運用健保資料庫研究台灣地區多汗症病人之就醫治療行為

Investigating healthcare seeking behavior changes in hyperhidrosis patients in Taiwan based on NHI claim databases

梁育誠(Yu-Cheng Liang)

指導教授 ： 劉建財

臺北醫學大學/醫學科技學院/醫學資訊研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00179

摘要

多汗症可以被定義或稱作為是一種出汗過多的生病情形和手掌的部分有超過生理需求的過多汗水，但是，卻沒有明顯的病因。它對於生活品質有顯著的負面影響。手掌的多汗症最為常見且大部分的案件都對生活有所影響。非手術的治療包括有局部用藥，離子導入，全身性抗膽鹼藥劑。近來，使用A型肉毒桿菌皮膚內注射毒素的治療方法趨於普及。為了多汗症病人所保留的手術治療交感神經切斷術和內視鏡交感神經切斷術兩種方法並不適合用來對局部多汗較為輕緩的病人。在本論文中，我們探索用健保申報資料庫對於台灣多汗症病人就醫行為的改變。

本研究根據國家衛生研究院2005年承保抽樣歸人檔所建立之全民健康保險研究資料庫(1997-2008)，研究多汗症病人長期在選擇就醫治療行為之改變包括就醫科別、就醫人次、就醫人數、發生率與盛行率以及施行胸交感神經切斷術病人。從1997年至2008年中共有2581位病人。男性1060(41.07%)和女性1513(58.62%)。對多汗症病人分組為多汗症病人2000年至2004年間曾施行手術治療、多汗症病人2005年至2008年間曾施行手術治療、多汗症病人2000年至2004年間就診且不曾施行手術治療和多汗症病人2005年至2008年間就診且不曾施行手術治療。進行Pearson's Chi-squared test在95%的信賴區間下得到P-value小於0.0001，因此可以知道多汗症的治療趨勢在法令修改前後是有顯著差異。多汗症病人在2005年後仍然尋求門診治療方式，並且以中醫科門診為主，平均每位病人每年因多汗症而就診的次數為兩次。多汗症且未施行交感神經切斷術的病人在長期上罹患腦血管疾病(OR = 7.15，95% CI= 4.34-12.80)、各種肺炎(OR = 3.85，95% CI= 2.85-5.33)、敗血症(OR = 3.87，95% CI= 0.80-61.60)和糖尿病(OR = 3.60，95% CI= 2.63-5.06)的機會比多汗症且施行交感神經切斷術病人高出許多。

關鍵字

手掌 ； 全民健康保險 ； 申報資料庫 ； 多汗 ； 交感神經 ； 治療趨勢

並列摘要

Hyperhidrosis is a disorder characterized by excessive sweating. It has a significant negative impact on quality of life. Palmar hyperhidrosis is the most common affecting most of cases. A common link to these disorders is an extreme non-thermoregulatory sympathetic stimulus of exocrine sweat glands, mostly due to emotional stimuli. Non-surgical treatment involves topical medication, iontophoresis and systemic anti-cholinergics. More recently the use of intradermal botulinum toxin has gained popularity. Surgical treatment reserved for severe cases, not responding to conservative management involves local excision, curettage and thoracoscopic sympathectomy. In this paper, we explore the trend for treatment of hyperhidrosis in Taiwan by using NHI claim database.

Data were from National Health Insurance Research Database for longitudinal health insurance database 2005 published by the National Health Research Institutes. Patients underwent surgery were identified by the treatment code 83085B. Factors in the study included age, gender and time of operation. A total of 2581 patients have had underwent transendoscopic dorsal sympathectomy, among them there were 1060 males (41.07%) and 1513 (58.62%) females. Hyperhidrosis patients group by who underwent endoscopic thoracic sympathectomy since 2000 to 2004 and hyperhidrosis patients who underwent endoscopic thoracic sympathectomy since 2005 to 2008. We compared the two groups by using Peason's Chi-squared test under 95% confidence level the p-value is less than 0.0001. It shows a significant difference for hyperhidrosis patient performed endoscopic thoracic sympathectomy treatment between act did not implement (2000-2004) and act implemented (2005-2008). However, hyperhidrosis patients are still seeking for medical treament. Instead of surgical and dermatology they went to seek for help from traditional china medicine. The chance of hyperhidrosis patients who did not undergo transendoscopic dorsal sympathectomy suffering on long-term risk of cerebrovascular disease (OR = 7.15，95% CI= 4.34-12.80), of pneumonia (OR = 3.85，95% CI= 2.85-5.33), sepsis (OR = 3.87，95% CI= 0.80-61.60) and diabetes (OR = 3.60，95% CI= 2.63-5.06) is much higher than hyperhidrosis patients who underwent transendoscopic dorsal sympathectomy
.

並列關鍵字

Palmar ； national health insurance ； claim database ； hyperhidrosis ； sympathectomy ； trend for treatment

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