下，期能最敏感地收案終止開立rosiglitazone藥物的醫師；而在模式B下，期能最特異地收案。本研究假設，母群體醫師的特性表現，當在此兩模式呈現的醫師特性之間。
本研究發現，內科專科醫師及專科醫師年資在十年以上的醫師，顯著有較多的比例終止處方。在不同的醫院層級工作的醫師間，則無顯著的差異。對於在診所執業的醫師來說，執業縣市的社會化程度及經濟狀況則非決定其實證醫學表現的因素。亦即病患仍無足夠力量影響該地區的診所醫師表現得更符合實證醫學。而醫師實行實證醫學所需的時間，平均在兩季以上，較英美要來的長。
本研究發現，在臺灣，實證醫學的實行，仍有很大的改善空間，而成立一個權威的機構做實證醫學即時的分析與建議，有其必要性。

Background: Evidence-based medicine (EBM) receives significant attention worldwide. Many studies have used questionnaires to discuss the factors obstructing the practice of EBM. There has however been no large-scale data analysis on who and when to practice EBM. This study aims to fill this gap in research by applying nationally representative data to analyze EBM practice after the provision of new evidence regarding rosiglitazone prescription.
Methods: We used the National Health Insurance Database in Taiwan to analyze the changes in the prescription of rosiglitazone after meta-analysis found the drug to increase the risk of myocardial infarction. The study period was 18 months from the second quarter of 2007 to the fourth quarter in 2008. Two models of doctors’ prescription behaviors were analyzed in the study. We conducted univariate analyses to distinguish significant differences in the variable and applied multivariate logistic analyses to predict the probability of physicians ceasing to prescribe rosiglitazone.
Results: We found a significant improvement in EBM practice from specialists and experienced physicians. When compared to other specialists, endocrinologists were four times more likely to change rosiglitazone prescription (OR: 4.129, 95% CI: 2.484-6.863). Doctors with more than 10 years of specialist experience performed better in EBM practice than younger doctors. The hospital level that a physician worked at was not a significant factor. Local urbanization and economic status did not affect the practice of EBM by physicians in clinics either.
Conclusions: Our study found that the EBM was still not well practiced among doctors in Taiwan. The practice of new evidence depended on the specialty or professional experience. Younger doctors and doctors working in medical centers seemed not to practice EBM well. In clinics, patients did not have enough influence to modify the doctor’s prescription behavior. There was a significant time lag between the EBM emergence and EBM practice. This suggests that setting up an authoritative organization to provide timely EBM recommendations is very important. Further improvements to the practice of EBM are still urgently needed within the medical community.

致謝 ii
摘要 iii
Abstract iv
Introduction 1
Method 3
Statistical analysis........................................................................... ..............................6
Results………………........................................................................................6
Discussion…………………………………………………………………………..10
Conclusion. 15
Reference………………………………………..………………………………… .. 16
Content of Tables
Table 1……………………………………………………………………………8
Table 2……………………………………………………………………………9
Table 3…………………………………………………………………………..11
Table 4…………………………………………………………………………..12

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