女性護理人員與其他醫事人員下背痛之就醫行為與用藥型態分析

Pattern of Medication Use and Utilization Behavior for Low Back Pain in Female Nursing Staff and Other Health Professionals

周英香(Ying-Hsiang Chou)

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(2012年)

https://doi.org/10.6834/CSMU.2012.00149

摘要

下背痛是醫療從業人員很常發生的醫療問題，也是非常重要的國民健康議題。國內外研究都指出醫療從業人員為下背痛之高危險群，但甚少研究分析其下背痛治療行為與一般民眾是否有所差異。因此本研究透過全民健保資料庫承保抽樣歸人檔，分析女性族群中，護理人員、其他醫事人員與一般民眾罹患急性下背痛之就醫行為以及用藥型態之異同。資料來源為2005~2009年之百萬抽樣歸人檔資料，擷取ICD-9-CM前三碼為720、721、722、724，扣除罹病部位明確為胸、頸部者，且刪除病程超過90天以及研究期間因下背痛診斷復發者，再合併醫事人員檔，最終得到罹患下背痛之女性護理人員1566人；其他女性醫事人員391人；一般女性民眾共82,728人進行研究分析。
本研究重要發現如下：三個研究族群在第一次就診的區域、醫療院所特約層級以及就診的科別有分布上不同，達到統計差異。相較於一般女性民眾只有18.8%選擇區域醫院以上層級的機構第一次就診，女性護理及其他醫事人員有超30%的比例選擇區域醫院以上層級的機構，P值<0.001。在科別的選擇上，選擇復健科的族群差異最大，女性護理人員有13.35%在第一次就診就選擇復健科、其他女性醫事人員則有17.65%；反觀一般民眾則只有7.6%，P值<0.0001。在所接受的治療類型中，有22.03%的女性護理人員接受藥物治療；女性醫事人員為20.72%，而一般女性較高有28.51%，達到統計差異(P值<.0001)；接受復健治療的比例中，女性護理人員為15.94%；女性醫事人員為17.62%，而一般女性較低，為11.71%，亦達到統計差異(P值<.0001)；接受中醫治療的比例則以一般女性民眾最高，為12.15%，女性護理人員及其他醫事人員則分別為9%及8.18%，亦達到統計差異(P值<.0001)。在用藥型態的比較上，本研究將使用口服藥的類型分為單方藥理以及複方藥理進行分析。使用單方的女性護理人員，醫事人員及一般民眾的比例分別為73.91%、81.48%、74.88%；使用複方藥理的比例則分別為26.09%、18.52%及25.12%，經檢定發現女性護理人員，其他女性醫事人員與一般女性民眾之間，使用單/複方藥理治療的比例並沒有達到統計上的差異(P值0.3591)。經過複迴歸分析後發現，申報年度、年齡、投保薪資、投保地點、第一次就診醫療院所特約層級、第一次就診科別為影響單複方藥理開立的因素。
本研究結論女性護理人員和其他女性醫事人員產生急性下背痛時與一般女性民眾就醫行為有所不同。女性護理及醫事人員比起一般民眾更常前往區域醫院以上之醫院以及復健科，而且較多比例接受復健治療。反觀一般女性民眾較易選擇基層院所進行初次診療，較多比例接受中醫的治療。至於用藥型態在使用單/複方藥理的比例上並無差異。影響單/複方藥理差異之因素包括申報年度、投保地點、年齡、投保薪資、第一次就診醫療院所層級及第一次就診科別。衛生機關應更深入了解醫療從業人員之急性下背痛現況，進而預防其發生，以及保障其治療之成效。

關鍵字

下背痛 ； 護理人員 ； 醫療人員 ； 全民健康保險 ； 次級資料分析 ； 用藥型態 ； 就醫行為

並列摘要

Low back pain is a very common health problem among health professionals, which is also a very important national health issue. Although research have found that health professionals are among the high risk group for low back pain, very few of them focus on the difference of the medical behavior and medication pattern used between general population and health care professionals. Our research intent to analyze the difference of the medical behavior and medication pattern used between female nursing staff, other female health care professionals, and general female population through National Health Insurance database. The source of the data came from claims data of the sampled registry of beneficiaries of National Health Insurance from 2005 to 2009. ICD-9-CM with initial three codes as 720, 721, 722 or 724 were selected with the exclusion of the codes that indicate illness located at the cervix or thorax regions. All those receiving treatments continued for more than 90 days or recurred during the survey were also excluded. After combining the data with basic profile of the health care professionals, a total of 1566 female nursing staffs; 391 female health care professionals other than nurses and 82728 general female patients with acute low back pain were collected for the study.
Research findings: The difference between the three study groups were significant in the aspects of the region of ambulatory care, the level of hospital and the specialty that they attend for their first visit under the diagnosis of acute low back pain. Only 18.8% of the general female population visited hospitals leveled above Regional hospitals in compare with more than 30% within female nursing staffs and other health professionals (P<0.001). The biggest difference among the choice of specialty was in Rehabilitation Medicine, while 13.35% of the female nursing staff and 17.65% of the other female health care professionals attend as their first ambulatory visit, only 7.6% of the general female population chose Rehabilitation Medicine as their first ambulatory visit specialty(P<0.0001). To compare the treatment received, 22.03% of the female nursing staff; 20.72% of the other professionals received medication treatment while general female population had a higher percentage of 28.51%, which is statistically significant, (P<.0001). 15.94% of the female nursing staff received rehabilitation treatment, while 17.62% of the other female health care professionals and only 11.71% of the general female population also received rehabilitation treatment (P<.0001). The ratios were opposite for the percentage receiving Chinese medicine, when 12.15% of the general population received Chinese medicine, only 9% and 8.18% of the female nursing staff and other health care professionals received Chinese medicine (P<.0001). When it comes to medication pattern, our research divided the medication used into single drug and combination drug treatment. The percentages of the use of single drug treatment among female nursing staff, female health care professionals and general female population were 73.91%、81.48% and 74.88%, while the percentages of the use of combination drug treatment among female nursing staff, female health care professionals and general female population were 26.09%, 18.52% and 25.12%. There were no statistical significant for the use of single/combination drug treatment among these three groups (P =0.3591). The multivariate analysis showed that the year of claims, age, salary for insurance, the region of claims, the hospital level for first ambulatory visit, and the specialty for first ambulatory visit for acute low back pain were the factors that influenced the medication pattern of single/combination drug treatment.
Conclusions: The medical behavior for acute low backpain was different between female nursing staff, other health professionals and the general population. Female health care professionals including nurses tend to visit hospital leveled above the Regional hospital and the Rehabilitation Medicine ambulatory clinic for help in the beginning, and also received more rehabilitation treatment when compared with general population. The female general population who had acute low back pain, on the other hand, tends to visit primary care clinic first and received more Chinese Medicine treatment. The medication pattern was not different between the three groups. The factor influencing the pattern of medication prescribed includes the year of claims, age, salary for insurance and the region of claims, the hospital level for first ambulatory visit, and the specialty for first ambulatory visit for acute low back pain. Further research is needed to understand the nature and cause of acute low back pain in medical professionals in order to establish preventive policies.

並列關鍵字

Low back pain ； Nurses ； Health care professionals ； National Health Insurance ； Secondary data analysis ； Medication pattern ； Utilization behavior

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