中醫介入對失智症照護成效及醫療費用之影響

Abstract

研究背景：依據台灣失智症協會2011年失智症流行病學調查結果顯示，我國目前約有30萬名失智症病患，盛行率達1.29%，亦即65歲以上老人每13人即有1名失智症患者，隨著社會高齡化進展，失智症病人的治療與所衍伸相關的問題將越來越受重視，可以預見成為全球重大公共衛生問題之一。經由過去研究結果發現，中醫治療對失智症病人各面項病況有不同程度的幫助，然而此類研究大多使用健保資料庫分析，缺乏較直觀的預後測量指標，或無利用失智症疾病診斷碼與相關認知功能測驗數據，精確篩選失智症病患。 研究目的：本研究欲探討中醫醫療利用對失智症病人日常生活功能、認知功能以及醫療費用之影響。 研究方法：本研究使用長庚醫院醫學研究資料庫，探討2004至2021年失智症患者之中醫利用情形，對於後續2年日常生活功能、認知功能以及醫療費用之影響。並針對年齡、性別、教育程度、就醫院區、共病症指數、居住都市化程度、失智症西藥使用情形、失智症嚴重程度等變項採用傾向分數配對方法，使組間分布較為一致，減少選樣偏差。因依變項有重複測量情形，故使用廣義估計方程式控制社會人口特質、地區特質、失智西藥治療後，檢測中醫醫療利用對依變項的影響。 研究結果：經配對後共441位研究對象，中醫介入組90位、非中醫介入組351位，多變項迴歸分析結果，中醫介入失智症的病人相較非中醫介入組，簡短智能測驗分數變化量每年會增加0.608分，而每年臨床失智分期分數變化量為非中醫利用組的0.702倍，皆達統計上顯著水準。中醫介入後每年之門診費用較無介入組增加14,766元，住院費用增加9,728元，總醫療費用增加24,477元，且達統計顯著差異。 結論：中醫介入會延緩失智症病人的簡短智能分數的下降，對於病人的臨床失智症分期分數有延緩上升趨勢，皆達統計顯著。中醫介入會增加失智症病人的醫療費用，尤其是門診醫療費用部分。若將來制定失智症相關政策時，可將中醫介入治療失智病人納入考量，並建議一年使用中醫門診治療須達6次以上。

Objectives: According to the 2011 dementia epidemiological survey conducted by the Taiwan Dementia Association, there are currently about 300,000 dementia patients in Taiwan, with a prevalence rate of 1.29%, that is, 1 out of every 13 people over the age of 65 Dementia patients, with the progress of aging society, the treatment of dementia patients and related issues will receive more and more attention, and it can be predicted to become one of the major public health problems in the world. Past research results have found that Chinese medicine treatment can help dementia patients to varying degrees. However, most of these studies use health insurance database analysis, lack of more intuitive prognostic indicators, or make good use of dementia disease diagnosis codes and related cognitive function test data to accurately screen dementia patients. This study aims to explore the influence of traditional Chinese medicine (TCM) medical utilization on the daily life function, cognitive function and medical expenses of dementia patients. Methods: This study used CGRD (Chang Gung Medical Research Database) to explore the influence of TCM utilization by dementia patients from 2004 to 2021 on the daily life function, cognitive function and medical expenses in the following 2 years. The propensity score matching method was adopted for variables such as age, gender, education level, hospital area, comorbidity index, degree of urbanization of residence, use of western medicine for dementia, and severity of dementia to make the distribution between groups more consistent and reduce sampling bias. Due to repeated measurement of the dependent variable, the generalized estimating equation was used to control the socio-demographic characteristics, regional characteristics, and dementia western medicine treatment to detect the influence of TCM medical utilization on the dependent variable. Results: After matching, a total of 441 research subjects were included, 90 in the TCM intervention group and 351 in the non-TCM intervention group. The results of multivariate regression analysis showed that compared with the non-TCM intervention group, the scores of short intelligence test scores changed each year in the TCM intervention group will increase by 0.608 points, and the annual change in clinical dementia stage scores is 0.702 times that of the non-TCM utilization group, both reaching statistically significant levels. After TCM intervention, the annual outpatient expenses increased by NT$14,766, the hospitalization expenses increased by NT$9,728, and the total medical expenses increased by NT$24,477 compared with the non-intervention group, and the difference was statistically significant. Conclusions: TCM intervention can delay the decline of brief intelligence scores of dementia patients, and delay the rise of patients' clinical dementia stage scores, both of which are statistically significant. The intervention of TCM will increase the medical expenses of dementia patients, especially the outpatient medical expenses. If policies related to dementia are formulated in the future, TCM intervention in the treatment of dementia patients can be taken into consideration, and it is recommended to use TCM outpatient treatment for more than 6 times a year.