探討急性下背痛病患之醫療資源利用及趨勢分析

研究目的: 下背痛係全球性最常見的健康問題之一，並造成個人與社會在財務上的負擔。在台灣，下背痛造成之醫療費用、健保支出亦佔有一定比例。而下背痛之病因複雜多樣，治療方法也有所不同。然而，如何提升治療下背痛的醫療品質並控制醫療資源耗係為值得探討的重要議題。本研究首先探討台灣地區急性下背痛之盛行率及其趨勢分析；其次，分析台灣地區急性下背痛病患之醫療資源耗用及其影響因子；最後探討急性下背痛復發之重要影響因素。研究方法: 運用國家衛生研究院釋出之「全民健康保險研究資料庫」之次級資料建立。研究樣本為1996至2010年間健保申報資料，主/次診斷碼為急性下背痛的患者挑選條件依據疾病及有關健康問題國際統計分類系統之第九修訂版進行ICD9-CM主(次)診斷碼為下背痛之診斷群，720、721、722、724的個案為研究樣本。探討急性下背痛患者之盛行率、醫療資源耗用(門診次數、住院次數、住院天數、門診費用、住院總費用) 及復發情形，並探討相關之影響因素。研究結果：本研究係依據中央健保局1996年-2010年統計之納保人數資料進行分析，其中急性下背痛的患者人數為446,683例，急性下背痛平均門診次數為10.6±21.65次。1996年急性下背痛的盛行率為22.38 (每十萬人口數)，逐年增加至2010年盛行率達77.57 (每十萬人口數)，在統計學上達到顯著差異。平均急性下背痛病患復發前門診住院相加總費用平均為65,351±79,354元。整體而言，平均年齡、門診次數、住院次數隨著時間的增加，呈現下降的趨勢；而住院各項醫療服務之費用呈現上升的趨勢。此外，急性下背痛病患隨著年齡增加，其復發風險增加。結論與建議：透過本研究結果瞭解急性下背痛醫療資源之利用分佈，建議將醫療資源重新適當分配使用，並且針對好發及高復發風險的族群來制定醫療照護計畫，提高醫療效能，維持良好醫療品質。

關鍵字

急性下背痛；盛行率；醫療資源利用；趨勢分析

並列摘要

Purposes Low back pain (LBP) is a globally common problem in public health and leads to a significant economic burden on individuals and society. In Taiwan, healthcare costs and medical expenditures on LBP has increased gradually. The causes of LBP are characterized by a wide spectrum and the treatments that providers offer are also varied. Therefore, how to improve treatment courses and to reduce healthcare utili-zation is a critical issue. Thus, our study purposed to describe the prevalence and tendency toward acute low back pain in Taiwan and secondly to analyze and to iden-tify the healthcare utilization and related influential factors. Methods The study retrospectively utilized the nationwide population-based claims data re-leased from “National Health Insurance Research Database” between 1996 and 2010, which contained the LBP patients with initial the International Classification of Dis-eases, Ninth Revision, Clinical Modification, ICD-9-CM three codes as 720, 721, 722 or 724. The confounders included the number of outpatient consultations, length of stays, outpatient expenditures, inpatient expenditures and recurrence of LBP, and identified the related influential factors. Results A total of 446,683 LBP patients were identified and the mean outpatient consultation rate was 10.6±21.65. The prevalence rate of LBP in 1996 was 22.23% per 100,000 people and gradually went up to 77.57 in 2010, which shows significant differences in statistics (P<0.05). Prior to recurrence, the mean total expenditures of outpatient consultation and inpatient hospitalization on LBP were NT$ 65,351±79,354. Over-all, it revealed that there is a declining tendency toward the mean age of the patients with LBP, the number of outpatient consultations and hospital admissions over time while the costs of medical service increased. In addition, the patients with acute LBP more easily develop the risks of recurrence as aging. Conclusions and Recommendations The more we know about the distribution of healthcare utilization, the more ade-quately we allocate the healthcare resources. Additionally, developing specific healthcare programs for those with high risks of recurrence would enhance medical effectiveness and efficiency, and also support healthcare quality.