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| DC 欄位 | 值 | 語言 |
|---|---|---|
| dc.contributor.advisor | 鄭守夏 | |
| dc.contributor.author | Yi-Jing Kuo | en |
| dc.contributor.author | 郭奕靚 | zh_TW |
| dc.date.accessioned | 2021-05-17T09:18:20Z | - |
| dc.date.available | 2017-09-17 | |
| dc.date.available | 2021-05-17T09:18:20Z | - |
| dc.date.copyright | 2012-09-17 | |
| dc.date.issued | 2012 | |
| dc.date.submitted | 2012-07-17 | |
| dc.identifier.citation | 中文部分
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| dc.identifier.uri | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/6798 | - |
| dc.description.abstract | 背景 依據衛生署統計資料，台灣糖尿病盛行率約4.3%，估計共約有100萬名糖尿病病人。健保局一年花在糖尿病上的費用達184億元，醫療負擔相當驚人。慢性病的治療與控制需要長期而持續地就醫用藥。為加強對慢性疾病病人的照顧，健保局自1995年起大力推動慢性病連續處方箋制度。
目的 本研究旨在評估慢性病連續處方箋所造成健康照護與醫療資源耗用影響。 方法 本研究利用2003-2005年健保資料庫糖尿病特殊需求檔，將口服糖病用藥穩定之第二型糖尿病人分為無慢箋組、間歇慢箋組與持續慢箋組，以無慢箋組之特性對另外兩組進行傾向分數配對，以配對後三組比較不同慢箋使用特性族群之醫療資源耗用情形與健康照護結果。 結果 配對後樣本無慢箋組、間歇慢箋組、持續慢箋組各16560人。連續處方箋使用對健康照護結果影響部分，以糖尿病相關急診與住院次數做為健康照護結果指標，結果無慢箋組次數最多，間歇慢箋組次之，持續慢箋組最少，亦即持續慢箋組有最佳之健康照護結果 (p<0.01)。醫療資源耗用部分，以糖尿病相關/總醫療花費、糖尿病相關/門診醫療花費與糖尿病相關/門診就診次數為指標皆顯示持續慢箋組有最少之花費，間歇慢箋組次之，無慢箋組最多 (p<0.01)。 結論 糖尿病人使用慢性病連續處方箋，有較佳的健康照護結果，且有較低的醫療資源耗用，皆未見明顯的負面影響。 | zh_TW |
| dc.description.abstract | According to the statistics of the Department of Health, the prevalence of diabetes is about 4.3% in Taiwan and there are about 1 million diabetes patients. For taking care of chronic disease patients, the Bureau of National Health Insurance implemented the prescription refill policy. However, diabetes has been a heavy burden of the health care system in Taiwan. This research is conducted to evaluate the impacts prescription refills has on the health care resources utilization and the health care outcome in Taiwan. We use the NHI claims data from 2003-2005, identifying different prescription-refill-usage characteristics into 3 groups: the sustain-use group, the intermittent-use group, and the never-use group. We choose the never-use group as the control group and select the intervention group from the sustain-use and the intermittent-use group by propensity score matching to construct a comparable matching group. The total sample size is 49680 (16560 each group). Subsequently, we take a generalized equation estimate (GEE) approach to compare the likelihood of the health care resources utilization and the health care outcome among the three groups. While using the diabetes related hospitalization and emergency utilization as the indictors of the health care outcome, the frequency are the sustain-use < the intermittent-use < the never-use group (p<0.01). On the other hand, the health care resources utilization is sustain-use < the intermittent-use< the never-use group (p<0.01) as well. That is, diabetes patients who using prescription refills have better health care outcome and lower health care resources utilization in Taiwan. | en |
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| dc.description.tableofcontents | 致謝 ............................................................... II
中文摘要 .......................................................... III ABSTRACT ........................................................ IV 目錄 ................................................................ V 第一章 緒論 ...................................................... 1 第一節 研究背景 ............................................................................................................................ 1 第二節 研究動機與問題 ................................................................................................................. 2 第三節 研究目的與重要性 ............................................................................................................. 2 第二章 文獻回顧 .................................................. 3 第一節 糖尿病簡介......................................................................................................................... 3 (一) 糖尿病的診斷 .................................................................................................................. 3 (二) 糖尿病相關併發症 .......................................................................................................... 4 (三) 糖尿病流行病學 .............................................................................................................. 5 (四) 糖尿病治療目標 .............................................................................................................. 6 (五) 糖尿病治療藥物 .............................................................................................................. 7 第二節 慢性病連續處方箋政策 ..................................................................................................... 9 第三節 國外連續處方箋相關研究 ................................................................................................. 9 (一) 連續處方箋制度 ............................................................................................................ 