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研究生:張麗晴
研究生(外文):Lee-Chin Chang
論文名稱:台灣中醫藥利用型態之研究
論文名稱(外文):Studies on the Utilization of Chinese Medicine and Herbs in Taiwan
指導教授:黃怡超黃怡超引用關係周穎政周穎政引用關係黃心苑黃心苑引用關係
指導教授(外文):Yi-Tsau HuangYiing-Jenq ChouNicole Huang
學位類別:博士
校院名稱:國立陽明大學
系所名稱:傳統醫藥學研究所
學門:醫藥衛生學門
學類:藥學學類
論文種類:學術論文
畢業學年度:97
語文別:中文
論文頁數:210
中文關鍵詞:中醫中藥藥物流行病學利用型態銀杏葉阿斯匹靈草藥藥物安全健保資料庫
外文關鍵詞:Chinese medicineherbspharmacoepidemiologyutilizationGinkgo bilobaaspirindrug safetyNHI
相關次數:
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全球有關補充及替代療法(Complementary or alternative medicine, 以下簡稱CAM)的使用,近年來具有增加之趨勢。在CAM的範疇中,即涵括傳統中醫學(traditional Chinese medicine)的針灸、草藥、推拿按摩等療法。中醫藥醫療利用研究有許多面向,在全民健保制度實施前,大都是以小樣本問卷調查形式,針對特定民眾研究有關傳統中醫藥的議題,例如中醫醫療利用型態等;近年則有特定醫院以其藥品資訊庫,觀察該院病患之中藥服用型態。然而,在全民健保制度實施之後,利用大樣本且深入研究台灣中醫藥使用型態之研究尚付之闕如。
台灣為中醫與西醫並存之醫療雙軌系統,中西醫師各自執行醫療業務,由於民眾就醫可近性提高,病患同時使用中藥及西藥治療分別或共同之疾病機率大幅升高。因此,中西藥物於同一療程併用可能導致產生交互作用。近年來多數藥物利用及處方開立型態研究(Drug utilization studies)均針對一般西藥,未見相關中醫藥使用型態及中西藥併用研究文獻。
本研究以人口大樣本之全民健保資料庫為基礎進行以下研究,包括:﹙一﹚中醫醫療利用型態;深入瞭解我國自全民健保實施後,民眾使用中醫醫療之型態,並與西醫醫療利用型態做對照。(二)常用中藥使用型態:探索包括常用中藥複方及單味藥,及其現代臨床應用。﹙三﹚草藥及處方藥合併服用型態;選擇大眾服用之草藥及處方藥,探索民眾合併服用之用藥風險。
我們發現女性無論是使用中醫或西醫的比率皆高於男性,中醫高使用率分佈於45-54歲人口,觀察社經收入,中醫使用者屬中上收入者;台灣中南部住民使用中醫較其他地區高,而山地、離島偏遠地區則甚少使用。另外,研究成果也發現高達九成以上的中醫醫療診治來自診所。中醫門診中,有68%診次使用中藥,因此中藥是中醫最主要的治療方法。而使用中醫之國際疾病分碼(ICD-9)主要是呼吸道與骨骼肌肉系統疾患。另外針對常用草藥品銀杏葉萃取物及處方藥aspirin進行觀察分析研究發現,此二類藥物近年來使用率逐漸上升,而合併服用上述二類藥物,以65歲以上老年病患居多,佔63.3-72.4%,42.4%合併服用處方由同一門診醫師所開立,多數為超過14天之長期服用處方。由於二藥交互作用之臨床病例時有所聞,醫師及病患仍須提高警覺,避免手術前後服用。
本研究探討有關台灣中醫藥醫療照護在全民健康保險制度下之利用型態相關議題,冀望能以實證研究之方式提供衛生政策決策者、藥物開發產學界及其他國家醫療制度參考。
There is an increasing trend in the utilization of complementary or alternative medicine (CAM) worldwide. Among different forms of CAM, Chinese medicine (CM) is well known for acupuncture, moxibustion, herbs, bone righting and massage.
Although information on different aspects of CM utilization in Taiwan is available, these reports were based on small samples using questionnaire interviews or limited to special populations. Moreover, some of these studies were conducted before the implementation of the National Health Insurance (NHI) program in Taiwan. So far, few studies on the utilization of CM have been conducted using the large database of Taiwan’s NHI program.
In Taiwan, both Western medicine (WM) and CM are licensed to practice. WM and CM are segregated and parallel in the provision of care. Taiwan’s NHI program is renowned for its accessibility to service. Patients are likely to seek both WM and CM care concurrently and the possibility of drug-herb interactions can not be ignored. Most of the information on drug utilization patterns has been derived from studies on WM. Studies regarding the utilization pattern of both CM and WM were relatively scarce.
The present study was undertaken to analyze firstly the prevalence and patterns of CM utilization in Taiwan, extracting data from the NHI claimed database. Secondly, the utilization and prescribing patterns of Chinese herbal medicines were also analyzed. Thirdly, the scale of co-prescriptions of aspirin and Ginkgo biloba extract was assessed, as an exemplary aspect of WM and CM co-prescriptions.
