下背痛的患者其健康相關生活品質及中西醫醫療資源使用

研究目的近數十年來由於全球人口老化、慢性病增加，替代醫療除了被國內民眾接受以外，也漸漸受到歐美國家重視，市場日益增加，醫療產業蓬勃的多元化發展。故本研究目的針對實際有下背痛的民眾之資料；瞭解不同程度下背痛病患之人口學特質、相關慢性疾病和相關疼痛；瞭解不同程度下背痛病患之健康相關生活品質；瞭解不同程度下背痛病患之中西醫的醫療服務利用。以提供醫療院所及衛生主管機關等訂定相關醫療服務策略管理之參考。研究方法本研究係以民國 90 年台灣地區國民健康訪問調查問卷，選取18 歲（含）以上之民眾共計20,830 位，以回溯性橫斷式資料進行統計，運用SPSS12.0 統計軟體分析工具，進行描述性及推論性比較分析。研究結果經常下背痛的預測因子有女性、年齡大、居住離島、未婚、宗教為佛道教、有心臟病、有肺部疾病、相關疼痛；偶爾下背痛的預測因子有女性、年齡大、居住離島、未婚、大學以上、有平均月收入、BMI 正常以上、有心臟病、有肺部疾病、有高血壓、全部相關疼痛（不包含經常坐骨神經痛）。健康相關生活品質PCS方面保健影響因子有BMI（正常及過重）、有教育程度、有工作及高階層月平均收入；傷害影響因子有女性、居住離島、年紀大、離婚、籍貫大陸及低階層月平均收入、相關慢性病、相關疼痛；MCS方面保健影響因子有居住山地、年紀大、BMI過重以上、教育程度國中以下及有工作。傷害影響因子有女性、居住離島、未婚及低階層月平均收入、心臟病、肺部疾病、糖尿病、中風及相關疼痛。依病人自述的中西醫療服務利用，住院利用顯著的影響因素為女性、有中風、有肺部疾病、經常關節疼痛；下背痛對住院方面無顯著差異。急診利用顯著的影響因素為教育程度高中、有肺部疾病、有中風、經常頭痛偏頭痛；下背痛對 III 急診利用是顯著的影響因素。西醫門診利用顯著的影響因素是教育程度大學以上、有糖尿病、有高血壓、經常頭痛偏頭痛；下背痛對西醫門診利用是顯著的影響因素。中醫門診利用顯著的影響因素為教育程度高中以上、居住山地、原住民、有肺部疾病、經常頸部酸痛；下背痛對中醫門診利用是顯著的影響因素。買中藥利用顯著的影響因素為教育程度國中以下、居住山地、原住民、有肺部疾病、經常關節疼痛；下背痛對買中藥的利用是顯著的影響因素。依實際使用情形的中西醫療服務利用，住院利用顯著的影響因素為原住民、未婚者、有中風、有糖尿病、經常關節疼痛；經常下背痛對住院利用是顯著的影響因素。急診利用顯著的影響因素為原住民、有心臟病、有糖尿病；下背痛對急診利用是顯著的影響因素。西醫門診利用顯著的影響因素教育程度高中以上、有糖尿病；偶爾下背痛對西醫門診利用是顯著的影響因素。中醫門診利用顯著的影響因素為教育程度高中以上、女性、高血脂、經常頸部酸痛；下背痛對中醫門診利用是顯著的影響因素。結論和建議針對好發下背痛的族群特色來制定照護計畫，應加強離島醫療照護，安排定期適合的體適能活動以強化心肺功能；對停經婦女應早期注意其疼痛問題，可以考慮先行預防骨質疏鬆。注重衛生教育的方面，因為有正確豐富的衛生生活概念，才會有真正健康的生活。安排銀髮族人員從事心理輔導工作，一方面讓長青族老有所用，以促進身體健康生活品質，也改善社會的心理健康生活品質。中醫醫政及醫療相關單位應該多針對老年人口的疾病多加研究發展，畢竟在老年人口對中醫藥的信任感較強及疼痛的中醫藥控制有優於西醫醫療的優勢。可以開發多元醫療讓老年化民眾使用，突破現在使用率僅30％左右的困境。並且應該多和西醫醫療提供者做交流，來讓他們多認識中醫，再來提倡中西醫合併治療，或是中醫治療成為輔助治療。除了提供民眾多元選擇外，可以藉由共同研究的力量達成台灣本土的醫療特色。

關鍵字

醫療服務利用；中醫；替代醫療(CAM) ；健康相關生活品質 (SF-36)

