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中醫藥研究論叢
 261.2 中風後帕金森氏症患者接受中醫治療可減少急診與住院醫療耗用
TJ TCM.26(1) : 13-28, 2023
DOI : 10.6516/TJTCM.202303_26(1).0002
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中風後帕金森氏症患者接受中醫治療可減少急診與住院醫療耗用
Reduced Use of Emergency Care and Hospitalization in Patients with Post-Stroke
Parkinson’s Disease Treated with Traditional Chinese Medicine
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吳佩芸1,2 陳朝宗1 孫茂峰3 陳大樑4,5,6 廖建彰3,5,6,7,8*
1 台北市立聯合醫院仁愛院區中醫科，台北，台灣
2 義守大學醫學院學士後中醫學系，高雄，台灣
3 中國醫藥大學中醫學院中醫系，台中，台灣
4 台北市立萬芳醫院麻醉科，台北，台灣
5 台北醫學大學醫學院醫學系麻醉科，台北，台灣
6 台北醫學大學附設醫院麻醉暨衛生政策研究中心，台北，台灣
7 台北醫學大學附設醫院麻醉科，台北，台灣
8 台北醫學大學萬芳醫院大數據暨統合分析研究中心，台北，台灣
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【摘要】
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背景：中風患者使用中醫後之療效已多次被證實，但目前尚無證據顯示中醫治療可改善中風後帕金森氏症患者之預後。本研究評估有中風病史的帕金森氏症患者接受中醫治療後是否會減少急診及住院醫療的耗用。
方法：本研究利用全民健康保險資料，篩選了2000-2007 年間40 歲以上初次罹患帕金森氏症且有中風病史之患者（30,373 位），來建立介入性的世代研究。我們利用傾向分數進行配對，選取合適的中醫治療組（2701 位）及非中醫治療組（2701 位）之患者進行追蹤，觀察病患在追蹤期間一年內的急診及住院醫療利用，再用Cox 迴歸模型來計算中醫治療與急診及住院之醫療耗用的危害比（hazard ratio, HR）及95% 信賴區間（confidence interval,CI）。
結果：中風後帕金森氏症患者接受中醫治療後的追蹤期間一年內，與沒有接受中醫治療組相比，中醫治療組與減少的急診次數（β=-0.06，p=0.0063）、住院次數（β=-0.22，p<0.0001）、住院醫療花費（β=-817.43，p=0.0001）及住院天數（β=-4.92，p=0.0006）等有關。中醫治療與減少中風相關急診利用風險（HR=0.89，95%CI=0.81-0.99）、住院利用風險（HR=0.78,95%CI=0.73-0.83）及加護病房利用風險（HR=0.67，95%CI=0.57-0.78）有關。另外，無論是僅使用針灸（HR=0.76，95%CI=0.62-0.93）、僅使用中藥（HR=0.67，95%CI=0.60-0.74）或使用針灸及中藥（HR=0.67，95%CI=0.59-0.77）的組別對降低醫療耗用都有統計上的顯著差異。結論：中風後帕金森氏症患者在追蹤期間接受中醫治療可以減少急診及住院的醫療耗用。建議醫療主管機關與各醫療院所可鼓勵帕金森氏症患者接受中醫治療。本研究結果將有助於作為未來擬定醫療政策的參考。
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【關鍵詞】急診、住院、帕金森氏症、中風、中醫
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Pei-Yun Wu1,2Chao-Tsung Chen1Mao-Feng Sun3Ta-Liang Chen4,5,6
Chien-Chang Liao3,5,6,7,8*
1Department of Chinese Medicine, Taipei City Hospital, Ren-Ai Branch, Taipei, Taiwan
2School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University,
Kaohsiung, Taiwan
3School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
4Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University
5Department of Anesthesiology, School of Medicine, College of Medicine, Taipei, Taiwan
6Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan
7Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
8Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical
University, Taipei, Taiwan
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【Summary】
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Background: It has been proved that traditional Chinese medicine (TCM) has beneficial effects on the clinical outcomes in patients with stroke. However, little was known about the effects of TCM on patients with Parkinson’s disease (PD). Our purpose is to evaluate the effect of TCM on the use of emergency care and hospitalization in patients with PD who had stroke history. Methods: Using research data of Taiwan’s National Health Insurance, we conducted a retrospective cohort study included 30,373 patients with post-stroke PD who aged over 40 years in 2000-2007. After propensity-score matching, we obtained 2,701 pairs of PD patients who had previous stroke with and without TCM treatment for comparison. Using multiple Cox proportional hazard models, we calculated the adjusted hazard ratio (HRs) and 95% confidence interval (CI) of 1-year use of emergency care and hospitalization associated with TCM treatment. Results: Among PD patients with previous stroke, those who received TCM treatment had significantly lower frequency of emergency care medical visits (β= 0.06, p=0.0063), frequency of hospitalization (β=-0.22, p<-0.0001), expenditure of hospitalization (β=-817.43, p=0.0001), and length of hospitalization (β=- 4.92, p=0.0006). The HRs of emergency care, hospitalization and intensive care associated with TCM treatment were 0.89 (95% CI 0.81-0.99), 0.78 (95% CI 0.79- 0.83) and 0.67 (95% CI 0.58-0.78). In addition, only acupuncture (HR=0.76, 95% CI=0.62-0.93), only Chinese herbal medicine (HR=0.67, 95% CI=0.60-0.74) and both acupuncture and Chinese medicine (HR=0.67, 95% CI=0.59-0.77) were associated with decreased risks of emergency care visit and hospitalization. Conclusion: Among patients with post-stroke PD, TCM treatment was associated with reduced risks of emergency care visit and hospitalization. Our findings implicated that the health authority and hospitals may encourage patients with post-stroke PD to receive TCM treatment.
【Keywords】Emergency care; Hospitalization; Parkinson’s disease; Stroke; Traditional Chinese Medicine
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