| 摘要: | 目的：根據美國USRDS最新報告指出，2008年台灣末期腎臟病(End-Stage Renal Disease，ESRD)的盛行率排名為世界第一，發生率則降為第三。本研究旨在探討慢性腎臟病患透析前三年醫療費用、看診次數、看診型態與對照組的差異以及看診型態一(包含中西醫皆沒看、僅看中醫、僅看西醫、中西醫皆有看)及看診型態二(包含中西醫皆沒看、僅看中醫、僅看西醫、中西醫皆有看(間隔兩個月以內) 、中西醫皆有看(間隔兩個月以上))與是有無接受透析治療的相關分析。
研究方法與結果：本研究以2005年承保抽樣歸人檔分析全民健保資料庫2000~2007年新發生末期腎臟病患透析前的醫療利用，並依性別、出生年進行1:5配對一般民眾為對照組進行回溯性病例對照研究。本研究新發生末期腎臟病患共2136名，而經由配對後對照組共10680名，以成對樣本T檢定比較末期腎臟病患者與對照組前三年、二年、一年總醫療費用差異，結果顯示病例組前三年分別較對照組高出22,985元、28,242元、52,827元，且均有達統計上顯著差異(p<0.001)，而比較西醫內科看診費用前三年、二年、一年差異，結果顯示病例組前三年分別較對照組高出17,190元、22,107元、34,352元，且均有達統計上顯著差異(p<0.001)，而比較西醫看診次數前三年、二年、一年差異，結果顯示病例組前三年分別較對照組高出7.71次、9.26次、12.36次，而中醫看診次數、住院費用、與住院天數，病例組皆高於對照組，並達統計上顯著差異(p<0.001)。且經由多變量條件式羅吉斯迴歸分析(multivariate conditional logistic regression)結果顯示，在控制其他因素之下，前三年、二年、一年兩個月內同時看中西醫內科門診者其發生末期腎臟病風險依序為1,66、1.8與3.62倍，而中西醫內科門診皆有看但間隔時間未在兩個月內者其前三年與前兩年發生末期腎病風險未顯著高於未看病者，但前一年則較未看病者高2.65倍的風險罹患末期腎病，且達統計上顯著差異。
結論：從研究結果可知，透析組即使在需要透析前三年總醫療費用、中西醫內科門診費用、僅腎臟內科費用、中醫看診次數、西醫看診次數、住院天數、住院費用仍顯著高於對照組，且兩個月內同時看中西醫內科門診者其發生末期腎臟疾病風險最高，可能表示仍有因未知的中西藥藥物交互作用，而使得慢性腎臟病患需要透析的風險提高，且隨者時間演進，得知自己有腎臟疾病之患者，將會尋求更多元更不同的醫療，以求治癒。
Background：According to USRDS ( The United States Renal Data System ) Report，the incidence rate in Taiwan in 2008 is the third degree in the world. The prevalence rate in Taiwan in2008 is the highest in the world. The purpose for this study is to investigate the relationship between medical behaviors of health service utilization and ESRD about patients with chronic renal disease in pre-dialysis Stage.
Methods: Using the National Health Insurance Database published from 1996 to 2007 by National Health Research Institute, Patients with ESRD are defined as those who had catastrophic illness registration cards for ESRD and started renal replacement therapy. There are 2136 patients in the case group. We conduct 1:5 matched method to choose control group. There are 10,680 people in the control group.
Results: In the past three years before dialysis, case groups have higher total west outpatient costs than control group. The series total west outpatient costs are 22,985、28,242 and 52,827 in the past three years. To compare only western outpatient costs, the difference western outpatient costs between case group and control group are 17,190、22,107、34,352 in the past three years. Case groups have higher western outpatient frequency、 traditional Chinese medicine outpatient frequency、 inpatient costs、 inpatient days than control groups. The results of multivariate conditional logistic regression, the patients who use both Chinese / western medicine have higher risk to obtain ESRD.
Conclusion: There may be something unknown about Chinese medicine and Western medicine interactions. In the future we can explore interactions about Chinese medicine and Western medicine. |
