臺灣使用低價值照護方式治療頸部疼痛的現況分析

Utilization of Low Value Care for Cervical Pain in Taiwan

王劼(Jye Wang) ； 曹昭懿(Jau-Yih Tsauo)

《物理治療》 44卷3期 (2019/09) Pp. 159-170

https://doi.org/10.6215/FJPT.201909_44(3).0001

摘要

近年來多國的專業醫學會開始倡導聰明就醫運動（Choosing Wisely）並公布其建議的5項最常開處方、最昂貴，或未有充分證據顯示對患者有益的低價值照護項目，稱之為Top Five List。本文比較臺灣健保申報資料與10個頸部疼痛臨床指引之異同，藉以凸顯目前臺灣因健保支付標準導致頸部疼痛物理治療普遍使用低價值照護的不合理現象。2011年全民健保資料顯示，頸部疾患物理治療之申報，依醫療院所層級分析，以基層院所申報比例最高；以申報項目來看，則以申報簡單─中度之百分比最高，患者在整體院所接受熱療、牽引、電療的治療組合約占27%至48%，治療組合有包含運動治療的比例只有30%左右，徒手治療則低於2%。然而10份頸部疼痛臨床指引大都不建議用熱療、頸椎牽引、電療來治療頸部疼痛，有較多的指引建議可在不同時期用徒手治療與運動治療來治療。建議主管機關應修改物理治療支付標準，以引導醫療人員避免使用低價值照護，讓健保與醫療體系永續經營。

關鍵字

頸部疼痛 ； 物理治療 ； 實證醫學 ； 低價值照護 ； 聰明就醫

並列摘要

In recent years many medical associations in different countries have joined the Choosing Wisely campaign and published their Top Five List to address the use of low value care. This article summarizes the recommendations of ten clinical guidelines for the conservative treatment of neck pain. We then analyzed the 2011 National Health Insurance claim data to illustrate how the reimbursement system for physical therapy has led to the widespread use of low value care in Taiwan for the treatment of neck pain. Analysis of the in 2011 National Health Insurance claim data shows that, most of the claims for treating neck pain patients were submitted by medical clinics, followed by local hospitals, regional hospitals, and medical centers. The standard treatment combination (heat therapy, traction, and electrotherapy) was the most common claim submitted (45 to 50%). Only 30% of the claims were for therapeutic exercises. Manual therapies constituted less than 2% of the claims. The majority of the ten clinical guidelines did not recommend using superficial heat, diathermy, traction, or different forms of electrotherapy to treat neck pain in its various stages. Manual therapies and therapeutic exercises were recommended by most clinical guidelines to treat neck pain. To ensure the long-term sustainability of the National Health Insurance in Taiwan, the current reimbursement system for physical therapy should be adjusted to reduce the use of low value care.

並列關鍵字

Neck pain ； Physical therapy ； Evidence-based medicine ； Low value care ； Choosing Wisely