藥物治療合併團體認知行為治療對恐慌症患者之研究 ——著重在醫療使用率改善之研究

Study of the Drug Therapy Combined with Cognitive-Behavior Group Psychotherapy for the Patients with Panic Disorder —— Focus on the Utilization Improvement

蔡明輝(Ming-Huei Tsai)

指導教授 ： 王興耀

高雄醫學大學/健康科學院/行為科學研究所/碩士(2004年)

摘要

摘要
本研究欲探討恐慌症患者，在精神科採用藥物治療合併認知行為團體心理後與只採用藥物治療，在醫療使用率上的變化比較。研究對象取自南部某一醫學中心急診照會精神科及精神科中，曾被精神科專科醫師確定診斷為恐慌症的患者。個案需符合DSM-Ⅳ的恐慌症診斷準則並排除腦傷、智能障礙、伴隨酒癮者且需無重大身體疾病者。
本研究為縱貫性研究，採用次級資料分析法進行資料分析，針對有無參與認知行為治療團體的恐慌症藥物治療病患，其在醫療使用率的差異進行探討。資料來源為來自中央健康保險總局，共包括92 位恐慌症患者（其中實驗組28名，控制組64名），在精神科診斷出其為恐慌症患者的前後各一年之就醫資料。
從研究結果可以知道，恐慌症病患在參與認知行為治療團體後（CBT組）在門診次數、急診次數及健保給付總金額、醫療檢查項目數、使用中醫次數以及精神科門診次數都較未參與團體者（非CBT組）為低。而在參與認知行為治療團體後，恐慌症患病在跨區域的求醫行為上也比未參與團體前降低，不僅僅減少了doctor shopping，更減少其在遠距交通上所需花費的時間與金錢，相對上就減少了大成本花費。

關鍵字

認知行為治療團體 ； 恐慌症 ； 醫療高使用率

並列摘要

Abstract

The purpose of this study was to investigate the utilization change of the patients with panic disorder, accepted the drug therapy combined with cognitive-behavior group psychotherapy ( CBGP, or CBT), as compared with only drug therapy treatment(control group). The subjects, referred from the Departments of Emergency and Psychiatry of a medical center in southern Taiwan, must meet the criteria of panic disorder of DSM-IV.

This was retrospective and longitudinal study. The data with all the service utilization of the patients with panic disorder was provided by Bureau of National Health Insurance ( N=92, experimental group=28, control group=64). The data of one year before the diagnosis and after the CBGP treatment for one year was included.

Analyses indicated that the patients with panic disorder of CBT group at outpatient visits and the visits of emergency department, the consume cost of lab and total medicine in BoNHI, the visits of Traditional Chinese Medicine and Department of psychiatry and had significantly reduced after one-year psychiatric treatment as compared to control group. The visits of trans-regional doctor were the same result. But inpatient visits had Not significantly reduced after one-year psychiatric treatment in experimental group as compared to control group.

It was concluded that patients with panic disorder, accepted the drug therapy combined with CBT, had effectively reduced outpatient visits and the visits of emergency department, the consume cost of lab and total medicine in BoNHI, the visits of Traditional Chinese Medicine, Department of psychiatry and trans-regional doctors, as compared with control group. But inpatient visits had Not significantly reduced after one-year psychiatric treatment in experimental group as compared to control group.

並列關鍵字

cognitive-behavior group psychotherapy ； panic disorder ； service utilization

參考文獻

參考文獻

一、中文文獻

藍忠孚總編輯（民90）：全民健康保險年度邀稿彙編。台北:國家衛生研究院。

郭守人、周麗芳、辛炳隆、江東亮(民90)：全民健康保險體檢小組報告。台北:國家衛生研究院。

中央健康保險局編印(民91)：全民健康保險統計。台北：三民書局。