類風濕性關節炎患者利用復健醫療之研究

Exploring the rehabilitation medicine utilization among rheumatoid arthritis patients

高金英(Chin-Ying Kao)

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

研究目的
類風濕性關節炎 (Rheumatoid arthritis ) 為一發炎性自體免疫疾病，造成關節腫脹與疼痛，各年齡層都有機會發病。臨床治療方式為長期藥物治療，抑制發炎反應，減緩疾病惡化。輔助以復健治療，包含物理治療與職能治療，使關節盡量能保有正常功能，避免永久性畸形發生。本研究主要目的為分析類風濕性關節炎患者之復健醫療利用之情形。
研究方法
運用衛生福利部衛生福利資料科學中心發行之健保資料庫100萬人抽樣檔，篩選18歲以上、2011-2012曾診斷類風濕性關節炎 (ICD-9-CM=714.0) 且至少2次門診或1次住院診斷、排除2010年曾診斷類風濕性關節炎樣本，所得之新診斷類風濕性關節炎患者資料共1741人，進行次級資料分析，以獨立樣本T檢定、卡方檢定、One-way ANOVA、邏輯斯迴歸等方法分析新診斷之類風濕性關節炎患者之復健科就診情形與施行物理或職能復健治療等復健醫療利用情形。
研究結果
描述性統計分析結果顯示女性占71.6%，約為男性2.5倍。就診地區以台北地區占大多數 (40.4%)，其次為中部地區占21%。察爾森共病症指標0分者35.1%，1分者48.2%，2分以上16.7%。有57%患者有服用NSAIDs治療。僅有3.4%患者施用Acetaminophen。有實施關節腔注入與人工關節置換手術皆小於1%。曾前往復健科就診患者有297人，占17.1%。不需復健治療者有92人，有施行復健治療者205人。其中僅施行物理治療患者199人，僅施行職能治療患者6人，無患者同時施行物理與職能治療。
卡方檢定分析結果顯示性別、就診地區、察爾森共病症指標、使用NSAIDs治療與否等因素均顯著影響復健科之醫療利用。
邏輯斯迴歸分析結果顯示針對復健科之醫療利用率，男性為女性的0.710倍，就診地區於中區者與南區者分別為台北分局之0.570倍與0.593倍，察爾森共病症指標1分者為0分者之1.360倍，有NSAIDs治療為無治療之1.446倍。
結論
類風濕性關節炎患者之復健科醫療利用率，男性明顯較女性低，相較於台北，中區與南區亦相對偏低。政府未來應該從醫療可近性的角度，檢視男性患者實際使用復健資源的阻礙，以維持其身體與社會經濟之功能。亦建議政府能多充實中區與南區之復健醫療資源，降低城鄉差距與充分發揮健保精神。

關鍵字

類風濕性關節炎 ； 全民健保資料庫 ； 復健治療

並列摘要

Objective
Patients with rheumatoid arthritis had high risk of disability. The rehabilitation treatment including physiotherapy and occupational therapy can improve the motility of joints and self-care for the patients with rheumatoid arthritis and minimize the consequences of the disease. This study aimed to explore the rheumatoid arthritis patients’ utilization of rehabilitation medicine.
Methods
This study used the 2010 Longitudinal Health Insurance Data Subset of the National Health Insurance Research Database. We selected the patients who were 18 years old or older and were newly diagnosed to have rheumatoid arthritis in 2011 to 2012. There were 1471 patients identified. Independent T-test, One-way ANOVA, Chi-square test and logistic regression were used to analyze the utilization of rehabilitation medicine.
Results
Descriptive statistics shows that 71.6% patients were female. Female-male ratio was around 2.5:1. Most patients (40.4%) lived in north Taiwan and 21% lived in central Taiwan. Among the patients, 35.1%, 48.2% and 16.7% had a Charlson comorbidity index of 0, 1 and ≥2 respectively. Fifty-seven percentages of the patients had been treated with NSAIDs while only 3.4% of the patients had been treated with Acetaminophen. Less than 1% of the patients received intra-articular injection or joint replacement. Among the 297 patients who ever visited a physical medicine and rehabilitation specialist, 199 patients were treated with physiotherapy, and 6 patients with occupational therapy. None of them received both physiotherapy and occupational therapy.
Chi-square test showed that sex, living area, comorbidity and NSAIDs treatment had significant impact on rehabilitation medicine utilization.
Logistic regression analysis showed that regarding the probability of rehabilitation medicine utilization, female: male was 1:0.710. Probability of rehabilitation medicine utilization for who lived in central Taiwan and south Taiwan was 0.570 and 0.593 times for who lived in Taipei. Those who had a Charlson comorbidity index of 1 were 1.360 times more likely to have rehabilitation medicine utilization as compared to those who had a Charlson comorbidity index of 0. Those with NSAIDs treatment also had a 1.446 fold of rehabilitation medicine utilization compared to those without.
Conclusion
Rehabilitation medicine utilization is less in male than in female, less in central and south Taiwan than in Taipei. The authority should pay attention to the medicine accessibility and possible obstacles for male patient in order to maintain their physical, social and economic function. Additionally, rehabilitation medicine resource allocation should take in to consideration the difference of rehabilitation medicine utilization between areas in Taiwan to reduce the urban-rural gap.

並列關鍵字

rheumatoid arthritis ； National Health Insurance Research Database ； rehabilitation medicine

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