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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 蘇喜(Syi Su) | |
| dc.contributor.author | Ming-Hsiu Lin | en |
| dc.contributor.author | 林明秀 | zh_TW |
| dc.date.accessioned | 2021-06-08T04:41:29Z | - |
| dc.date.copyright | 2009-09-16 | |
| dc.date.issued | 2009 | |
| dc.date.submitted | 2009-08-11 | |
| dc.identifier.citation | Aday LA, Andersen R.A framework for the study of access to medical care. Health Serv Res. 1974 Fall;9(3):208-20.
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Katz HI, Waalen J, Leach EE.Acitretin in psoriasis: an overview of adverse effects.J Am Acad Dermatol. 1999 Sep;41(3 Pt 2):S7-S12 Mallbris L, Granath F, Hamsten A, Ståhle M.Psoriasis is associated with lipid abnormalities at the onset of skin disease.J Am Acad Dermatol. 2006 Apr;54(4):614-21. Marchetti A, LaPensee K, An P.A pharmacoeconomic analysis of topical therapies for patients with mild-to-moderate stable plaque psoriasis: a US study.Clin Ther. 1998 Jul-Aug;20(4):851-69. Margolis D, Bilker W, Hennessy S, Vittorio C, Santanna J, Strom BL.The risk of malignancy associated with psoriasis.Arch Dermatol. 2001 Jun;137(6):778-83. Mease PJ, Menter MA.Quality-of-life issues in psoriasis and psoriatic arthritis: outcome measures and therapies from a dermatological perspective.J Am Acad Dermatol. 2006 Apr; 54(4):685-704. Moll JM, Wright V.Psoriatic arthritis.Semin Arthritis Rheum. 1973;3(1):55-78. Najarian DJ, Gottlieb AB.Connections between psoriasis and Crohn's disease.J Am Acad Dermatol. 2003 Jun;48(6):805-21. Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB, Gelfand JM.Prevalence of cardiovascular risk factors in patients with psoriasis.J Am Acad Dermatol. 2006 Nov;55(5):829-35. Neumann NJ, Mahnke N, Korpusik D, Stege H, Ruzicka T.Treatment of palmoplantar psoriasis with monochromatic excimer light (308-nm) versus cream PUVA.Acta Derm Venereol. 2006;86(1):22-4 Nevitt GJ, Hutchinson PE.Psoriasis in the community: prevalence, severity and patients' beliefs and attitudes towards the disease.Br J Dermatol. 1996 Oct;135(4):533-7 Offidani AM, Ferretti G, Taus M, Simonetti O, Dousset N, Valdiguie P, Curatola G, Bossi G.Lipoprotein peroxidation in adult psoriatic patients.Acta Derm Venereol Suppl. 1994;186:38-40 Olsen JH, Møller H, Frentz G.Malignant tumors in patients with psoriasis.J Am Acad Dermatol. 1992 Nov;27(5 Pt 1):716-22. Orem A et al.The significance of autoantibodies against oxidatively modified low-density lipoprotein (LDL) in patients with psoriasis.Clin Chim Acta. 1999 Jun 15;284(1):81-8. Prodanovich S, Shelling ML, Federman DG, Kirsner RS.Cytokine milieu in psoriasis and cardiovascular disease may explain the epidemiological findings relating these 2 diseases. Arch Dermatol. 2008 Nov;144(11):1518-9. Rapp SR, Feldman SR, Exum ML, Fleischer AB Jr, Reboussin DM.Psoriasis causes as much disability as other major medical diseases.J Am Acad Dermatol. 