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研究生:朱逸民
論文名稱:急性下背痛西醫醫療利用分析
論文名稱(外文):An analysis of acute low back pain medical ulitilizatioin
指導教授:郝宏恕郝宏恕引用關係
學位類別:碩士
校院名稱:中國醫藥學院
系所名稱:醫務管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2001
畢業學年度:89
語文別:中文
中文關鍵詞:急性下背痛疾病管理證據醫學
外文關鍵詞:Low back painDisease managementEviden based medicine
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下背部疼痛為現代工商社會常見疾病,其成因有許多,可分為功能性與解剖性兩類,許多往往是功能性之姿式不良,或肌肉拉傷。下背痛醫療利用佔健保之支出相當大金額(全民健康保險統計),下背痛於國內一般治療方式有衛教、藥物、復健、手術、中醫及民俗療法等方式。本研究為分析八十五年,八十六年,八十七年,三年健保西醫門診檔藥品及復健醫療有無改變。研究發現八十五年八十六年,八十七年,三年中(1)腰痛患者數量,逐步成長,(2)藥品及治療明細亦成長,(3)門診人次以科別分以骨科及復健科占大部分,(4)治療費用以基層診所及地區醫院為主。
疾病管理為近年來於美國施行之整體醫療計劃以降低醫療費用,其多應用於老人,慢性病患者,其成員含醫療提供者,疾病管理者,資訊系統,臨床指引,專家系統,自我照顧系統,衛教,為治療流程之再造,初級治療者教育,醫療系統整合,保險人。臨床上已有許多計劃於不同之疾病,於不同之醫療保險系統推行,皆有其效果,多於慢性病照護。參考臨床指引,藥價基準之建立,實證醫學之應用,以提供臨床及管理上之參考,以降低醫療費用耗用。
Low back pain is a common disease in recent years. The etiology of low back pain has many factors, which may be classified as functional and organic. Most cases of low back pain result from incorrect postures or sprains. The cost of low back pain treatment is huge under National Health Insurance.
Disease management is a complement management of disease, which includes prevention, treatment and continuous management of the whole disease. Participation management of disease involves clicians, case managers and health care organizations. The maladies covered in disease management include low back pain.
The aim of this study is to analyze the cost of low back pain treatment. The data source comes from the 1997-99 National Health Insurance database. The study analyzes the cost of pharmacy and physical therapy through the 1997-1999 period. The result of the analysis shows that the cost of drug and rehabilitation increase from 1997 to 1999. Primary care and local hospital catch the most health care expenditure of low back pain patients.
Disease management profile can decrease the cost of low back pain treatment, including the utilization of drug and physical therapy. Certain organizations have set up profiles or programs on disease management. AHCPR is one of them.
目 錄
第一章 緒論 I
第一節 研究背景 9
第二節研究動機 11
第三節研究目的 11
第二章 文獻探討 12
第一節疾病管理 12
第二節國內現況 16
第三節下背痛之照護 18
第四節急性下背痛之診斷治療指引 20
第五節高科技檢查高科技使用限制 22
第六節藥費之控制 24
第三章 研究設計與方法 27
第一節研究假設 27
第二節樣本及資料來源 28
第三節 研究模型 29
第四節 分析方法 31
第五節 研究限制 32
第四章 研究結果 33
第一節 復健下背痛醫療利用人次分析 33
第二節 下背痛門診人次性別、年齡差異 34
第三節 下背痛門診人次醫院層級與科別差異 41
第四節 下背痛之復健門診層級別差異 49
第五節 下背痛之藥物治療耗用分析 65
第六節 下背痛門診治療費用分析 71
第七節 下背痛門診總金額分析 88
第八節 下背痛之復健治療層級別 94
第五章 結論 100
第六章 討論與建議 102
參考文獻 105
中文部分:
郝宏恕,管理式照護法則應用於全民健康保險制度之探討,行政院衛生署講稿,民國87.2。
郝宏恕等,管理式照護模式在全民健保應用之可行性分析,行政院衛生署委託研究計畫,民國87.9。
郝宏恕,疾病管理,台灣醫管學會醫管研討會,民國89.7。
蔡淑玲,高科技檢查如MRI,CT 檢查控制,醫管研討會,民國89.9。
蔡淑玲,藥價基準,中區健保局,台灣醫管學會醫管研討會,民國89.7。
石曜堂,台灣健康管理藍圖,台灣醫管學會研討會,民國90.6。
詹啟賢,台灣醫療環境之新思考,中國醫管所演講,民國90.4。
徐宏正,健保醫審制度之趨勢與探討,復健醫學期中研討會民國90.6。
黃宗炎,下背痛,人愛醫訊,1卷1期,民82.01,頁17-19。
劉作仁,臨床醫學,36卷4期,民84.10 頁227-234。
王國哲、賴世偉、賴明美,急性下背痛病人的評估與處理原則,基層醫學,15卷11期,民89.11 頁241-247。
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