- 學位論文
台灣巴金森氏症患者確診前後一年醫療利用及其與非巴金森氏症患者之比較
The utilization of health care services before and after the diagnosis of Parkinson’s disease and the comparison with those without Parkinson’s disease in Taiwan
摘要
研究背景與目的：巴金森氏症是一個慢性且漸進之神經退化疾病，好發於老年人族群，其盛行率僅次於阿茲海默氏症，是重要的老人疾病。病程初期之症狀不定也未必明顯，且至今未有生理指標可幫助確診，患者通常因出現症狀而就醫，卻無法得到解釋，造成四處求醫的現象。本研究主要目的在於探討巴金森氏症患者於確診前及後之門診醫療利用有無差異，透過此探討確診前後對病患就醫行為之影響。另外，亦探討巴金森氏症患者確診前、後之門診醫療利用，與非巴金森氏症之患者在同一段期間有無差異。 研究方法：本研究資料來自國家衛生研究院之全民健康保險研究資料庫之2005年一百萬人承保抽樣歸人檔，所使用之子檔包含門診處方及治療明細檔(CD)、醫事機構基本資料檔(HOSB)、住院醫療費用清單明細檔(DD)、門診處方醫令明細檔(OO)及承保資料檔(ID)。採用隨機對照研究，研究對象有兩組，分別為巴金森氏症確診個案(個案組)與非巴金森氏症者(對照組)。個案組擷取於2008年兩次主診斷碼為332.0，且前一年沒有此主診斷就醫紀錄之病人謂之確診，即納入個案(共222人)，另外，經性別、年齡、查爾森共病指數等匹配後，使用1:2之比例隨機選取對照組(共444人)，比較個案組確診前後一年期間，兩組樣本在同期間醫療利用的差異。使用配對樣本t檢定、獨立樣本t檢定及廣義估計方程式等統計方法進行分析。 研究結果：巴金森氏症患者確診後一年與確診前一年相比，門診利用次數無顯著改變，門診總費用增加，總藥費增加；巴金森氏症患者與非巴金森氏症之患者間，確診前一年及確診後一年總門診利用次數較多，門診費用較高；控制其他變項後，巴金森氏症患者相對於對照組確診後一年較確診前一年之總門診利用次數不變、神經科門診次數增加，門診總費用增加，門診總藥費增加、住院總次數無顯著改變、住院醫療費用無顯著改變。 研究結論：巴金森氏症患者與非巴金森氏症患者比較，不論確診前後，其利用門診之次數及費用均較多。且確診使巴金森氏症患者對於醫療利用之需求增加，個案組和對照組間之醫療利用差距更大。
並列摘要
Background and objectives: Parkinson’s disease (PD) is a chronic progressive neurodegenerative disorder, which mostly appears in elderlies. As an important disease for old people, PD’s prevalence rate is slightly lower than that of Alzheimer’s disease. In the early stage of PD, the symptoms are not obvious. Until now, there is no physiology criteria used in PD diagnosis. Therefore, patient will seek for medical explanations by visiting multiple hospitals or clinics as PD’s symptom emerges. The aim of this study was to examine the medical utilization of the PD patients before and after they were diagnosed , and compare it with those who did not have PD to find out the impacts that PD on patients’ medical seeking behavior. Methods: The data are selected from National Health Insurance Research Database from 2007 to 2009. As a case-control design is used, we have 2 groups of study targets. A total 222 patients diagnosed with PD (ICD-9 code 332.0), treated with PD medications in 2008 and without any PD diagnosis in 2007 are the case group. Other 444 patients who were randomly match by sex, age and “level of the most frequently visited institution” serves as control group. The medical care utilization by the case group within 1 year before and after diagnosis is explored and compared to that of the control group. The study used paired-sample t test, independent two sample t test and General Estimation Equation (GEE) to test the hypotheses. Results: The ambulatory expenditure (total fees, drug fees) of PD patients after diagnosis was significantly higher than they did before diagnosis, while the number of ambulatory visits did not have significant change. PD patients used significantly more ambulatory services (total clinics visits, total fee) than control group before and after diagnosis. The diagnosis has no significant effect on hospitalization care. Conclusions: PD patients used significantly more ambulatory services than control group before and after diagnosis. The diagnosis increases the medical need of PD patients.
參考文獻
延伸閱讀
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