1999 Sep;41(3 Pt 1):401-7. Raychaudhuri SP,Farber EM: The prevalence of psoriasis in the world. J Eur Acad Dermatol Venereol 15:16,2001 Robinson D Jr, Hackett M, Wong J, Kimball AB, Cohen R, Bala M; The IMID Study Group.Co-occurrence and comorbidities in patients with immune-mediated inflammatory disorders: an exploration using US healthcare claims data, 2001-2002.Curr Med Res Opin. 2006 May;22(5):989-1000. Rocha-Pereira P, Santos-Silva A, Rebelo I, Figueiredo A, Quintanilha A, Teixeira F.Dislipidemia and oxidative stress in mild and in severe psoriasis as a risk for cardiovascular disease.Clin Chim Acta. 2001 Jan;303(1-2):33-9 Ros AM.Photosensitive psoriasis. An epidemiologic study. J Am Acad Dermatol 1987; 17:752–758. Ryder KW, Epinette WW, Jay SJ, Ransburg RC, Glick MR. Serum angiotensin converting enzyme activity in patients with psoriasis.Clin Chim Acta. 1985 Dec 13;153(2):143-6. Seçkin D, Tokgözoğlu L, Akkaya S.Are lipoprotein profile and lipoprotein (a) levels altered in men with psoriasis?J Am Acad Dermatol. 1994 Sep;31(3 Pt 1):445-9. Seishima M, Seishima M, Mori S, Noma A.Serum lipid and apolipoprotein levels in patients with psoriasis.Br J Dermatol. 1994 Jun;130(6):738-42. Shapiro J, Cohen AD, David M et al.The association between psoriasis, diabetes mellitus, and atherosclerosis in Israel: a case-control study. J Am Acad Dermatol. 2007 Apr;56(4):629-34 Sommer DM, Jenisch S, Suchan M, Christophers E, Weichenthal M.Increased prevalence of the metabolic syndrome in patients with moderate to severe psoriasis.Arch Dermatol Res. 2006 Dec;298(7):321-8. Epub 2006 Sep 22. Stern RS, Nijsten T, Feldman SR, Margolis DJ, Rolstad T.Psoriasis is common, carries a substantial burden even when not extensive, and is associated with widespread treatment dissatisfaction.J Investig Dermatol Symp Proc. 2004 Mar;9(2):136-9 Sterry W, Strober BE, Menter A. Obesity in psoriasis: the metabolic, clinical and therapeutic implications. Report of an interdisciplinary conference and review.Br J Dermatol 2007; 157: 649–55 Tam LS, Shang Q, Li EK et al. Subclinical carotid atherosclerosis in patients with psoriatic arthritis.Arthritis Rheum. 2008 Sep 15;59(9):1322-31. Toker A, Kadi M, Yildirim AK, Aksoy H, Akçay F.Serum lipid profile paraoxonase and arylesterase activities in psoriasis. 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Yip SY.The prevalence of psoriasis in the Mongoloid race.J Am Acad Dermatol. 1984 Jun;10(6):965-8. 陳玄祥 曾美萍 蔡呈芳An Epidemiologic Study of Taiwanese Psoriatic Patients in A Single Clinic Dermatol Sinica 2003;21(3): 216-2 張啟杉 林明薇 張雲亭 劉漢南 The associated systemic diseases in 127 consecutive psoriasis cases Dermatol Sinica 2003;21(3): 225-2 劉靜玲 合併症和併發症影響醫療資源利用之分析：以內科系三種疾病為例。碩士論文。高雄醫學大學公共衛生學研究所 2001 郭翎甄 縱貫性比較慢性腎臟病患與非慢性腎臟病患之病程風險因子暨長期醫療資源耗用 。碩士論文。高雄醫學大學公共衛生學研究所 2007 | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/23091 | - |
| dc.description.abstract | 研究背景與目的: 乾癬是一種慢性免疫相關皮膚疾病，影響世界人口自0.4 %到3 %不等，疾病只能夠控制而不易根治，影響患者健康及健康照護體系甚鉅，文獻探討乾癬容易合併多種合併症(comorbidities)，諸如糖尿病、高血壓、高血脂症、心血管疾病等，並增加癌症發生機率，目前國內並無乾癬合併症及相關醫療資源利用研究，故本研究以全民健康保險學術研究資料庫探討乾癬合併症及醫療資源利用情形，目的詳列如下：ㄧ、瞭解乾癬患者之合併症分佈。二、瞭解乾癬患者之合併症罹病風險。三、探討乾癬患者併有合併症之醫療資源利用情形。四、探討影響乾癬患者醫療資源利用之相關因素。
