台灣非愛滋替代治療藥癮者全民健康保險資源使用情形探討

Medical care utilization under National Health Insurance by people with heroin addiction enrolled in a methadone substitution treatment program

黃紀諺(CHI-YEN HUANG) ； 董鈺琪(YU-CHI TUNG) ； 諶立中(LIH-JONG SHEN) ； 鄭淑心(SHEU-SHIN CHENG) ； 洪嘉璣(CHIA-JI HUNG) ； 楊銘欽(MING-CHIN YANG)

《台灣公共衛生雜誌》 38卷5期 (2019/10) Pp. 498-508

https://doi.org/10.6288/TJPH.201910_38(5).107067

摘要

目標：我國於2009年起對非愛滋病之藥癮者提供治療補助，本研究以回溯性世代研究法，探討穩定使用美沙冬替代治療與否，對於藥癮者健保使用之影響。方法：以2009至2014年間之美沙冬替代治療藥癮者作為研究樣本，以傾向分數加權後使用加權複迴歸分析美沙冬替代治療之穩定組與中斷組間健保資源使用情形之差異。結果：在門急診點數對數值之加權複迴歸檢定結果顯示，在控制性別、年齡、收入、就醫場所層級別、權屬別、地區別後，穩定組年平均門急診點數對數值比中斷組增加9%（p=0.0023）；在門急診就醫次數部分之卜瓦松複迴歸分析結果顯示，控制前述變項後，穩定組年平均門急診次數較中斷組增加14%（p＜0.001）。結論：穩定組之健保門急診之年平均次數、年平均點數對數值都顯著高於中斷組，惟傾向權重配分後之中斷組年平均住院點數多於穩定組，雖未達統計上顯著差異，仍可後續研究探討其原因。

關鍵字

美沙冬替代治療 ； 藥癮者 ； 全民健康保險資源使用 ； 傾向分數

並列摘要

Objectives: Since 2009, the Taiwanese government has subsidized treatment for non-AIDS-related drug addiction. The aim of this retrospective cohort study was to investigate the effect on National Health Insurance (NHI) resources of treatment for people with addiction who enrolled in a methadone substitution treatment program. Methods: Data from 2009 to 2014 of people with drug addiction who were treated with methadone were collected as samples. Analytical tools such as the Inverse Probability of Treatment Weighting (IPTW), which is based on propensity score and weighted multiple regression, were used to further compare the use of NHI resources by the stable-treatment and interrupted-treatment groups. Individual characteristics of sex, age, and income level were controlled for in addition to the level, ownership, and Bureau of NHI branch of the medical institution. Results: According to the weighted multiple regression analysis results of the NHI point values of the outpatient and emergency departments, the NHI point values of the stable-treatment group increased by 9% relative to the interrupted-treatment group (p = 0.0023). The results of a Poisson regression on the NHI utilization frequency of outpatient and emergency department visits indicated that with the same control variables, the average NHI utilization frequency of the stable-treatment group increased by 14% relative to the interrupted-treatment group (p ＜ 0.001). Conclusions: Among people with addiction who enrolled in the methadone substitution treatment program, those in the stable-treatment group had not only higher logarithmic NHI point values but also higher NHI utilization frequency in their outpatient and emergency department visits compared with the interrupted-treatment group. Although no statistical significance was observed, further research should investigate why, after IPTW, the average annual inpatient point values for the interrupted-treatment group were higher than those for their stable-treatment counterparts.

並列關鍵字

methadone substitution treatment program ； drug addicts ； National Health Insurance utilization ； propensity scores

參考文獻

廖定烈、陳保中：美沙冬門診患者感染症及肝功能狀況。台灣法醫學誌 2014；6：17-22。doi:10.6134/tjfm.2014.0601.02。Liao DL, Chen PC. Infections and liver function in methadone maintenance patients. Taiwan J Forensic Med 2014;6:17-22. doi:10.6134/tjfm.2014.0601.02. [In Chinese: English abstract]

李元民、吳坤駿、蔡坤霖：台灣地區注射藥癮者間C型肝炎基因型之流行病學變化。內科學誌 2010；21：172-6。doi:10.6314/jimt.2010.21(3).02。Lee YM, Wu KJ, Tsai KL. The changing epidemiology of hepatitis C virus genotypes among injecting drug users in Taiwan. J Intern Med Taiwan 2010;21:172-6. doi:10.6314/jimt.2010.21(3).02. [In Chinese: English abstract]

廖敏策、吳雅潔、朱士傑、吳清平、蔡適鴻：海洛因濫用患者之照護。內科學誌 2009；20：139-47。doi:10.6314/jimt.2009.20(2).05。 Liao MT, Wu YC, Chu SJ, Wu CP, Tsai SH. The care of patients with heroin addiction. J Intern Med Taiwan 2009;20:139-47. doi:10.6314/jimt.2009.20(2).05. [In Chinese: English abstract]

秦文鎮、張永源、侯瑞瑜、蔡毓瑄、黃心蔓。美沙冬替代療法對於海洛因成癮者藥物濫用信念及生活適應之成效分析。台灣衛誌 2010；29：420-30。doi:10.6288/tjph2010-29-05-05。Chin WC, Chang YY, Hou JY, Tsai YH, Huang HM. The effectiveness of methadone maintenance treatment on beliefs about drug abuse and life adjustment among heroin addicts. Taiwan J Public Health 2010;29:420-30. doi:10.6288/tjph2010-29-05-05. [In Chinese: English abstract]

Adrish M, Duncalf R, Diaz-Fuentes G, Venkatram S. Opioid overdose with gluteal compartment syndrome and acute peripheral neuropathy. Am J Case Rep 2014;15:22-6. doi:10.12659/ajcr.889954