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中医药研究论丛
 221.2 台湾心房颤动患者中医利用率之调查研究
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TJ TCM.22(1) : 13-22, 2019
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台湾心房颤动患者中医利用率之调查研究
A Survey of Traditional Chinese Medicine Use Among Patients with Atrial Fibrillation: a Claim Data-Based Cohort Study
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郑秝丞1 赖姿华2 叶家舟1,3* 蔡宗益4,5*
1 佛教慈济医疗财团法人大林慈济医院 中医部，嘉义，台湾
2 佛教慈济医疗财团法人大林慈济医院 护理部，嘉义，台湾
3 慈济大学学士後中医学系，花莲，台湾
4 佛教慈济医疗财团法人大林慈济医院 医学研究部，嘉义，台湾
5 慈济科技大学护理系，花莲，台湾
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【摘要】
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背景：中医治疗常用以缓解慢性疾病患者症状与改善预後。然而对心房颤动(atrial fibrillation, AF) 个案而言，其中医医疗利用率为何，仍无法从现今文献窥一究竟。本研究旨在探讨心房颤动个案之中医医疗利用率及其采行之中医治疗类型。
方法：研究对象取自全民健康保险研究资料库之2000 年百万承保抽样归人档，後以1998-2007 年间被诊断为心房颤动者为研究世代，并透过年龄、性别配对及1：1 方式，随机筛选非心房颤动世代。所有研究对象皆追踪至2012 年，估计两组之中医利用发生率比值(incidence rate ratio, IRR) 与95%信赖区间(confidence interval, CI)。
结果：研究指出，AF 世代之中医医疗利用率之发生密度为每千人年1935.66，非AF 世代之中医医疗利用率则为每千人年1552.47，前者之中医医疗利用率较常人多出25%。AF 个案较常使用之型态以中药治疗为多(76%)，其次为针灸或伤科手法治疗(14%)，合并两类型之个案则有10%。
讨论：本研究有助於厘清AF 患者之中医医疗利用率与其常用的治疗类型，後续研究可进一步评估中西医合并对AF 患者之照护成效。
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【关键词】心房颤动、中医、利用率、发生密度
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Li-Cheng Zheng1, Tzu-Hua Lai2, Chia-Chou Yeh1,3*, Tzung-Yi Tsai 4,5*
1Department of Chinese Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical
Foundation, Chia-Yi, Taiwan
2Department of Nursing, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chia-Yi, Taiwan
3School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
4Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical
Foundation, Chia-Yi, Taiwan
5Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan
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【Summary】
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Background: Traditional Chinese Medicine (TCM) is commonly used for symptom relief in patients with chronic diseases. Nevertheless, large-scale surveys focusing on the utilization of TCM among patients with atrial fibrillation (AF) are limited, especially in Taiwan, where TCM is highly popular. This cohort study aimed to describe the utilization of TCM among Taiwanese AF patients.
Methods: All subjects were extracted from Longitudinal Health Insurance Database 2000, which was a subset of the National Health Insurance Research Database and contained all medical claims data for one million beneficiaries. Study cohort was comprised of the patients who had received a newly diagnosis of AF from 1998 to 2007. Controls were randomly selected from the remaining cases at a ratio of 1:1 frequency matched by age and sex. All subjects were followed up until the end of 2012, and were estimated the incidence rate ratio and the corresponding confidence interval with Poisson regression model.
Results: After adjustment for potential confounders, patients with AF were found to have higher utilization of TCM services than those without AF (1935.66 vs 1552.47, respectively, per 1000 PYs), with an adjusted IRR of 1.25 (95% CI:1.15-1.31).With regard to the commonly used categories of TCM, we found that herbal remedies (76%) constituted the most commonly-used therapeutic approach, followed by acupuncture alone (14%), and the combined therapy (10%).
Conclusions: The findings allow healthcare providers to identify the pattern of TCM use and commonly used therapeutic approaches among AF patients. Further research is required to fully address the efficiency and safety of TCM in treating AF patients.
Keywords：Atrial fibrillation, traditional Chinese Medicine, utilization, incidence density
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