- 學位論文
以臺灣健保資料庫探討小兒門診氣喘病患中西藥處方型態
The Prescription Patterns of Western and Chinese Medicine of Young Asthma Patients Using Taiwan National Health Insurance Claim Data
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摘要
研究目的： 小兒門診氣喘病患處方箋中西藥物處方型態分析。 研究方法： 橫斷性(cross-sectional)描述研究。 研究結果： 2007年15歲以下、主診斷為氣喘之小兒門診氣喘病患共10,241人，其中，只看西醫10,068人(98.31%)、合併中西醫105人(1.03%)、只看中醫68人(0.66%)。年齡在8歲以上只用中醫以及合併中西醫的百分比(約6-9%)較8歲以下(約1-2%)的族群高。 年齡分佈以4歲至7歲的年齡層最多，共4,783人(約50%)；性別分佈男性約60%、女性約40%。醫療院所層級以基層診所最多(約70%)；健保分局別以台北分局為主(約30%)，東區分局在4-7歲以及8-11歲族群只用中醫以及合併中西醫的百分比高於其他分局(6-9%)。 就醫科別方面，只看西醫部分，0-3歲族群約有80%以小兒科為主、其他20%；4-7歲族群約有70%以小兒科為主、其他30%；8-11歲族群約有65%以小兒科為主、35%其他；12-15歲族群約有50%以小兒科為主、其他50%。 共病症方面，次診斷有過敏性鼻炎或是異位性皮膚炎的診斷，當年度有共病症診斷約20-30%、沒有共病症約70-80%，只看中醫的病患共病症的百分比低於只看西醫以及合併中西醫的百分比。 當年度急診及住院的醫療利用方面，當年度曾經使用急診或住院的診斷約25%、沒有使用約75%，12-15歲族群使用急診和住院的百分比最少。 平均處方箋數方面，只看西醫部分以4-7歲平均處方箋3.04張最多；合併中西醫部分以8-11歲平均處方箋8.84張最多；只看中醫部分以4-7歲平均處方箋3.52張最多。 小兒門診氣喘病患總處方箋共28,517張，只用西藥27,532張處方箋(96.55%)、只用中藥199張處方箋(0.70%)、合併中西藥786張處方箋(2.75%)；參加「全民健康保險氣喘醫療給付改善方案」處方箋5,821張(20.90%)、未參加處方箋22,181張(70.10%)；參加「小兒氣喘緩解期中醫優質門診照護試辦計畫」41張處方箋(8.63%)、未參加434張處方箋(91.27%)。 處方開立氣喘西藥劑型部份，只用西藥處方箋與合併中西藥的處方箋當中，開立吸入劑型最少(分別為7%、10%)、開立口服劑型最多(分別為76%、64%)、開立吸入加口服劑型次之(分別為17%、26%)。在參加或未參加「全民健康保險氣喘醫療給付改善方案」的處方箋當中，開立吸入劑型最少(分別為13%、5%)、開立口服劑型最多(68%、78%)、開立吸入加口服劑型次之(19%、17%)。 處方開立氣喘西藥數量部分，在只用西藥處方箋與合併中西藥處方箋皆以開立一種氣喘用藥為主(分別為48%及33%)。在參加或未參加「全民健康保險氣喘醫療給付改善方案」的處方箋當中，也是開立一種氣喘用藥最多(分別為54%和47%)。 處方開立氣喘西藥排名，在只用西藥和中西藥並用處方箋中，口服乙型交感神經興奮劑在只用西藥的處方箋排名第一(20%)；白三烯受體拮抗劑與口服乙型交感神經興奮劑、口服類固醇類加上口服乙型交感神經興奮劑三種氣喘用藥皆為並用中西藥排名第一的藥品(各為11%)。在參加或未參加「全民健康保險氣喘醫療給付改善方案」的處方箋當中，參加組以白三烯受體拮抗劑最多(23%)、未參加組以口服乙型交感神經興奮劑最多(23%)。 處方開立氣喘中藥複方數量方面，在只用中藥和合併中西藥的處方箋當中，以開立一種氣喘中藥複方的處方箋為主(80%及62%)。在參加或未參加「小兒氣喘緩解期中醫優質門診照護試辦計畫」處方箋當中，也是以開立一種氣喘中藥複方為主(61 %與70%)。 處方開立氣喘中藥複方排名，在只用中藥處方箋中，排名第一為治療氣喘實症的小青龍湯(30%)、在合併中西藥處方箋中排名第一的為治療氣喘實症的定喘湯(20%)。在參加「小兒 [鍵入文字] v 氣喘緩解期中醫優質門診照護試辦計畫」排名第一的是治療氣喘虛症的蘇子降氣湯(44%)、未參加組排名第一的是治療實症小青龍湯( 24%)。 結論: 小兒氣喘門診病患共10,241人，以男性、4歲至7歲、基層診所、台北健保分局為主要的分佈族群，就醫科別以小兒科為主，沒有共病症、當年度沒有使用急診或住院的人數百分比多於有共病症以及有使用急診或住院的人數百分比。在8歲以上的族群使用中醫或合併中西醫的百分比大於8歲以下的族群。 小兒門診氣喘處方箋共28,517張，只用西藥27,532張處方箋、只用中藥199張處方箋、合併中西藥786張處方箋。在只用西藥或合併中西藥的處方箋皆以開立一種氣喘西藥為主，最常使用的為口服乙型交感神經興奮劑；只用中藥或合併中西藥的處方箋氣喘中藥以開立一種氣喘中藥複方為主，最常使用的為治療實症的氣喘用藥小青龍湯或定喘湯。 參加或未參加「全民健康保險氣喘醫療給付改善方案」處方箋用藥型態比較，參加組使用吸入型氣喘西藥的百分比高於未參加組，且用藥排名有差異，參加組用藥排名以白三烯受體拮抗劑為主、未參加組以口服乙型交感神經興奮劑為主。 參加或未參加「小兒氣喘緩解期中醫優質門診照護試辦計畫」處方箋用藥型態比較，參加組用藥排名以治療氣喘虛症的蘇子降氣湯為主、未參加組以治療氣喘實症的小青龍湯為主。
並列摘要
Objective: To analyze the outpatient characteristics and prescription patterns of younger asthma patients’ of both Chinese and Western medicine. Methods: Cross- sectional study Results: There are tatal 10,241 younger asthma patients devided in 3 seeking behavior: using Western medicine only (98.31%), using Chinese medicine only (0.66%) and using both Western and Chinese medicine (1.03%). The age devided in 4 groups: 0-3,4-7,8-11,12-15 years old, the 4-7 years old group having the most patients (4,783,46.70%).The 8-11 and 12-15 years old group has more percentage of using both Chinese and Western medicine and using Chinese medicine only (3%) compare to the 0-3 and 4-7 years old group(1%). The younger asthma patients’ gender percentage of male is 60% and female is 40%. Most of patients seeking for doctors in pediatric clinics (70%) at Taipei (30%). The 4-7 and 8-11 years old asthma patients having more percentage (6%) in using