研究方法: 本研究為回溯性研究，資料來源採用國家衛生研究院全民健康保險資料庫，以2004年歸人抽樣檔中曾以乾癬診斷(診斷碼696.1及696.0)就醫的病患為研究樣本，以性別相同、年齡相近之非乾癬患者樣本配對，擷取為對照組分析乾癬患者罹病風險及醫療資源利用。研究中合併症以糖尿病、高血壓、心血管疾病、高血脂症、發炎性腸道疾病、惡性腫瘤、憂鬱症為變項，醫療資源利用以門診就醫次數、門診醫療費用、平均給藥日數、住院與否、總醫療費用為變項，使用SPSS16版軟體分析其相關性。 研究結果: 乾癬患者與對照組患者相較，罹患糖尿病之罹病風險為1.829(95% CI= 1.237-2.704)，罹患高血壓之罹病風險為1.449(95% CI=1.071-1.959)，罹患高血脂症之罹病風險為2.912(95% CI=1.745-4.860)；乾癬患者之醫療資源利用平均皆高於對照組，乾癬患者與對照組之醫療資源利用比較，發現乾癬患者門診就醫次數、門診醫療費用、平均給藥日數，總醫療費用均顯著高於對照組；乾癬患者合併之合併症數目越多，醫療資源利用有越多的傾向，此外人口學特質、就醫機構特質、合併症會影響乾癬患者醫療資源利用，年齡組60-69歲、70歲以上比年齡組小於40歲總醫療費用為高；性別方面男性總醫療費用、門診醫療費用明顯較女性為低；就醫機構層級方面，在醫學中心就診總醫療費用高於地區醫院，在基層診所就診總醫療費用低於地區醫院；就醫區域方面，各區無明顯差別；合併症方面，有糖尿病、高血壓、心血管疾病、惡性腫瘤及憂鬱症者總醫療費用較無合併症者高。 討論與結論: 乾癬患者合併症盛行率，其中高血壓盛行率最高，依序為糖尿病、心血管疾病、高血脂症、惡性腫瘤、憂鬱症，罹病風險方面乾癬患者罹患糖尿病、高血壓、高血脂症之罹病風險皆提高，醫療費用方面，門診醫療費用歸因於合併症為35.25%，住院醫療費用歸因於合併症為81.98%，總醫療費用歸因於合併症為42.94 %，乾癬合併症中，高血壓、糖尿病、心血管疾病、高血脂症醫療資源利用最多，乾癬患者併有合併症-糖尿病、高血壓、高血脂症、心血管疾病、惡性腫瘤、憂鬱症者，相較無合併症者所使用醫療資源顯著較多，乾癬患者較無乾癬患者有較高的醫療資源利用，人口學特質、就醫機構特質、合併症會影響乾癬患者醫療資源利用。 | zh_TW |
| dc.description.provenance | Made available in DSpace on 2021-06-08T04:41:29Z (GMT). No. of bitstreams: 1 ntu-98-P96843015-1.pdf: 578046 bytes, checksum: 8b20625210b83eebcbcd17c759dd093c (MD5) Previous issue date: 2009 | en |
| dc.description.tableofcontents | 誌謝………………………………………………………………… i
中文摘要…………………………………………………………… ii 英文摘要…………………………………………………………… iv 目錄………………………………………………………………… vi 表目錄……………………………………………………………… viii 圖目錄……………………………………………………………… x 第一章 緒論……………………………………………………… 1 第一節 研究動機………………………………………………… 1 第二節 研究目的………………………………………………… 3 第二章 文獻探討………………………………………………… 4 第一節 介紹乾癬………………………………………………… 4 第二節 乾癬及其合併症………………………………………… 11 第三節 乾癬醫療資源利用……………………………………… 23 第三章 研究設計與方法 ………………………………………… 30 第一節 研究設計與研究架構 …………………………………… 30 第二節 研究假說………………………………………………… 32 第三節 研究材料與工具………………………………………… 33 第四節 資料處理與統計分析 …………………………………… 37 第四章 研究結果………………………………………………… 40 第一節 乾癬患者特質…………………………………………… 40 第二節 乾癬合併症分佈及罹病風險…………………………… 43 第三節 乾癬患者與合併症之醫療資源利用情形……………… 49 第四節 影響乾癬患者之醫療資源利用差異的相關因素……… 54 第五章 結論與建議……………………………………………… 58 第一節 研究結果與相關文獻討論……………………………… 58 第二節 結論……………………………………………………… 63 第三節 研究限制與未來研究方向……………………………… 64 第四節 建議……………………………………………………… 65 參考文獻 ………………………………………………………… 66 | |
| dc.language.iso | zh-TW | |
| dc.subject | 乾癬 | zh_TW |
| dc.subject | 醫療資源利用 | zh_TW |
| dc.subject | 合併症罹病風險 | zh_TW |
| dc.subject | 合併症 | zh_TW |
| dc.subject | psoriasis | en |
| dc.subject | comorbidities | en |
| dc.subject | medical utilization | en |
| dc.subject | odds ratio of comorbidities | en |
| dc.title | 乾癬患者合併症及醫療資源利用 | zh_TW |
| dc.title | On the Comorbidities and Medical Utilization in
Psoriasis Patients | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 97-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 李婉若,黃松共 | |
| dc.subject.keyword | 乾癬,合併症,合併症罹病風險,醫療資源利用, | zh_TW |
| dc.subject.keyword | psoriasis,comorbidities,odds ratio of comorbidities,medical utilization, | en |
| dc.relation.page | 72 | |
| dc.rights.note | 未授權 | |
| dc.date.accepted | 2009-08-12 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 醫療機構管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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