接受單一藥物治療兒童氣喘病人醫療資源耗用之長期縱貫性研究

研究目的：兒童氣喘是世界各國重要的公共衛生議題。本研究目的主要在探討各種因素對於接受藥物治療的兒童氣喘病患之醫療資源耗用的影響，以及目標族群就醫後四年內醫療資源耗用之變化趨勢和主要預測因子分析。研究方法：本研究採用國家衛生研究院所提供之2000年全民健保百萬抽樣歸人檔擷取2004-2006年期間主診斷氣喘且年齡3-14歲兒童的就醫資料進行回溯性次級資料庫的縱貫性研究分析(Longitudinal Study)。首先，探討不同人口學特性、醫療機構特性、處方型態、就醫科別、就醫季節的兒童氣喘新增個案就醫後四年內各項醫療資源耗用的差異。接著，再進一步利用廣義估計方程式(Generalized Estimating Equation；GEE)探討目標族群就醫後四年期間醫療資源耗用之變化趨勢以及重要預測因子分析。研究結果：本研究所分析的兒童氣喘新增個案數共4,874位。結果發現，在就醫後四年期間，年齡層3-6歲的氣喘病童之平均門診次數(97.2次 vs. 65.5次, P<0.001 )、門診費用(新台幣53,081元 vs. 新台幣36,260元, P<0.001)、住院天數(1.6天 vs. 0.8天, P<0.001)、住院費用(新台幣6,590元 vs. 新台幣3,320元, P<0.001)、及總氣喘相關費用(新台幣59,671元 vs. 新台幣39,579元, P<0.001)均顯著高於年齡層7-14歲之氣喘病童；男性氣喘病童較女性病童有較高的住院費用(新台幣5,734元 vs. 新台幣3,969元, P=0.026)及總氣喘相關醫療費用(新台幣52,389元 vs. 新台幣46,617元, P=0.013)。趨勢分析顯示接受藥物治療的氣喘兒童之各項醫療資源耗用用皆大致呈現逐年減少的趨勢。預測因子分析則顯示3-6歲年齡層、男性等因子是兒童氣喘病人醫療資源耗用的主要正向預測因子；就醫科別耳鼻喉科與家醫科是主要的負向預測因子。結論與建議年齡層、性別、就醫科別等因子是兒童氣喘病人醫療資源耗用的主要預測因子。建議衛生主管機關應針對高醫療耗用的兒童氣喘族群擬定更完善的疾病管理方案並且落實執行。唯有如此，才能使其病情得到有效的控制，從而減少國內兒童氣喘的疾病負荷。

關鍵字

兒童氣喘；醫療資源耗用；廣義估計方程式；長期縱貫性研究

並列摘要

Objective: The disease burden of asthma in childhood is a major public health issue worldwide. The aim of this study is to investigate the trends and major predictors of the medical resource utilization among asthmatic children under monotherapy in Taiwan. Methods: A retrospective longitudinal study was conducted by using Panel Claim Data of National Health Insurance Beneficiaries in Taiwan. Outpatients between 3 and 14 years of age under monotherapy were enrolled if the main diagnostic code were 493.xx during 2004-2006. Impacts of demographic characteristics, characteristics of medical care organizations, prescription patterns, clinical specialties, and seasons on medical resource utilization were evaluated. Furthermore, generalized estimating equations (GEE) was used to analyze the trends and major predictors of medical resource utilization among the target population. Results: A total of 4,874 asthmatic children were enrolled in this study. Mean outpatient visits (97.2 vs. 65.5 visits, P <0.001), outpatient costs ($NTD 53,081 vs. $NTD 36,260, P <0.001), length of hospital stay (1.6 days vs. 0.8 days, P <0.001), hospital costs ($NTD 6,590 vs. $NTD 3,320, P <0.001), and total mean costs($NTD 59,671 vs. $NTD 39,579, P <0.001) of asthmatic children 3-6 years of age were significantly higher than those of 7-14 years of age; male patients had higher mean hospital costs ($NTD 5,734 vs. $NTD 3,969, P = 0.026) and total mean costs ($NTD 52,389 vs. $NTD 46,617, P = 0.013) than female patients. Medical resource utilization was presented with a significantly decreasing trend during the period of 4 years after diagnosis. Age group of 3-6 year-old, and male gender were positively correlated with medical resource utilization, while clinical specialties of ENT and family medicine were negatively correlated with it. Conclusion: Age group, gender, and clinical specialty are major predictors of medical resource utilization among asthmatic children. It is suggested that the health authorities develop a disease management program for asthmatic children with high medical utilization to enhance the control level of the disease, and thereby reduce the disease burden of asthma in childhood.