氣喘處方型態與醫療照護利用的關係

Abstract

研究目的：探討台灣氣喘門診處方型態及其與醫療照護利用的關係。 研究設計：回溯性研究分析。 研究對象：3,346位慢性氣喘患者，在2001年1月和2001年12月間至少有一次門診氣喘用藥處方。 主要結果測量：每一位氣喘病患經過一年的追蹤，有住院、急診和門診醫療照護利用氣喘病人的百分比。 研究結果：門診氣喘藥物治療的使用，仍以口服為主，約佔五分之四，且以β2-agonists和xanthine類為主。而吸入劑型的使用只佔五分之一，其中仍以吸入性β2-agonists為主，吸入性皮質類固醇次之。在氣喘相關門診醫療照護利用方面，僅用吸入劑氣喘用藥明顯的比僅用口服劑型（1 vs. 0.49）以及併用吸入劑和口服氣喘用藥（1 vs. 0.60）的多。而用藥數量方面，使用四種或四種以上氣喘用藥氣喘相關門診醫療照護利用明顯的比使用一種（1 vs. 0.50）或併用兩種氣喘用藥（1 vs. 0.67）要多。Charlson comorbidity index分數在1分以上的病患其氣喘相關門診利用明顯的比0分的多（3.69 vs. 1）。醫學中心氣喘相關門診利用明顯的比地區醫院（1 vs. 0.77）多。 結論：門診氣喘用藥以口服為主。氣喘門診處方型態只與氣喘相關門診醫療照護利用有關。僅用吸入性氣喘用藥的門診利用比僅用口服及吸入與口服併用的病患多，使用藥物數量在一種或兩種的病患，氣喘相關門診利用比四種或四種以上少。病患年齡在45-64歲，Charlson comorbidity index分數在1分以上，有較多氣喘相關門診醫療照護利用。地區醫院門診利用明顯比醫學中心少。

Objective: To investigate the relationship of the prescribing pattern of antiasthmatics to healthcare utilization in Taiwan. Design: Retrospective study analysis. Setting: From 2000 to 2002 claim data from all contracted hospital of the Bureau of National Health Insurance, Taiwan. Subjects: 3,364 chronic asthma patients who received at least one outpatient prescription of antiasthmatic medication between January 2001 and December 2001. Main outcome measurements: Percentages of patients whose utilization of hospitalization, emergency room visits, and ambulatory care visits during the 12-month follow-up period. Results: Patients were prescribed with oral antiasthmatic agents more frequently than inhaled (approximately 80% vs. 20%). The prescribing pattern of antiasthmatics was only associated with ambulatory care visits for asthma. Compared with inhaled antiasthmatics alone, using oral alone and combination of inhaled and oral agents significantly decreased the likelihood of an asthma-related ambulatory care visit by 33% and 50%. Patients who taking one (1 vs. 0.50) or two (1 vs. 0.67) types of antiasthmatics had lower ambulatory care visits for asthma than those taking more than 4 types. Among patients who aged 45-64 years old had more ambulatory care visits for asthma than those did 0-18 years old (1 vs. 1.58). District hospitals had fewer asthma-related ambulatory care visits than medical centers (1 vs. 0.77). Conclusions: Asthma-related healthcare utilization, only ambulatory care visits was associated with the prescribing pattern of antiasthmatics. Patients with Charlson comorbidity index score greater than 1 incurred greater ambulatory care visits for asthma than did patients with zero. Medical centers had more asthma-related ambulatory care visits than district hospitals．