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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 楊銘欽(Ming-Chin Yang) | |
| dc.contributor.author | Chia-Yuan Chang | en |
| dc.contributor.author | 張家源 | zh_TW |
| dc.date.accessioned | 2021-06-16T16:15:50Z | - |
| dc.date.available | 2018-03-04 | |
| dc.date.copyright | 2013-03-04 | |
| dc.date.issued | 2013 | |
| dc.date.submitted | 2013-02-06 | |
| dc.identifier.citation | 英文部分
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(2005). New cardiovascular drugs: patterns of use and association with non-drug health expenditures. Journal Information, 42(4). Neaton, J. D., & Wentworth, D. (1992). Serum Cholesterol, Blood Pressure, Cigarette Smoking, and Death From Coronary Heart Disease Overall Findings and Differences by Age for 316099 White Men. Archives of internal medicine, 152(1), 56. OECD. (2010). OECD Health Data 2010, June 2010. Sanz, G., & Fuster, V. (2008). Fixed-dose combination therapy and secondary cardiovascular prevention: rationale, selection of drugs and target population. Nature Clinical Practice Cardiovascular Medicine, 6(2), 101-110. Schwartz, G. L., & Sheps, S. G. (1999). A review of the sixth report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Current Opinion in Cardiology, 14(2), 161. Sever, P. S., Dahlof, B., Poulter, N. R., Wedel, H., Beevers, G., Caulfield, M., et al. (2003). Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. The Lancet, 361(9364), 1149-1158. Trialists’Collaboration, B. P. L. T. (2000). Effects of ACE inhibitors, calcium antagonists, and other blood-pressure-lowering drugs: results of prospectively designed overviews of randomised trials. Lancet, 355(1), 955-964. Van Wijk, B. L. G., Klungel, O. H., Heerdink, E. R., & de Boer, A. (2005). Rate and determinants of 10-year persistence with antihypertensive drugs. Journal of hypertension, 23(11), 2101-2107. YUSUF, S. (2002). MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals: a randomised placebo-controlled trial. Commentary. Lancet, 360(9326), 7-22. 丁予安. (2003). 高血脂防治手冊: 國人血脂異常診療及預防指引: 行政院衛生署國民健康局. 文羽苹, 黃旭明, & 江東亮. (2012). 台灣醫療保健支出成長率的分析: 醫療通膨, 質量與公平性. 臺灣公共衛生雜誌, 31(1), 2-11. 王俊雄, 紀櫻珍, 吳振龍, 施奕仲, & 薛亞聖. (2007). 高血壓病患疾病管理之臨床應用. 金山, 3610(35), 15.15. 江東亮. (2002). 台灣醫療保健支出之趨勢. [公衛]. 台灣衛誌, 21(3), 7. 行政院衛生署中央健保局. (2009). 中央健保局98藥費申報資料. 吳尹中. (2011). 台灣與 OECD 國家醫藥支出之比較. 藥學雜誌電子報, 107(27(2)). 李德福 , 曾., 丁予安. (2010). 2010 台灣地區高血壓治療指引. 全國醫師聯合會. 汪秀玲, & 關皚麗. (2011). 健康照護系統中潛在浪費的衡量與國際比較. 臺灣醫學, 15(3), 233-243. 張瓊云. (2007). The Impacts of New Drug Angiotensin II Receptor Blockers on The Health Expenditure of Hypertension Patients. 國立成功大學臨床藥學研究所. 陳建仁, 游山林, 白其卉, 蘇大成, 曾慶孝, 簡國龍, et al. (2003). 台灣地區高血壓, 高血糖, 高血脂盛行率調查報告. 台北市, 國民健康局. 衛生署統計室. (2009). 衛生署統計室 98年全民健康保險醫療統計年報. 衛生署統計室. (2010). 衛生署死因分析. 輝瑞藥廠. (2009). 脈優中文仿單. 謝明家, 張毓泓, & 曾慶孝. (2009). 老年人高血壓的治療. 台灣老年醫學暨老年學雜誌, 4(1), 1-14. | |
| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/62942 | - |