Chinese medicine in Eastern part of Taiwan. The percentage of younger asthma patients in ER and inpatient is about 30%, and the percentage of atopic dermatitis or allergic rhinitis co-diease is about 25%. The total prescriptions of younger asthma patients are 28,517, 27,532 using Western medicine only(96.70%), 199 using Chinese medicine only(0.55%); 786 using both Western and Chinese medicine(2.75%). Among these prescriptions, 5,821 attending the Western medicine pay-for-performance program(20.90%); 41 attending the Chinese medicine pay-for-performance program(8.63%). The prescription of inhaled type antiasthmatic medicine using in the Western medicine only group and both Western and Chinese medicine group are about 10%, the oral type are about 70%, and about 20% are both inhaled and oral type antiasthmatic medicine. The prescriptions of inhaled type antiasthmatic medicine using in the attending Western pay-for-performance group are about 13% but 5% in not attending group, the oral type antiasthmatic medicine using in the attending group are about 68% but 78% in not attending group, and using both inhaled and oral type antiasthmatic medicine are about 19% in attending group and 17% in not attending group. The total prescriptions usually have 1 antiasthmatic medicine, the number 1 antiasthmatic medicine in using Western medicine only group are oral beta-2 agonists(20%), and leukotrienes ,oral beta-2 agonists and oral corticosteroids plus oral beta-2 agonist are both the number 1 antiasthmatic medicine using both Western and Chinese medicine group(11%). The number 1 antiasthmatic medicine in attending Western pay-for-performance group are leukotrienes(23%), but the number 1 antiasthmatic medicine in not attending group are oral beta-2 agonists. The number 1 antiasthmatic Chinese medicine complex in using Chinese medicine only group are Xiao-Qing-Long Tang(30%) , and Ding-Tran-Tang are the number 1 antiasthmatic Chinese medicine complex in both using Chinese and Western medicine group.(20%). The number 1 antiasthmatic Chinese medicine complex in attending the Chinese pay-for-performance group are Suzi-Jiang-Qi-Tang(44%) and the Xiao-Qing-Long Tang in not attending group(24%). Conclusions: [鍵入文字] viii The total outpatient younger asthma patients are 10,241 in 2007, 4-7 years old male in Taiper clinics are the main groups about these patients.The patients senior than 8 years old using Chinese medicine more then the patients who younger than 8 years old. The prescription patterns of these patients are usually prescribed one antiasthmatic medicine, and the oral beta-2 agonists are the number 1 medicine. The prescription patterns of these patients are usually prescribed one antiasthmatic Chinese medicine complex,the “shizheng” medicine (Xiao-Ching-Long Tang and Ding-Tran-Tang) are the number 1 antiasthmatic Chinese medicine complex in one prescription. In attending Western pay-for-performance group’s prescriptions, the inhaled type of antiasthmatic medicine having more percentage than not attending group, and the number 1 antiasthmatic medicine are not the same. In attending Chinese pay-for-performance group’s prescriptions, the number 1 antiasthmatic Chinese medicine complex are not the same compare with not attending group.
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