以價值為基礎的下背痛物理治療

以價值為基礎的醫療照護理念結合了實證醫學、比較成效研究、以個案為中心的照護三大概念，提倡醫療照護應兼顧成本效益，有科學實證支持，並考量個案主觀的喜好。本文的目的是檢視臺灣下背痛個案接受物理治療現況，並比較其與臨床指引建議之異同，以瞭解臺灣下背痛個案是否接受以價值為基礎的物理治療。本文分析2011年全民健保研究資料庫呈現之臺灣下背痛個案接受各類物理治療項目之申報狀況，並與9份下背痛臨床指引的建議相比較。大部分臨床指引建議治療下背痛個案使用運動治療與徒手治療，不建議使用熱療、牽引、電療；而我國下背痛物理治療申報以熱療、牽引、電療為主，運動治療與徒手治療申報比例偏低，與臨床指引的建議以及價值取向之醫療相悖離。建議中央健保署應依據實證醫學證據修改物理治療支付制度，讓個案得到以價值為基礎的物理治療，避免無謂的健保支出，讓健康保險與醫療體系能永續經營。

關鍵字

價值為基礎的醫療照護；實證醫學；下背痛；物理治療

並列摘要

Value-based medicine incorporates three concepts: evidence-based medicine, comparative effectiveness research, and patient-centered care. Under this framework, health care is delivered based on scientific evidence while taking into account its cost-benefit and patients' preference. This paper contrasts the current practice of physical therapy for low back pain in Taiwan and the recommendations of nine clinical guidelines to determine if patients receive value-based physical therapy. The 2011 National Health Insurance Research Database were analyzed to show the utilization of different physical therapy modalities and compared the results to recommendations made by nine clinical guidelines. The majority of the nine clinical guidelines did not recommend the use of heat therapy, lumbar traction, and electrotherapy to treat low back pain but instead recommend exercise and manual therapy. The majority of the claims for low back pain treatment were for the treatment combinations of heat therapy, lumbar traction, and electrotherapy. Exercise and manual therapy constitutes lower percentages of the insurance claims. The National Health Insurance Administration should revise the reimbursement rules based on clinical evidence to allow patients with low back pain to receive value-based physical therapy. This will reduce unnecessary health insurance expenditure and ensure the long-term sustainability of the National Health Insurance in Taiwan.

並列關鍵字

Value-based medicine ； Evidence-based medicine ； Low back pain ； Physical therapy

國際替代計量

以價值為基礎的下背痛物理治療

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