臺灣博碩士論文加值系統

研究背景：全球人口老化的時代已經來臨，而台灣也已經於21世紀的前十年步入高齡化社會，然而，這些老年人口卻使用了我國大部分的醫療資源。內政部老人狀況調查顯示，65歲以上老人患有慢性或重大疾病者佔了75.92%，其中骨骼肌肉系統疾病24.17%。這些慢性病的疾病治療與症狀控制多半需仰賴藥物，亦有一些人會選擇使用中藥或者另類療法，因此老人用藥議題在此更顯得重要。本研究以Andersen行為模型為基礎，透過資料庫分析的方式，試圖尋找出台灣患有骨頭疾病的老人在其他疾病、健康狀態、活動功能、醫療利用等情形與特質，並且探討這些特質與患有骨頭疾病的老人及其使用中醫藥與否的關係及影響程度。
研究方法：本研究分兩階段進行，第一階進行「國民健康訪問調查-65歲以上個人問卷」資料庫分析，以探討患骨頭疾病與否之老人其自述反應與中醫藥相關使用的關係，並進一步探討老人自陳主觀健康狀態之相關影響因素。第二階段進行全民健康保險研究資料庫分析，了解台灣老人患骨關節炎或骨質疏鬆與否其中醫藥實際健保申報情形，針對有使用中醫醫療照護的老人進行分析，探討使用中醫藥相關(針灸或及曾使用中藥)之影響因素。兩階段皆使用羅吉斯回歸模型，以自述有骨頭疾病與否為依變項，將性別、年齡分層、個人月收入、現住地區四個自變項納入模型，計算出每個受訪者之傾向分數，並以用最近鄰居配對法進行1：1之比例配對。以敘述性統計與羅吉斯回歸模型進行特質比較及相關影響因素探討，再分別針對骨頭疾病組與非骨頭疾病組個別進行相關統計分析，以評估其對中醫藥使用影響程度之差異，並於設計之中醫藥使用影響因素的主模型下分別加入可能的干擾因素，以探討主模型的穩健及其與干擾因素之關係。本研究主要使用IBM SPSS 22進行統計分析，設定以p<0.05為統計上顯著的意義。
研究結果：本研究使用Andersen行為模型為理論基礎，發現老人不論是自述罹患骨頭疾病或由醫師診斷患有骨關節炎或骨質疏鬆者的確會提高中醫藥使用的可能性，居住在中部地區的老人相較於北部較傾向於使用中醫藥。其他宣稱為中等個人收入、有購買其他保險、有髖關節等疼痛、門診診次多或藥品品項多、有行動或某些活動困難、有喝酒、主觀健康狀態不比去年差、或有跌倒經驗特質的老人，不論是否患有骨頭疾病，都有相對較高比例會使用中醫藥及其相關醫藥照護；然而，自述有納入健保、教育程度高、有高血壓、高血脂、癌症、住長照機構、過去一年曾住院、於醫療院所測血脂、有憂鬱傾向、有認知障礙特質者卻相對比較不會有中醫藥及其相關使用。某些傾向因素下的併行疾病與中醫藥使用的關係從自述問卷和健保申報資料結果甚至呈現相反的趨勢。
結論：老人自陳罹患骨頭疾病或診斷有骨頭疾病的確會增加中醫藥使用的傾向，兩資料庫之羅吉斯迴歸分析結果發現，患骨頭疾病與否的老人，其部份特質影響中醫藥使用之結果有些相同、有些不同、甚至相反，未來需要更多中醫藥使用相關成效研究來驗證這些結果。本研究探討台灣老人(特別是骨頭疾病與否)使用中醫藥的相關因素，從主客觀及健保申報資料反應找出來相關影響因素及其程度與方向，希冀可以以實證提供給醫療人員於照護老年病人參考，也可提供給醫療政策規劃者於修改未來醫療政策時參考。期許本研究的結果可引起大眾關注到老人—尤其是有骨頭疾病的老人，其中醫藥使用的議題，共同擬定最佳的策略以提升老人醫療照護品質及用藥安全。

Background: This is an era of global population aging. Taiwan has been evolving towards an aging society since the early 21th century, while elderly have been consuming most of the national health resources. According to the Ministry of the Interior, 75.92% of people aged 65 and above suffered from chronic diseases, of which 24.17% were skeletal and muscular disorders. Most patients with chronic diseases were managed with western medicines for symptom relief or health maintenance. Yet some of them would also use traditional Chinese medicine (TCM) or alternative therapies. Therefore, medication use among elderly population has been of increasing concern. Based on the Andersen health behavior model, we evaluated characteristics regarding comorbidities, health status, mobile and physical functions, and healthcare utilization among elderly with or without bone disorders in Taiwan. Further, we explored the associations between these factors and TCM use and its extent of impact among the elderly population.
Methods: There were two stages in this study. At the first stage, the National Health Interview Survey (NHIS) database in Taiwan from 2005 was analyzed. T-tests and chi-square tests were used to describe the differences of the defined characteristics, which were further evaluated with logistic regression. At the second stage, the National Health Insurance Research database was analyzed. Descriptive statistics and logistic regression were used to discuss TCM-related uses (used acupuncture or ever used Chinese medicine, ever used Chinese medicine, used acupuncture, used acupuncture and ever used Chinese medicine) in elderly with bone disorders. The statistical analysis was mainly calculated with IBM SPSS 22 software. P-value <0.05 indicated statistical significant.
Results: Elderly aged 65 and above with either self-reported or diagnosed bone disorders were found to have increased TCM-related use in both databases. Elderly with bone disorders who resided in the central part of Taiwan (lived or took out National Health Insurance in Central Division) were more likely to use TCM than those in the north part. Elderly with bone disorders had higher tendency to use TCM if they had the following factors: medium level personal income, family income 30,000-199,999 NT dollars, purchasing other commercial insurance, had pain problems, high-frequency outpatient visits, had mobile and physical problems, alcohol consumption, self-evaluated health status worse than the previous year, history of fall experience. In contrast, individuals with self-reported National Health Insurance coverage, high level education, with hypertension, hyperlipidemia, cancer, living at long term care units, hospitalization in the past year, checked lipid levels in healthcare institute, depression tendency, with cognitive problem were not tend to use TCM.
Conclusion: Elderly with self-reported or diagnosed bone disorders appeared to increase TCM use. However, several findings were reported differently between the two databases. Further research should focus on evaluating the whole picture of TCM use in elderly with bone disorders. Hopefully, this study can promote public awareness of aging related issues, which can ultimately enhance the quality of elderly care and drug safety.