The study showed that females used both WM and CM health care services more than males. Moreover, the age distribution of CM utilization peaked at 45-54 years. The utilization of CM was higher in the regular salary income group than the low-income group, farmers and fishermen and the other group. CM usage was more prevalent in the central and southern parts of Taiwan, but infrequently used in mountainous areas and offshore islands. In addition, that over 90% of the CM services were provided by clinics instead of hospitals. In CM clinics, herbs were prescribed in 68% of visits. Based on the ICD-9-CM code, the most frequent main diagnoses were the respiratory system and diseases of the musculoskeletal system and connective tissue. In addition, the study showed that there was an increase in the number of aspirin prescriptions (from 29 986 out of 2 454 879 (1.2%) in 1997, to 50 614 out of 2 499 605 (2.0%) in 2003). Aspirin was mostly prescribed to patients over 50 years old. The percentage of prescriptions with aspirin increased rapidly from 57% to 84%, among those over 50 years old. The number of prescriptions with Ginkgo biloba extract also increased from 3039 to 6171 and 78–84% was prescribed to those 50 years or older. During the study period, combined prescriptions of aspirin and Ginkgo biloba extract dramatically increased four times. The combination was mostly prescribed to patients over 65 years old. Most prescriptions were longer than 14 days and 42.4% of combined prescriptions were found to be at the same ambulatory care visit.
The present study revealed that there is an increasing trend in the utilization of Chinese medicine including herbs in Taiwan in recent years. This increasing trend may be due to the coverage of CM service in the national health insurance system. This exploration of usage patterns can provide a basis for improving the safety of medication use. It is hoped that the present study could offer some useful information to both health policy makers and clinicians in Taiwan.
中文摘要2
Abstract4
目錄7
表目錄9
圖目錄10
第一章緒論11
第一節、研究背景與動機11
第二節、研究目的13
第二章文獻探討14
第一節、補充與替代醫學之定義14
第二節、世界各國有關補充與替代醫學使用現況17
第三節、補充與替代醫學利用型態研究19
第四節、影響民眾使用補充與替代醫學之因素探討20
第五節、草藥使用型態及安全性探討30
第六節、傳統中醫藥與補充與替代醫學之發展37
第七節、台灣全民健保制度下之傳統中醫藥醫療服務38
第八節、台灣中醫藥利用型態相關研究40
第三章 研究設計與方法59
第一節、研究假設59
第二節、資料來源60
第三節、台灣全民健保制度下之中醫藥利用型態62
第四節、中藥單方及複方利用型態73
第五節、草藥與西藥合併服用型態-以銀杏葉及阿斯匹靈為例78
第四章 研究結果84
第一節、台灣全民健保制度下之中醫藥利用型態84
第二節、中藥單方及複方利用型態102
第三節、草藥與西藥合併服用型態-以銀杏葉及阿斯匹靈為例116
第五章討論125
第一節、台灣全民健保制度下之中醫藥利用型態125
第二節、中藥複方及單方利用型態130
第三節、草藥與西藥合併服用型態-以銀杏葉及阿斯匹靈為例133
第四節、研究限制139
第六章 結論與建議
第一節、研究結143
第二節、未來研究方144
第三節、政策建議146
參考文獻(英文) 148
參考文獻(中文) 166
附錄169
已發表論文195
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1. 丁志音: 誰使用了非西醫的補充與另類療法?社會人口特質的無區隔性與健康需求的作用. 臺灣公共衛生雜誌 2003, 22: 155-166.
2. 丁志音: 誰使用了非西醫的補充與另類療法?社會人口特質的無區隔性與健康需求的作用. 臺灣公共衛生雜誌 2003, 22: 155-166.
3. 王廷輔: 台中地區居民中西醫療行為取向之研究. 公共衛生 1990. 17: 21-33.
4. 王廷輔: 台中地區居民中西醫療行為取向之研究. 公共衛生 1990. 17: 21-33.
5. 石曜堂, 葉金川, 楊漢湶, 羅紀瓊, 張明正, 吳正儀: 台灣地區國民自付醫療費用調查:1992年國民醫療保健支出調查之初步發現. 中華公共衛生雜誌1994, 13: 473-484.
6. 石曜堂, 葉金川, 楊漢湶, 羅紀瓊, 張明正, 吳正儀: 台灣地區國民自付醫療費用調查:1992年國民醫療保健支出調查之初步發現. 中華公共衛生雜誌1994, 13: 473-484.
7. 李丞華, 周穎政, 陳龍生, 張鴻仁: 全民健保中醫門診利用率及其影響因素. 臺灣公共衛生雜誌2004, 23: 100-107.
8. 李丞華, 周穎政, 陳龍生, 張鴻仁: 全民健保中醫門診利用率及其影響因素. 臺灣公共衛生雜誌2004, 23: 100-107.
9. 李卓倫, 紀駿輝, 賴俊雄: 時間、所得與中西醫療價格對中醫門診利用之影響. 中華公共衛生雜誌1995, 14: 470-476.
10. 李卓倫, 紀駿輝, 賴俊雄: 時間、所得與中西醫療價格對中醫門診利用之影響. 中華公共衛生雜誌1995, 14: 470-476.
11. 李浤岦, 畢柳鶯, 周碧瑟: 脊髓損傷患者對傳統中醫的知識、態度與行為意向之探討. 中華民國復健醫學會雜誌 2001, 29: 15-24.
12. 李浤岦, 畢柳鶯, 周碧瑟: 脊髓損傷患者對傳統中醫的知識、態度與行為意向之探討. 中華民國復健醫學會雜誌 2001, 29: 15-24.
13. 李浤岦, 畢柳鶯: 中部地區脊髓損傷病患求診傳統中醫之探討. 中華民國復健醫學會雜誌2000, 28: 245-251.
14. 李浤岦, 畢柳鶯: 中部地區脊髓損傷病患求診傳統中醫之探討. 中華民國復健醫學會雜誌2000, 28: 245-251.
15. 吳明玲, 季瑋珠: 中壢市嬰幼兒使用中醫門診相關因素之研究. 中華公共衛生雜誌 1996, 15: 303-318.