| dc.description.abstract | 研究背景：高血壓、高血脂是心血管疾病的重要危險因子，各國無不致力於對於高血壓及高血脂的預防與治療。
研究目的：本研究目的為了解高血壓合併高血脂之病人單方併用療法或固定複方用藥在心血管相關疾病的控制情形，及其與心血管疾病相關的醫療費用。 研究方法：本研究以國家衛生研究院全民健康保險學術資料庫2005年百萬承保歸人檔為資料來源，選出2005到2010年間有就醫資料者，針對高血壓合併高血脂並使用單方併用藥品與固定複方用藥治療的45歲以上成年人，排除過去心血管病史、資料不全的就診資料，共有15,124人納入研究分析。其中持有單方併用藥品的人數為14,545人，複方用藥的人數有579人。統計方法包括威爾克森符號等級檢定、卡方檢定、Cox Proportional Hazard Regression及Multiple regression analysis。 研究結果：男性、年齡越高者、使用單方併用藥品者、疾病嚴重度低者、在基層醫療院所就醫者，罹患心血管疾病的風險越高。醫療費用方面，男性、年齡低者、單方併用藥品者、藥品持有率越高者、疾病嚴重度越嚴重者、北區、南區、東區健保分局、基層醫療院所以外醫療機構的平均每人每月門診總費用較高。男性、年齡高者、單方併用藥品者、藥品持有率越低者、疾病嚴重度越嚴重、北區、中區、高屏區、東區健保分局、基層醫療院所以外醫療機構的平均每人每月住院費用較高。複方用藥平均追蹤天數1,178天和持有藥品天數1,371天都較單方併用藥品的平均追蹤天數為1,256天和持有藥品天數1,622天少，但發生心血管疾病的每萬人口發生率卻較低。使用單方併用藥品的病人得到心血管疾病風險是複方用藥是得到心血管疾病風險的1.244倍。 研究結論：複方用藥平均追蹤天數和持有藥品天數都較顯著低於單方併用藥品者，但發生心血管疾病的每萬人口發生率卻較低，使用單方併用藥品的病人得到心血管疾病風險是複方用藥是得到心血管疾病風險的1.244倍。單方併用藥品組的門診醫療費用及住院醫療費用皆顯著高於複方用藥組。 | zh_TW |
| dc.description.abstract | Background: Hypertension and Hyperlipidemia are the important risk factors of cardiovascular disease. Developed Countries are doing every effort to prevent and treat hypertension and hyperlipidemia.
Objective: To compare the treatment results and expenditure between fix dose combination and free combination treatment of hypertension with hyperlipidemia patients. Method: The data of this study came from the National Health Insurance database released by the National Health Research Institute. Toally15,124 patients with hypertension and hyperlipidemia were identified. Among them, fix dose combination treatment group has 579 patients while free combination treatment group has 14,545 patients. We used Wilcoxon signed Rank test, Chi-square Test, Cox Proportional Hazard Regression Model and Multiple regression analysis to test the relationship between cardiovascular disease and different treatment to observe result and expenditure. Results: Being male, older, free combination medicine and the more severity of disease had higher risk of cardiovascular disease. In terms of medical costs, male, free combination treatment, the high medicine coverage rate, severe cases and patients belong to North, Southern, Kaohsiung and Pingtung District Health Insurance Branch or patients in Medical center and Regional hospital and Area hospital had higher outpatient expenditure. Being female, older, free combination group, the low medicines coverage rate, the more severity of disease, patients belong to North, South, Kaohsiung-Pingtung Eastern District Health Insurance Branch or patients in Medical center and Regional hospital and Area hospital had higher hospitalization expenditure. The average follow up days of fix dose group was 1,178 days and 1,371 days medicine days while free combination group was 1,622 days and 1,256 days. But the occurrence rate of cardiovascular disease was lower than free combination group. According to the analysis result of the Cox Proportional