探討慢性阻塞性肺部疾病吸入型藥物遵從性之研究

Adherence in Inhalation Drug among Chronic Obstructive Pulmonary Disease Patient

李淑玲(Shu-Lin Lee)

指導教授 ： 許弘毅

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士班/碩士(2016年)

摘要

研究目的
探討吸入型藥物對慢性阻塞性肺疾病（COPD）之服藥順從性對於疾病發展長期趨勢及相關影響因子並瞭解吸入型藥物服藥順性，是否引響疾病發展與醫療資源耗用分布趨勢之影響。

研究方法
本研究為回溯性觀察型研究，研究材料取自全民健保百萬歸人檔資料，指標日期為2004年至2008年。研究對象為指標日期檔案內初次在確診為慢性阻塞性肺疾病（COPD）其ICD-9診斷碼為496之患者。確診定義為其2004至2008年1-12月一年期間並含有吸入型藥物處置碼之患者，以吸入型藥品使用天數來換算藥品持有率(medi
-cation possession ratio, MPR)，瞭解慢性阻塞性肺疾病（COPD）之服藥順從性探討相關影響因子。

研究結果
依2004年至2012年全民健保百萬歸人檔資料進行分析，透過卡方檢定及獨立樣本t檢定MPR對於城鄉屬性、社經地位、醫院權屬別、CCI指數及年齡是有顯著差異的。確診後65歲以上的患者男性門診就醫次數多於女性且第二年後費用亦會逐年增加，吸入型藥物遵從性高者門診就診次數明顯頻率較高，醫院的屬性相對會影響病患的服藥順從性。在發病後的四年後吸入型藥物服藥順從性高者其存活率較高，但在發病的前四年吸入型藥物服藥順從性高者其存活率較低。

結論與建議
目前GOLD治療共識上，吸入型藥物不只可以減輕此類病人的症
狀，更可以改善肺功能及生活品質，透過此研究更可印證。建議於
臨床上更應加強其慢性阻塞性肺疾病整合性照護並收集肺功能之數
據與mMRC 及CAT 問卷來作症狀評估，讓患者得到更好的醫療處置。

關鍵字

慢性阻塞性肺疾病（COPD） ； 服藥順從性 ； 診斷與治療

並列摘要

Objective: The study purposed to evaluate the trends of adherence in inhaled drugs for chronic obstructive pulmonary disease (COPD) patients and to explore the associated factors of influence and understanding of drug inhaled medication compliance, whether incorporated sound development of the disease affects the distribution and consumption of medical resources utilization.
Methods: This study is a retrospective observational study, and research materials from the NHI one million people return profile data from 2004 to 2008. The subjects in the target date for the first file in the diagnosis of chronic obstructive pulmonary disease (COPD) which ICD-9 diagnosis code of 496 patients. Defined as having diagnosed between 2004 to 2008 year ,January to December period and contains the patient's inhaled drug disposition codes to use inhaled medicines in terms of the number of days to hold the rate of the drug (medication possession ratio, MPR), with chronic obstructive pulmonary disease (COPD) Discussion related to the medication compliance impact factor.
Results: According to the 2004-2012 National Health Insurance one million people return profile data for analysis, t test MPR through the chi-square test and independent samples for urban and rural properties, socioeconomic status, hospital ownership do, CCI index and age there is a significant difference. After the diagnosis of male patients over the age of 65 the number of outpatient visits than women and also increase the cost of the second year, inhaled medication adherence clinic the higher frequency significantly, the relative property will affect patients’ medication compliance. In the four years after the onset of the drug inhaled medication compliance by its high survival rate higher, but in the four years before the onset of drug inhaled medication compliance by its high survival rate is low.
Conclusions and Recommendations: GOLD consensus currently on treatment, inhaled drugs not only can relieve the symptoms of these patients, but also can improve medical outcomes. On clinical recommendations should strength its integration with chronic obstructive pulmonary disease according to care and collect data of lung function and mMRC and CAT questionnaire for assessment of symptoms, so that patients get better medical treatment.

並列關鍵字

chronic obstructive pulmonary disease (COPD) ； medication compliance ； diagnosis and treatment

參考文獻

英文文獻

1. WHO. The top 10 causes of death.at:http://www.who.int/mediacentre

/factsheets/fs310/en/#Accessed updated May ,2014.

2. National Heart, Lung, and Blood Institute, National Institutes of Health. Morbidity & mortality: 2009 chart book on cardiovascular, lung, and blood diseases.

3. 台灣胸腔暨重症加護醫學會：慢性阻塞性肺病(慢阻肺)2012診治指引。http://www.tspccm.org.tw/files/guide/COPD%E6%8C%87%E5%BC%952012.pdf。Taiwan Society of Pulmonary and Critical Care Medicine. Diagnosis and treatment guidelines of Chronic Obstructive Pulmonary Disease (COPD),2012. Available at: http://www.tspccm.org.tw/files/ guide/COPD%E6%8C%87%E5%BC%952012.pdf.