10 (二) 連續處方箋與健康照護結果 ........................................................................................ 11 (三) 連續處方箋與醫療資源耗用 ........................................................................................ 11 (四) 連續處方箋與調劑順從度 ............................................................................................ 12 第四節 國內連續處方箋相關研究 ............................................................................................... 13 (一) 連續處方箋使用行為 .................................................................................................... 13 (二) 連續處方箋與健康照護結果 ........................................................................................ 13 (三) 連續處方箋與醫療資源利用 ........................................................................................ 13 第五節 小結 .................................................................................................................................. 15 第三章 研究材料與方法 ........................................... 16 第一節 研究架構 .......................................................................................................................... 16 第二節 資料處理流程................................................................................................................... 18 第三節 變項定義 .......................................................................................................................... 26 第四節 研究假說 .......................................................................................................................... 32 第五節 統計分析 .......................................................................................................................... 33 第四章 研究結果 ................................................. 34 VI 第一節 配對前後樣本特質 ............................................................................................................ 34 (一)整體糖尿病人基本資料 ........................................................................................................ 34 (二)連續處方箋分組後樣本特性描述 ........................................................................................ 36 (三)配對後樣本特性描述 ............................................................................................................ 38 (四)配對前後特性比較 ................................................................................................................ 39 第二節 多變項分析 ........................................................................................................................ 54 (一)連續處方箋對健康照護結果影響 ........................................................................................ 54 (二)連續處方箋對醫療資源耗用影響 ........................................................................................ 54 (三)其他發現 ................................................................................................................................ 54 第五章 討論 ..................................................... 64 第一節 研究設計與方法討論 ........................................................................................................ 64 第二節 研究結果討論 .................................................................................................................... 67 第三節 研究限制 ............................................................................................................................ 72 第六章 結論與建議 ............................................... 73 第一節 結論 .................................................................................................................................... 73 第二節 政策與未來研究建議 ........................................................................................................ 74 參考文獻 ........................................................... 75 中文部分 ........................................................................................................................................... 75 英文部分 ........................................................................................................................................... 77 附錄 ............................................................... 82 | |
| dc.language.iso | zh-TW | |
| dc.title | 慢性病連續處方箋影響評估-以第二型糖尿病人為例 | zh_TW |
| dc.title | The Evaluation of Prescription Refills for Chronic Diseases: The Case of Type II Diabetes Care | en |
| dc.type | Thesis | |
| dc.date.schoolyear | 100-2 | |
| dc.description.degree | 碩士 | |
| dc.contributor.oralexamcommittee | 楊銘欽,黃文鴻 | |
| dc.subject.keyword | 連續處方箋,醫療資源耗用,健康照護結果,糖尿病,傾向分數配對, | zh_TW |
| dc.subject.keyword | prescription refill,health care resources utilization,health care outcome,diabetes,propensity score matching, | en |
| dc.relation.page | 106 | |
| dc.rights.note | 同意授權(全球公開) | |
| dc.date.accepted | 2012-07-17 | |
| 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 | |
文件中的檔案：
| 檔案 | 大小 | 格式 | |
|---|---|---|---|
| ntu-101-1.pdf | 1.06 MB | Adobe PDF | 檢視/開啟 |
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