中文摘要 I
英文摘要 IV
目錄 VI
表目錄 IX
圖目錄 X
中英名詞對照表 XI
英文縮寫對照表 XIII
第一章 緒論 1
第一節 研究背景 1
第二節 研究目的 5
一、 研究問題 5
二、 研究目標 5
第二章 文獻探討 6
第一節 老人醫療資源利用與花費 6
第二節 老人疾病與慢性病 8
一、 老人疾病概述 8
二、 老人骨頭疾病 9
(一) 骨關節炎 9
(二) 骨質疏鬆症 10
第三節 老人藥物之使用 13
第四節 老人中醫藥之使用 14
第五節 醫療利用行為理論與ANDERSEN行為模型介紹 15
第六節 國家型健康相關資料庫 17
一、 國民健康訪問調查資料庫 17
(一) 國民健康訪問調查簡介 18
(二) 使用國民健康訪問調查資料庫進行研究之優勢與限制 19
二、 全民健康保險研究之料庫 19
(一) 全民健康保險研究資料庫簡介 20
(二) 使用健保資料庫的研究優勢與限制 21
第七節 總結 25
第三章 研究方法 26
第一節 研究步驟 26
一、 研究假設 26
二、 研究架構 26
三、 研究設計 27
四、 使用資料之來源 28
五、 研究流程 29
第二節 全國性自陳問卷調查次級資料分析 31
一、 研究對象與分組 32
二、 研究變項 34
三、 分析策略及統計方法 41
(一) 非骨頭疾病老人之傾向分數配對 41
(二) 老人自陳罹患骨頭疾病與否及使用中醫藥與否的特質差異探索 41
(三) 自陳罹患骨頭疾病與否之老人使用中醫藥之相關因素探討 42
(四) 老人自陳健康成效之影響因素探討 43
(五) 分層分析 45
第三節 全民健康保險研究資料庫之次級資料分析 46
一、 研究對象與分組 47
二、 研究變項 50
三、 資料處理流程 53
四、 分析策略及統計方法 55
(一) 非骨頭疾病老人之傾向分數配對 55
(二) 老人罹患骨頭疾病與否及中醫藥使用與否之特質探索 55
(三) 罹患骨頭疾病之老人中醫藥相關使用之因素探討 57
第四章 研究結果 59
第一節 全國性自陳問卷調查次級資料分析結果 59
一、 老人自陳罹患骨頭疾病及使用中醫藥之特質探索 60
(一) 研究對象之族群特質 60
(二) 老人中醫藥使用之特質比較 70
二、 自陳罹患骨頭疾病之老人使用中醫藥之因素探討 87
(一) 環境因素 88
(二) 特徵傾向因素 88
(三) 可用資源因素 89
(四) 需求因素 89
(五) 醫療服務使用因素 90
(六) 健康狀態因素 91
(七) 敏感性分析 98
三、 老人自述健康成效之影響因素探討 99
(一) 研究對象與去年比較其主觀健康狀態之相關特質差異 99
(二) 老人患骨頭疾病與否之健康狀態比去年沒有比較差的因素探討 106
第二節 全民健康保險研究資料庫之次級資料分析結果 117
一、 老人罹患骨頭疾病使用中醫藥相關之情形 118
(一) 研究對象配對前後之患骨頭疾病與否的基本特質 118
(二) 老人罹患骨頭疾病與否之中醫藥相關使用比較 124
二、 罹患骨頭疾病之老人中醫藥相關使用之因素探討 129
(一) 使用針灸或曾使用中藥之因素 129
(二) 曾使用中藥之因素 134
(三) 使用針灸之因素 139
(四) 使用針灸且曾使用中藥之因素 144
三、 敏感性分析 149
第五章 討論 160
第一節 本研究之重大發現 160
第二節 骨頭疾病老人使用中醫藥之特質及因素 163
第三節 老人患骨頭疾病與否之去年相比健康狀態不比較差的因素探討 167
第四節 使用傾向分數配對及敏感性分析探討有關因素的相關程度 171
第五節 本研究之限制 173
第六節 本研究之價值與未來研究方向 177
第三節 結論 180
參考文獻 182
附錄 192

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