2002年台灣全民健保氣喘病患之中醫醫療利用

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Title:	2002年台灣全民健保氣喘病患之中醫醫療利用 The utilization of traditional Chinese medicine and associated factors among outpatients with asthma under the National Health Insurance in Taiwan in 2002
Authors:	王筱蓉;Hsiao-Jung Wang
Contributors:	中醫學院中醫學系碩士班
Keywords:	氣喘;中醫;醫療利用;處方型態;asthma;traditional Chinese medicine;utilization;prescription
Date:	2010
Issue Date:	2010-09-29 12:00:56 (UTC+8)
Abstract:	氣喘是全球最常見的慢性病之一，但對於台灣氣喘病患的中醫醫療利用很少有大型的調查性研究，故本研究目的是分析所有台灣氣喘病患中醫醫療利用的盛行率及其相關影響因素，並針對治療氣喘所開立的有君方之處方評估常見的處方模式。採用國家衛生研究院提供的全民健保申報資料進行橫斷面研究，以2002年診斷碼(ICD-9-CM)為493的氣喘病患為研究對象。使用二部模型(two-part model)的迴歸分析。P<0.05視為具有統計學上顯著的意義。共有416,446位氣喘病患於2002年使用西醫門診，其中有5,928位患者(1.4%)曾使用中醫門診，開立的處方有26,570筆。在有無使用中醫的勝算比方面，年齡別於31-45歲呈現高峰(OR = 1.72; 95% CI = 1.51-1.95)；曾使用急診者有較高使用中醫的可能(OR = 2.81, 95% CI = 2.63-3.01)；較傾向利用中醫的共併症為高血壓、上呼吸道感染、慢性鼻炎&鼻竇炎、過敏性鼻炎、慢性阻塞性肺病、中耳炎、結膜炎、消化性潰瘍，及慢性肝病；納保金額在31801元以上、主要就醫場所在醫學中心、居住在每萬人口有7位以上的中醫師，及每萬人口有10家以上的診所之地區，最有可能使用中醫。在中醫處方模式方面，前十名最常被使用的君方依序為定喘湯、小青龍湯、麻杏甘石湯、蘇子降氣湯、辛夷清肺湯、辛夷散、葛根湯、射干麻黃湯、華蓋散，及麥門冬湯；其中最常不添加任何單味藥的方劑為定喘湯、小青龍湯、辛夷清肺湯、辛夷散，及葛根湯；最常添加地龍的方劑為射干麻黃湯、華蓋散，及麥門冬湯；而蘇子降氣湯最常添加杏仁，麻杏甘石湯最常添加葶藶子。 Asthma is one of the most common chronic diseases in the world. Few studies investigated the utilization of traditional Chinese medicine (TCM), particularly by a large-scale surveillance in Taiwan. We undertook a survey to analyze the prevalence and factors associated with TCM using entire asthma population in Taiwan, and to define the most common drug-use patterns of CHM with sovereign formula prescriptions in treating asthma. For our study, the database of all asthma patients whose diagnosis number (ICD-9-CM) is 493 in 2002 was provided by the National Health Insurance (NHI) for research purpose. The two-part model regression was used for analysis. A significance level was set at 0.05. A total of 416,446 patients with asthma used ambulatory Western services in 2002. Among them, 5,928 (1.4%) used TCM outpatient services, representing 26,570 TCM drugs uses, were screened during the study period. In the one side, the odds of TCM utilization were increased with age to a peak in the 31-45-year-group (OR = 1.72; 95% CI = 1.51-1.95). Asthma patients with emergency service utilization (OR = 2.81, 95% CI = 2.63-3.01) were more likely to use TCM. Comorbidities associated with higher TCM used were hypertension, upper respiratory tract infection, chronic rhinitis & sinusitis, allergic rhinitis, COPD, otitis media, conjunctivitis, peptic ulcer and chronic liver disease. Asthma patients with highest level of insurance premium, seeking care at medical center and living at areas with higher number of Chinese physicians per 10,000 population and higher number of clinics per 10,000 population have the largest odds of TCM use. In the other side, the top 10 monarch Chinese herbal formula with sovereign formula prescriptions was Ding-Chuan-Tang (DCT) (21.85%), followed by Xiao-Qing-Long-Tang (XQLT) (14.52%), Ma-Xing-Gan-Shi-Tang (MXGST) (7.10%), Su-Zi-Jiang-Qi-Tang (SZJQT) (3.21%), Shin-Yi-Qing-Fei-Tang (SYQFT) (3.18%), Shin-Yi-San (SYS) (3.13%), Ge-Gen-Tang (GGT) (2.56%), She-Gan-Ma-Huang-Tang (SGMHT) (2.03%), Hua-Gai-San (HGS) (1.66%), and Mai-Men-Dong-Tang (MMDT) (1.58%). For DCT, XQLT, SYQFT, SYS, and GGT, no adding single Chinese herb was the most commonly modification of a prescription (16.43%, 21.64%, 53.29%, 19.93%, and 58.84%, respectively). For SGMHT, HGS, and MMDT, Di-Long (Lumbricus) was the most commonly added herb (29.35%, 36.33%, and 32.87%, respectively). For SZJQT, Xing-Ren (Semen armeniacae amarum) was the most commonly added herb (18.38%). For MXGST, Ting-Li-Zi (Semen lepidii seu descurainiae) was the most commonly added herb (18.21%).
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