Hazard Regression Model, the risk of having cardiovascular disease for patients using free combination medicine was 1.244 times higher compared to fix dose combination group. Conclusions: The average follow up days and prescription days for the fix dose group were all significantly lower than that of free combination group. However, the risk of having cardiovascular disease was lower for the fix dose group. The outpatient and hospitalization expenditures were significantly higher in the free combinational group. | en |
| dc.description.provenance | Made available in DSpace on 2021-06-16T16:15:50Z (GMT). No. of bitstreams: 1 ntu-102-P98843013-1.pdf: 585201 bytes, checksum: 372e5f7dc96674b6da1996780644ab0b (MD5) Previous issue date: 2013 | en |
| dc.description.tableofcontents | 誌謝 i
中文摘要 ii Abstract iii 第一章 緒論 1 第一節、前言 1 第二節、研究背景與動機 1 第三節、研究目的 3 第四節、研究的預期重要性 3 第二章 文獻探討 4 第一節、高血壓與高血脂之簡介 4 第二節、藥物治療概況 9 第三節、單方併用療法與固定複方 13 第四節、相關實證研究 16 第五節、綜合文獻評論 19 第三章 研究材料與方法 20 第一節、研究架構 20 第二節、研究假說 21 第三節、研究材料及對象 22 第四節、研究變項與操作型定義 30 第五節、統計分析方法 34 第四章 研究結果 36 第一節、描述性統計 36 第二節、雙變項分析 39 第三節、用藥型態的相關結果進行描述 43 第四節、多變項分析 46 第五章、討論 52 第一節、研究結果之討論 52 第三節、研究限制 59 第六章 結論與建議 60 第一節 結論 60 第二節 建議 64 參考文獻 65 表目錄 表2-1、高血壓指南分期（第七版） 5 表2-2、國人血脂異常分類 7 表2-3、NCEP-ATP III 血脂異常標準定義 7 表2-4、常見口服降壓劑類別及作用機轉 9 表2-5、風險因子與治療目標 12 表3-1、本研究資料來源和使用欄位 22 表3-2、有關藥品持有率之名詞定義 27 表3-3、變項操作型定義 32 表4-1、所有變項之描述性分析（N=15,124） 38 表4-2、變項之間的雙變項分析 41 表4-3、單方及複方用藥分析 43 表4-4、Log rank test分析表 45 表4-5、探討單方複方病人罹患心血管疾病之Cox proportional hazard model 48 表4-6、探討單方複方病人門診醫療費用之複迴歸分析 49 表4-7、探討單方複方病人住院醫療費用之複迴歸分析 50 表5-1、全民健康保險降血脂藥物給付規定表（101年版） 54 圖目錄 圖3-1、研究架構 20 圖3-2、各檔案串接所使用欄位…………………………………………………….25 圖3-3、資料分析流程……………………………………………………………….29 圖4-1、單方併用藥品和複方用藥病人生存的Kaplan-Meier估計圖 44 | |
| dc.language.iso | zh-TW | |
| dc.subject | 高血脂 | zh_TW |
| dc.subject | 高血壓 | zh_TW |
| dc.subject | 單方及複方用藥 | zh_TW |
| dc.subject | 健保資料庫 | zh_TW |
| dc.subject | fix dose combination | en |
| dc.subject | hyperlipidemia | en |
| dc.subject | Nation Health Insurance Research Database | en |
| dc.subject | Free combination | en |
| dc.subject | hypertension | en |
| dc.title | 罹患高血壓合併高血脂之病人使用單方併用療法與固定複方治療之醫療支出 | zh_TW |
| dc.title | The Medical Expenditure of Free Combination and Fix dose Combination for Treating Hypertension with Hyperlipidemia | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 101-1 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 蒲若芳(Raoh-Fang Pwu),湯澡薰(Chao-Hsiun Tang) | |
| dc.subject.keyword | 單方及複方用藥,高血壓,高血脂,健保資料庫, | zh_TW |
| dc.subject.keyword | Free combination,fix dose combination,hypertension,hyperlipidemia,Nation Health Insurance Research Database, | en |
| dc.relation.page | 69 | |
| dc.rights.note | 有償授權 | |
| dc.date.accepted | 2013-02-06 | |
| dc.contributor.author-college | 公共衛生學院 | zh_TW |
| dc.contributor.author-dept | 健康政策與管理研究所 | zh_TW |
| 顯示於系所單位： | 健康政策與管理研究所 | |
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