並列摘要

Objective In recent decades due to the global aging of population and increase of chronic diseases, complementary and alternative medical services have not only been accepted by domestic people, but also been paid much attention to by the European and American countries gradually. The medical service market has grown increasingly and the medical service industry has flourished with diversification. The purpose of this research is to understand the demographic characteristics, related chronic diseases, related pain, health-related Quality of Life and the Chinese and Western medical services utilization of patients with various degrees of lower back pain so as to provide the medical care institutions and health authorities references for making related managerial strategy of medical services. Methods The data of this research comes from the National Health Interview Survey questionnaires of Taiwan in 2001. There are 20,830 people of 18-year-old (inclusive) or more selected. Statistical analysis has been carried out by using retrospective cross-sectional data. The comparative analysis of description and inference has been conducted by using SPSS 12.0 statistical software. Results The predictors of recurrent low back pain are female, elders, inhabitants of offshore islands, single, the Buddhism and Taoism religions, heart disease, lung disease, and related pain. The predictors of occasional low back pain are female, elders, inhabitants of offshore islands, single, education degree of university or above, employment with monthly average income, BMI normal or above, heart disease, lung disease, hypertension, and all related pain (recurrent sciatica excluded). The positive influence factors of PCS are BMI (normal and overweight), V educated intellectuals, and employment with high monthly average income. The negative influence factors of PCS are female, inhabitants of offshore islands, elders, divorce, Mainland China origin, low monthly average income, related chronic diseases and related pain. The positive influence factors of MCS are inhabitants in mountains, elders, BMI overweight or above, education degree of junior high school or below, and employment. The negative influence factors of MCS are female, inhabitants of offshore islands, single, low monthly average income, heart disease, lung disease, diabetes, stroke and related pain. According to the patient’s own description of Chinese and Western medical services utilization, the influence factors of admission utilization are female, stroke, lung disease, and recurrent joint pain. Low back pain has no significant differences in utilization of admission. The influence factors of emergency utilization are education degree of senior high school, lung disease, stroke, recurrent headache and migraine. Low back pain has significant differences in utilization of emergency. The influence factors of western medical out-patient service utilization are education degree of university or above, diabetes, hypertension, recurrent headache and migraine. Low back pain has significant differences in utilization of western medical out-patient service. The influence factors of Chinese medical out-patient service utilization are education degree of senior high school or above, inhabitants in mountains, aboriginal people, lung disease, and recurrent neck soreness. Low back pain has significant differences in utilization of Chinese medical out-patient service. The influence factors of Chinese medicine utilization are education degree of junior high school or below, inhabitants in mountains, aboriginal people, lung disease, and recurrent joint pain. Low back pain has significant differences in utilization of Chinese medicine. According to the actual utilization of Chinese and Western medical services, the influence factors of admission utilization are aboriginal people, single, stroke, diabetes, and recurrent joint pain. Recurrent low back has significant differences in VI utilization of admission. The influence factors of emergency utilization are aboriginal people, heart disease, and diabetes. Low back pain has significant differences in utilization of emergency. The influence factors of western medical out-patient service utilization are education degree of high school or above, and diabetes. Occasional low back pain has significant differences in utilization of western medical out-patient service. The influence factors of Chinese medical out-patient service utilization are female, education degree of high school or above, hyperlipiemia, and recurrent neck soreness. Low back pain has significant differences in utilization of Chinese medical out-patient service. Conclusion and suggestion The medical care plans should be developed for patient groups of high incidence of low back pain with different characteristics. For patients of subsidiary islands, medical care should be reinforced and appropriate physical fitness activities should be arranged in order to strengthen their heart and lung function. For postmenopausal women, early attention should be paid to their pain problems and prevention of osteoporosis could be considered in advance. Health education should be emphasized since correct health concept leads to truly healthy lives. For the elderly, engagement in counseling work could be arranged to improve their physical health-related quality of life and social psychological health-related quality of life as well. Since the stronger trust in Chinese medical therapy by the elderly and the advantage in better pain control of Chinese medical therapy compared to western medical therapy, health authority and related institutions of Chinese medical service should engage in more research and development on Geriatrics so as to develop diversification of medical therapy for the elderly to utilize and break through the Chinese medical service utilization rate of 30%. More exchange should be made with western medical service providers to let them know more about Chinese medical service so as to promote combined therapy of Chinese with western medical service VII or Chinese medical therapy as a complementary and alternative medical therapy, which can offer patients diversification of medical service to choose and reach the uniqueness of traditional Chinese medical service by working together with western medical service.