臺灣博碩士論文加值系統

美國WHI報告後，影響全球荷爾蒙使用觀念，本論文研究主要目的為探討WHI對台灣更年期醫療耗用之影響。研究之材料方法為2000年-2004年健保門診歸人檔，分析以ICD-9疾病代碼627：更年期症候群，7330：骨鬆症看診者開立荷爾蒙藥物之分析，且比較WHI之前（2000-2002），之後（2003-2004）之差異，依不同科別：婦產科、骨科、其他科，醫院層級，醫院權屬，醫師性別、年齡，患者年齡、都市化程度，探討這些因素開藥行為是否不同。結果為WHI報告後，荷爾蒙使用下降，占健保總藥費也比率下降，不管醫師科別、年別、年齡，醫院層級、權屬，患者年齡、都市化程度全都呈有意義的下降趨勢。分析影響因子中，婦產科及骨科醫師為主要開藥醫師，WHI對婦產科影響大，婦產科醫師開藥因WHI報告而下降，但骨科醫師不受影響，反而增加。併存兩種疾病時中心，區域醫院開藥下降，骨鬆症看診者，WHI以後中心，區域醫院開藥增加，公立醫院下降，男醫師不受WHI影響，開藥都高於女醫師，且WHI之後，開藥仍上升。
WHI在醫師年齡影響不大，患者年齡，高齡（≥60歲）併存兩種疾病時，開藥較多，WHI報告後，高齡因更年期症候而用藥比率下降。都市患者併存兩種疾病時，開藥較低，WHI使都市患者因更年期症候群，骨鬆症看診開藥比率下降，更年期症狀者都市仍高於鄉村患者，骨鬆症看診者，都市患者低於鄉村患者。總結為WHI對台灣醫療耗用影響很大，使荷爾蒙費用占全健保藥費比率下降，婦產科、骨科為使用荷爾蒙最多者，不同專科、不同醫院屬別、層級，WHI對其影響不同，男醫師較女醫師易開荷爾蒙，且不受WHI影響，故用藥共識與準則是必需的。WHI對都市患者與鄉村患者，高齡與低齡患者有不同之影響，患者本身的認知與意願也影響荷爾蒙使用。

The women health initiative (WHI) report provokes dramatic change in hormone therapy universally. The aims of the thesis are proposed to investigate the effect of WHI report on Taiwanese menopausal medicine. We analysed the data of out-patient clinic (2000-2004) collected from Taiwan Health Insurance Bureau, and the confounding factors of specialist, hospital, gender and age of the doctors, age and socioeconomic status of the patients are included. The results reveal the consumption of hormone therapy has decreased significantly after WHI report. The trends of the decreament were identical among the confounding factors. Gynecologist and Orthopedist are the major specialist to prescribe hormone therapy. The prescription from Gynecologist decreased after WHI report, on the contrary, the prescription from Orthopedist increased after WHI report. The WHI effect differently on the levels of the hospitals. The prescription under ICD-9 of 7330 (osteoporosis) increased from Medical Center and district hospitals after WHI report, oppositely, it decreased from the public hospitals. Male doctors prescribed more hormone therapy than those of female doctors. The WHI report did not effect the hehavior of the male doctors. For ages of the doctor, WHI report has no significant influence. Patients aged more than 60 years old were easier to use hormone therapy if they suffered from both climacteric syndrome and osteoporosis. After WHI report, the prescription of hormone therapy decreased for climacteric syndrome in the patients aged more than 60 years old. The urban patients took less hormone if they were diagnosed both climacteric syndrome and osteoporosis. WHI report influenced the urban patients to decrease the hormone therapy. Urban patients took more hormone therapy than the rural patients if under the diagnosis of climacteric syndrome, but it is contrary in the diagnosis of osteoporosis.
Taken together, WHI really impact on the hormone therapy in Taiwan, however, there are controversial effects on different specialist and hospitals. Therefore, the consensus and guide lines are essential. The effect of WHI on patient ages, socioeconomic levels were not alike. On the other words, the knowledge and attitude of the patients have effect on the hormone therapy.

致謝……………………………………………………………………Ⅰ
中文摘要………………………………………………………………Ⅱ
英文摘要………………………………………………………………Ⅲ
目錄……………………………………………………………………Ⅴ

第一章 緒論………………………………………………………01
第一節 研究背景與動機…………………………………………01
第二節 研究目的…………………………………………………02
第三節 預期貢獻…………………………………………………03
第四節 名詞解釋…………………………………………………03

第二章 文獻探討…………………………………………………05

第三章 研究方法…………………………………………………07
第一節 研究設計…………………………………………………07
第二節 研究架構…………………………………………………07
第三節 研究方法…………………………………………………08

第四章 研究結果…………………………………………………15
第一節 研究樣本基本資料統計分析結果………………………15
第二節 目的一和其沿引假說之統計分析結果…………………17
第三節 目的二和其沿引假說之統計分析結果…………………18

第五章 討論與結論………………………………………………24
第一節 依研究目的和研究假說討論……………………………24
第二節 研究目的外其他發現之討論……………………………26
第三節 研究限制及未來研究方向………………………………27
第四節 結論和建議………………………………………………27

圖表…………………………………………………………………29
參考文獻……………………………………………………………55

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