中醫肝病常用中藥處方模式與給藥行為之探討

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题名:	中醫肝病常用中藥處方模式與給藥行為之探討 The commonly used in prescription patterns and behavior of Traditional Chinese Medicine for liver disease in Taiwan.
作者:	張志煌
贡献者:	公共衛生學系碩士班
关键词:	傳統中醫;中草藥;肝病;處方模式 Traditional Chinese medicine;Chinese herbal;Liver disease;Prescription patterns;Inappropriate prescriptions
日期:	2011-07-26
上传时间:	2011-10-17 16:16:46 (UTC+8)
出版者:	中國醫藥大學
摘要:	研究目的：傳統中醫醫療利用中草藥及天然藥物治療疾病已有幾千年歷史。中草藥取材多來自於自然動植物及礦物，與西方醫學比較起來藥性較為溫和無副作用。中草藥在國內及亞洲地區使用甚為普遍，國外也逐漸以此做為西醫醫療外的重要醫療方式。中醫問診及處方開立有其學理依據，然而中草藥處方複雜，一般民眾較不易了解其中之處方藥性，容易造成藥物誤用及濫用而形成醫療漏洞。台灣為肝炎及肝病高盛行率地區，有賴於我國健保資料庫建立日斟完善，基於提供民眾及中醫師更多中草藥治療肝病患者的處方趨勢，本研究將分析近年中醫師治療肝病患者常用處方模式，並深入研究中醫師處方型態相關因素，以提供國人用藥安全及資訊參考。研究方法：本研究以國家衛生研究院所提供2004年-2008年全民健康保險資料庫之特定主題分檔為母群體資料來源，統計工具則採用SAS軟體9.2版。研究對象則以國際疾病分類診斷碼(ICD-9CM CODE)篩選出肝病患者相關診斷代碼進行研究。爾後，就時間、病患以及醫療特質，進行處方分析探討，以了解中醫師針對肝病患者所開立之處方特性及型態差異。並追述相關醫療用藥問題之使用情況。研究結果: 2004-2008年共有238,038名肝病患者使用過中醫門診，其中155,731位是男性，82,307位是女性，男性人數比例為女性的1.9倍，而平均每位肝病患者中醫門診利用次數為5.7次。2004-2008年肝病患者處方總張數共有1,358,506張，平均處方品項數為5.7項，平均處方天數為9.5天，平均處方費用則為284.6元。中醫師最常開立用來治療肝病患者的單方前三名為：丹參5.8％、茵陳蒿4.3％、虎杖2.2％。複方前三名則為：加味逍遙散9.2％、小柴胡湯6.8％、龍膽瀉肝湯6.7％。處方箋常開立用藥種數前三名為：六種16.0％、五種16.0％、四種13.5％，常開立的處方箋配伍形態前三名分別為：兩種複方加三種單方，佔總處方箋的7.1％；兩種複方加四種單方，佔總處方箋的6.6％；三種複方，佔總處方箋的5.7％。經統計檢定，處方型態與不同時間特性，病患特性以及醫療特性之間都有顯著差異。而處方用藥問題方面，經羅吉斯迴歸檢定後發現病患為男性、醫師年齡≦40歲、醫師性別為女性、醫療機構為公立醫院者不管在何種處方問題都有較高的危險勝算比。研究結論: 在肝病患者處方型態方面，不管是處方品項數、處方天數以及處方費用都有逐年增加的趨勢；而處方用藥問題在特定特質方面有較高的危險勝算比。希望相關醫療單位能針對這些問題做改善，建立屬於中藥的用藥評估制度，減少潛在的藥物不良反應並保障民眾的健康權益。 Background and aims: Traditional Chinese Medicine (TCM) have used Chinese herbal medicine (CHM) and the natural medicine for adjuvant treatment for thousands years ago. Most Chinese herbal medicine derived from natural plants, animals and minerals. It have been used in China and Asia quite commonly, and more moderate and no toxic effects than Western medicine. However, interrogation and prescribing of physicians come from personal experience, and Chinese herbal prescription is complex, the general public is not easy to understand the basis of their diagnosis and prescription, likely to cause the formation of drug misuse and health vulnerability. In addition, Taiwan is a high prevalence area of hepatitis and liver disease. It is a major factor of cirrhosis and liver cancer. The hepatitis patients’ drug treatment should be more cautious. On the other hand, the establishment of National Health Insurance Database is perfected in Taiwan. We can use it to provide the public with more information on Chinese herbal medicine practitioners prescribing trends in the treatment of patients with liver disease. This study will analyze the Chinese medicine treatment of liver disease common in recent years, prescription patterns and administration of behavior-depth study of factors related to Chinese medicine practitioners to provide the people and the drug safety information for reference. Method and material: This study collected and analyzed the National Health Insurance Research database in Ambulatory care expenditures by visits of Chinese medicine（中醫門診處方及治療明細檔）and Details of ambulatory care orders of Chinese medicine（中醫門診處方醫令明細檔） from January 2004 to December 2008. The statistical tools are used SAS software version 9.2. This study used International Classification of Diseases diagnostic codes (ICD-9CM CODE) selected patients with hepatitis-related diagnosis code, and select the payment of health insurance Bureau code of scientific research of Chinese medicine prescriptions. Thereafter, Analysis of the Prescription for five attributes: gender, age, geographic distribution, health care level and symptoms. In order to understand Chinese medicine for hepatitis patients and characteristics of the prescription pattern differences.The case of repeat prescriptions and the use of hepatotoxic herbals in Chinese medicine practitioners. Results: A total of 238,038 were used by Chinese medicine out-patients with liver disease from 2004 to 2008, of which 155,731 are male and 82,307 are female (male: female=1.9:1).The average per-patient use of the number of Chinese out-patients with liver disease was 5.7 times. The prescriptions of liver disease were 1,358,506 sheets. The mean number of medications per prescription is 5.7 items, and the averaged expense and the duration of administration are NT$284.6 and 9.5 days. Utilization of liver disease herbs, the most frequently used of single herbs are Dan-shen(5.8％) Yin-chen-hao(4.3％) and Hu-gon(2.2％).The most frequently used of herbal formula are Jia-wei-xia-yao-san(9.2％),Xiao-chai-hu-tang(6.8％) and Long-dan-xie-gan-tang(6.7％). The most frequently items of a prescription are 6 items(16.0％),5 items(16.0％), and 4 items(13.5％).The most frequently compatibility of a prescription are two kinds of herbal formula and three kinds of single herbs(7.1％).The second are two kinds of herbal formula and four kinds of single herbs(6.6％),and the thirth are three kinds of herbal formula(5.7％). By the statistical test, significant differences are found in prescription patterns with time characteristics, patient characteristics, and medical characteristics .The logistic regression test revealed that the patients were male, physicians aged ≦ 40 years old, doctors gender are female, medical institutions is public hospital who have a higher risk of inappropriate prescriptions odds ratio. Conclusions: Prescribing patterns in terms of liver disease, regardless of the number of prescription items, the number of prescription days and prescription costs are an increasing trend year by year. In addition, the prescription drug problem in some of the attributes also had a higher odds ratio. We hope that the relevant medical institutions to make improvements to address these issues, and establishing Chinese medicine drug evaluation system to reduce the potential adversing drug reactions and to protect people's health rights.
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