罹癌醫師醫療資源利用及醫療療效之研究

The medical resources utilization and medical outcomes among physicians with cancers

顏淯璇(Yu-Shiuan Yen)

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在職專班/碩士(2018年)

摘要

研究目的
全民健保自1995年正式實施，醫學醫療科技的進步，腫瘤不再只有開刀切除之治、也因面臨醫療成本提高的窘境，透過整合性的個案管理方式，期待能有攺善醫療資療耗用在醫療療效之研究後及提升生活品質；本研究目的首先探討罹癌醫師其人口學特性、臨床特性與機構特性之長期趨勢，接著探討罹癌醫師其醫療資源利用之長期趨勢及其重要相關影響因子，最後探討罹癌醫師其醫療療效(再復發、死亡率)之長期趨勢及其重要相關影響因子。
研究方法
本研究針對接受住院治療罹癌醫師為研究對象，採回溯性緃性研究設計，以全民健康保險資料庫進行研究；資料收集期間為1997年至2013年共17年。運用卡方趨勢分析評估罹癌醫師個人特性、臨床特性與機構特性長期趨勢之攺變狀況，線性複迴歸分析以及Cox存活分析，探討罹癌醫師在十七年期間醫療資源耗用與醫療療效之趨勢變化及其重要相關影響因素。
研究結果
本研究罹癌醫師針對國家衛生研究院全民健保資料庫百萬人抽樣檔，共有175位，其發生罹癌為97,289人年，罹癌的發生率每千人為1.80，相對的，一般民眾共有79757位，其發生罹癌為10,565,379人年，罹癌的發生率每千人為7.55，以一般民眾罹癌者當參考組，罹癌醫師的風險為一般民眾的0.24(95%CI 0.21-0.28)，顯著比一般民眾罹癌風險為低；罹癌人員共計有79,932人，經由傾向分數1：10配對後，一般民眾有1,730人，醫師有173人，平均年齡為59.94歲與59.49歲。一般民眾男性為1,551人(89.7%)，女性為179人(10.3%)；男性醫師為157人(90.8%)，女性為16人(9.2%)(P=0.747)。

結論與建議
本研究結果發現醫師與一般民眾在罹癌後續的醫療資源耗用及醫療療效並没有顯著性差異，罹癌醫師並没有自身接受專業的醫療知識及豐富的診療經驗，進而高度耗用醫療的資源，也没有提早接受醫療治療或提早接受癌症預防。建議罹癌醫師身為專業醫療人員，在平時工作忙碌之餘，更應該要加倍的愛護自己的身心健康，這樣才能早期預防或早期發現及積極投入治療，提高自身的生活品質。

關鍵字

罹癌醫師 ； 趨勢分析 ； 醫療資源利用 ； 醫療療效

並列摘要

Purpose

National Health Insurance system has formally implemented in 1995. With the advancement in medical technology, treatments for tumors are not limited to removal. However, medical costs are on the increase. Hence, with the integration of case management, studies of medical treatments expected to present improvement in efficacy of medical resources and in quality of life. This study first explores the long-term trends in the demographic, clinical, and institutional characteristics of physicians with cancers, and then explores the long-term trends in the use of medical resources by the physicians with cancers as well as important relevant factors. Finally, this study discusses the long-term trends of medical treatment (recurrence, mortality) for the physicians with cancers and relevant factors.
Methods
This study aimed at the treatment for inpatients who are physicians with cancer as the research object. The research design of this study is retrospective, which makes analysis of the data from National Health Insurance from 1997 to 2013. Chi-squared trend analysis is applied to assess the long-term trends in personal, clinical, and institutional characteristics of the physicians with cancer who are patients. Linear Multiple Regression Analysis and Cox Model Analysis are employed to explore the changes of how the medical resources are used and how effective the medical treatment is for the patients within 17 years, as well as relevant influential factors.

Results

In total, 79,932 cancer patients were included in this study. With Propensity Score Matching of 1:10, 1,730 participants were general population, and 173 were doctors. The average age of the former is 59.94 years, and the latter, 59.49 years. General public of male accounts for 1,551 (89.7%), and female, 179 (10.3%); male doctors accounts for 157 (90.8%), and females, 16 (9.2%) (P=0.747). In terms of total medical expenses, there was a significant correlation with the subjects, ages, CCI index, insurance levels, hospital levels, and the medical treatment (P<0.01), but there was a significantly positive correlation between the general population and medical expenditures (P=0.088). In terms of inpatient days and outpatient visits, there was no significant correlation in the general population or the doctors (P=0.595 & P=0.764). In terms of tumor metastasis for the doctors, there was also no significant correlation compared to the general population (OR=0.93, 95% CI=0.12~7.30). In terms of survival time, the average survival time for doctors was 169.6 months, and the general population, 156.9 months. There was also no significant difference between the two groups (P=0.061).
Conclusions and Suggestion

The results of this study found that there is no statistically significant difference between the doctors and the general population in terms of the expenditure of medical resources and the effectiveness medical treatments for cancers. The doctors who suffer from cancers do not take advantage of medical resources, nor do they receive medical treatment or take any precaution against cancers earlier. As professional medical personnel, physicians who suffer from cancers are advised to take extra care of their own physical and mental health when they are off-duty. Hence, the physicians with cancers should take necessary precaution or receive medical treatment to improve quality of life, once being diagnosed with cancers.

並列關鍵字

physicians with cancer ； trend analysis ； medical resource utilization ； medical efficacy

參考文獻

Chen, T.-Y., et al. (2017). "Higher risk for thyroid diseases in physicians than in the general population： a Taiwan nationwide population-based secondary analysis study." QJM： An International Journal of Medicine110(3)： 163-168.

Doll, R. and R. Peto (1977). "Mortality among doctors in different occupations." Br med j1(6074)： 1433-1436.

Eriksson, M., et al. (1998). "Increased cancer incidence in physicians, dentists, and health care workers." Oncology reports5(6)： 1413-1421.

Hsu, Y.-H., et al. (2015). "A comparison of the stages at which cancer is diagnosed in physicians and in the general population in Taiwan." Canadian Medical Association Journal187(13)： E412-E418.

Innos, K., et al. (2002). "Cancer incidence and cause-specifi c mortality in male and female physicians： a cohort study in Estonia." Scandinavian journal of public health30(2)： 133-140.