運用健保資料庫探討台灣乳癌病患於診所與醫院之中藥使用差異與療效

Investigation of Difference and Efficacy of Chinese Herbal Medicine used Among Breast Cancer Patients in Taiwan from National Health Insurance Research Database

高資承(Tzu-Chen Kao)

指導教授 ： 楊哲銘

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2016年)

摘要

乳癌是台灣女性最常見的癌症，在台灣地區的乳癌病患除了接受西醫常規治療以外，
亦有許多病患接受中醫治療。由於台灣絕大多數民眾均納入全民健康保險，在健保體制之
下有關乳癌使用中藥的研究已所在多有。此外，中醫師絕大多數均在診所執業，而台灣尚
未有關於醫院與診所之間的差異研究文章，故本研究針對乳癌病患在醫院與診所間使用藥
物之差異。
本研究採取世代研究的方法，對於 2003-2012 年全民健康保險研究資料庫所登錄之註 記 ICD-9-CM 174.0-174.9 代碼的乳癌病患進行研究，排除男性與性別未明之病患，針對最
後一次手術後的乳癌病患並追蹤五年，且經過中藥治療三次以上，最後再分析醫院與診所
間用藥差異分析。
研究結果顯示在病患特質、醫師特質上，醫院與診所病患就醫喜好無顯著差異，但醫
院特質中醫院區域、醫院權屬別則有顯著差異(p<.001)；有關用藥差異方面，方劑使用上 無顯著差異，但是單味藥上在醫院中醫師較喜歡使用白花蛇舌草(p=.01)、酸棗仁(p<.001)
治療乳癌病患，乳癌復發狀況則在醫院與診所間無顯著差別。

關鍵字

中醫 ； 乳癌 ； 全民健康保險 ； 世代研究

並列摘要

Breast cancer is the common cancer in Taiwan. The patients in Taiwan accept not only Western Medicine, but also accept Traditional Chinese Medicine therapy. Most Taiwanese people are included in National Health Insurance, so there are lots of research about breast cancer used Traditional Chinese Medicine. Besides, most of Chinese medical physicians work in clinics, but there are no thesis about the difference between hospitals and clinics. This thesis is about Chinese Herbal Medicine Utilization Among Breast Cancer Patients in Taiwan.
Investigate the breast cancer patient in 2003-2012, whom included in the National Health Insurance Research Database and signed ICD-9-CM code for 174.0-174.9. Rule out male and sex unknown patients and track the patients who accepted the latest breast cancer surgery for 5 years with Chinese medicine over 3 times. Finally, investigate the Chinese medicine difference between clinics and hospitals.
The result is that there are no difference between patient characteristics, physician characteristics, and habit of medical service between hospitals and clinics. But there are evident differences between hospitals and clinics about patient seeking medical service areas and hospital ownership in Taiwan (p<.001). However, there are no difference between hospitals and clinics about using Chinese medicine compounds. But the Chinese medical doctors who work in hospitals like to use the single herb: Hedyotis diffusa (p=.01) and Semen Ziziphi Spinosae (p<.001). The efficacy are also no difference between hospitals and clinics.

並列關鍵字

Traditional Chinese medicine ； breast cancer ； hospitals ； National Health Insurance ； Cohort Study

參考文獻

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