台灣地區老年人骨關節炎患者利用復健醫療之研究

Rehabilitation medicine utilization among the elderly osteoarthritis patients in Taiwan

林穎逸(Ying-Yi Lin)

指導教授 ： 邱政元

中山醫學大學/健康管理學院/醫療產業科技管理學系碩士班/碩士(2017年)

摘要

一、研究背景
骨關節炎係長者常見疾病，故本文將分析台灣地區老年人骨關節炎之現況，並探討察爾森共病症指標、止痛藥物治療、人工關節置換手術後，對復健科醫療資源利用情形。
二、研究方法
以台灣全民健保資料庫2000年的100萬歸人檔，選取2011-2013年65歲以上門診或住院且曾診斷為骨關節炎患者，以卡方檢定、獨立樣本T檢定統計分析，另針對有利用復健科醫療且有治療的及有利用復健科醫療但無治療者相對於無利用復健醫療進行邏輯斯迴歸分析。
三、研究結果
結果顯示年齡越大且投保地區為台北分局以外之老年人，復健科醫療利用相對於台北地區低；察爾森共病症指標，1及 2分以上，相對於0分的復健科醫療利用分別為1.34倍及1.39倍；而有進行人工關節置換手術之患者，復健科醫療利用是沒有做的0.62倍。
以完全無利用復健醫療為參考組，邏輯斯迴歸分析結果顯示，76以上有接受復健科門診但未治療相對於65-70歲復健醫療利用較低，健保投保分局於中南部地區相對於為台北地區對復健科醫療利用低，察爾森共病症指標1及2分相對於0分高，接受人工關節置換手術相對於未手術利用機率低；在未接受復健科門診亦無利用復健科醫療，中南部分局相對於台北分局利用機率低，察爾森共病症指標1、2分以上者相對於0分利用機率低，使用NSAIDs、Acetaminophen及關節腔藥物注入為未使用機率高，執行人工關節置換者為未執行手術者利用機率低。
四、研究結論
針對年紀較大於76歲以上的骨關節炎患者，且於復健醫療資源較為缺乏的中南部，地區察爾森共病症指標被評估1分以上及有接受過人工關節置換手術之患者，應多利用復健醫療，讓復健科醫師診斷是否需進一步復健治療。

關鍵字

骨關節炎 ； 復健科 ； 醫療利用

並列摘要

Objective
Osteoarthritis is a common disease in the elderly. Treatment options for osteoarthritis include medication, intra-articular injection, joint replacement surgery and rehabilitation. The main objective of this study was to investigate the rehabilitation resources utilization. This study also investigated the epidemiology of osteoarthritis in Taiwan, and other treatment options of osteoarthritis.
Method
This studyused the Longitudinal Health Insurance Data subset of 1 million beneficiaries from the National Health Insurance Research Database.Those aged 65 or above who had been diagnosed to have osteoarthritis during 2011-2013 were included in this study. The pattern of rehabilitation resources utilization by them in 2013 was investigated. Besides, demographic profile, Charlson Comorbidity Index, the pattern of medication prescription, whether the beneficiaries received intra-articular injection, whether they received joint replacement surgery were also examined. Data were analyzed using Student's t-test, Chi-square test and Logistic regression.
Result
Student's t-test and Chi-square test revealed that rehabilitation resources utilization was significantly affected by age, living area ,comorbidity, and the history of joint replacement surgery.
Logistic regression analysis showedthat the rehabilitation resource utilizationdecreased beyond the age of 76. People who lived outside Taipei or Kaohsiung-Pingtung area had lower rehabilitation resource utilization.People with more comorbidity were more likely to use rehabilitation resources. People received joint replacement had a lesser rehabilitation resource utilization than those who did not.
Conclusion
This study of rehabilitation resources utilization for the elderly patients with osteoarthritis in Taiwan revealed that, osteoarthritis patients who were older than 76 years old, who lived outside Taipei or Kaohsiung-Pingtung area, and who had more comorbidity were more likely to use rehabilitation resources. Concern should be raised regarding the increasing need of rehabilitation resources for the aging population in Taiwan and the possible urban-rural gap of rehabilitation resources accessibility. The fact that joint replacement reduces the need for rehabilitation we found in this study may contribute to public health policy.

並列關鍵字

Osteoarthritis ； rehabilitation ； Medical service utilization

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