臺灣博碩士論文加值系統

一、研究背景
骨關節炎係長者常見疾病，故本文將分析台灣地區老年人骨關節炎之現況，並探討察爾森共病症指標、止痛藥物治療、人工關節置換手術後，對復健科醫療資源利用情形。
二、研究方法
以台灣全民健保資料庫2000年的100萬歸人檔，選取2011-2013年65歲以上門診或住院且曾診斷為骨關節炎患者，以卡方檢定、獨立樣本T檢定統計分析，另針對有利用復健科醫療且有治療的及有利用復健科醫療但無治療者相對於無利用復健醫療進行邏輯斯迴歸分析。
三、研究結果
結果顯示年齡越大且投保地區為台北分局以外之老年人，復健科醫療利用相對於台北地區低；察爾森共病症指標，1及 2分以上，相對於0分的復健科醫療利用分別為1.34倍及1.39倍；而有進行人工關節置換手術之患者，復健科醫療利用是沒有做的0.62倍。
以完全無利用復健醫療為參考組，邏輯斯迴歸分析結果顯示，76以上有接受復健科門診但未治療相對於65-70歲復健醫療利用較低，健保投保分局於中南部地區相對於為台北地區對復健科醫療利用低，察爾森共病症指標1及2分相對於0分高，接受人工關節置換手術相對於未手術利用機率低；在未接受復健科門診亦無利用復健科醫療，中南部分局相對於台北分局利用機率低，察爾森共病症指標1、2分以上者相對於0分利用機率低，使用NSAIDs、Acetaminophen及關節腔藥物注入為未使用機率高，執行人工關節置換者為未執行手術者利用機率低。
四、研究結論
針對年紀較大於76歲以上的骨關節炎患者，且於復健醫療資源較為缺乏的中南部，地區察爾森共病症指標被評估1分以上及有接受過人工關節置換手術之患者，應多利用復健醫療，讓復健科醫師診斷是否需進一步復健治療。

Objective
Osteoarthritis is a common disease in the elderly. Treatment options for osteoarthritis include medication, intra-articular injection, joint replacement surgery and rehabilitation. The main objective of this study was to investigate the rehabilitation resources utilization. This study also investigated the epidemiology of osteoarthritis in Taiwan, and other treatment options of osteoarthritis.
Method
This studyused the Longitudinal Health Insurance Data subset of 1 million beneficiaries from the National Health Insurance Research Database.Those aged 65 or above who had been diagnosed to have osteoarthritis during 2011-2013 were included in this study. The pattern of rehabilitation resources utilization by them in 2013 was investigated. Besides, demographic profile, Charlson Comorbidity Index, the pattern of medication prescription, whether the beneficiaries received intra-articular injection, whether they received joint replacement surgery were also examined. Data were analyzed using Student''s t-test, Chi-square test and Logistic regression.
Result
Student''s t-test and Chi-square test revealed that rehabilitation resources utilization was significantly affected by age, living area ,comorbidity, and the history of joint replacement surgery.
Logistic regression analysis showedthat the rehabilitation resource utilizationdecreased beyond the age of 76. People who lived outside Taipei or Kaohsiung-Pingtung area had lower rehabilitation resource utilization.People with more comorbidity were more likely to use rehabilitation resources. People received joint replacement had a lesser rehabilitation resource utilization than those who did not.
Conclusion
This study of rehabilitation resources utilization for the elderly patients with osteoarthritis in Taiwan revealed that, osteoarthritis patients who were older than 76 years old, who lived outside Taipei or Kaohsiung-Pingtung area, and who had more comorbidity were more likely to use rehabilitation resources. Concern should be raised regarding the increasing need of rehabilitation resources for the aging population in Taiwan and the possible urban-rural gap of rehabilitation resources accessibility. The fact that joint replacement reduces the need for rehabilitation we found in this study may contribute to public health policy.

謝誌 II
中文摘要 III
英文摘要 V
目次 VII
圖次 IX
表次 X
第一章緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章文獻探討 4
第一節老年人與慢性疾病 4
第二節骨關節炎概述 7
一、骨關節炎之定義 7
二、骨關節炎之流行病學 12
第三節 合併症嚴重指標 16
第四節 骨關節炎之藥物治療 17
第五節 骨關節炎之手術治療 21
第六節 免疫風濕疾病患者醫療利用 24
一、僵直性脊椎炎患者醫療利用影響因子 24
二、紅斑性狼瘡患者醫療利用影響因子 25
三、 異位性皮膚炎患者醫療利用影響因子 28
四、 痛風患者醫療利用影響因子 30
五、類風濕性關節炎患者利用復健醫療影響因子 32
六、全民健保復健科利用情形 34
七、骨關節炎患者之復健醫療 36
八、骨關節炎患者利用復健醫療影響因子 43
第三章研究方法 44
第一節研究架構 44
第二節資料來源 46
第三節研究對象選取流程 48
第四節資料處理流程 49
第五節研究變項定義 51
第六節統計分析方法 57
第四章結果 58
第一節 基本資料描述 58
一、骨關節炎患者之基本資料 58
二、察爾森共病症指標分布情形 58
三、藥物治療分布情形 59
四、手術治療分布情形 60
五、復健科醫療利用情形 60
第二節 影響骨關節炎患者復健科醫療利用因素 63
第五章結論與建議 72
第一節 討論 72
第二節 結論 79
第三節 研究限制 80
第四節 未來研究方向與建議 82
參考文獻 83

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