| 摘要: | 背景：手術治療已在治療下背痛病人上有技術的進步，研究大多探討藥物治療、復健治療對於改善下背痛，鮮少研究探討手術治療和藥物治療後續的醫療利用情形，因此本研究針對下背痛病人探討其不同治療方式之短期及長期醫療利用及費用差異情形。
方法：以2005年100萬承保抽樣歸人檔1996年至2013年門住診申報資料進行分析，ICD-9-CM前三碼「720關節粘連性脊椎炎」、「721退化性脊椎炎」、「722椎間盤疾患」、「724其他及未明示之背部疾患」、「737脊椎側彎」、「738後天畸形」、「756其他先天性肌肉異常」「805無脊髓損傷的脊柱骨折」、「806有脊髓損傷的脊柱骨折」、「扭傷拉傷846、847、922、926」即定義為下背痛病人，將進一步使用意向分析以一年內使用之治療方式將族群對象分成手術治療、藥物治療、藥物及復健治療方式，探討病人個人、疾病和就醫醫院等不同特質以了解不同治療模式之第一年、第三年、第五年醫療費用及差異情形，使用SAS 9.4版統計套裝軟體進行資料整理及分析。
結果：下背痛醫療利用情形第一年追蹤期共17,865人，第三年追蹤期共16,708人，第五年追蹤期共15,125人，第一年醫療情形中手術治療在門診次數、費用和住院次數、天數和費用皆顯著高於藥物、藥物及復健治療組，第三年門診次數以藥物復健治療最多次，第三年門診費用以手術治療花費最高，而第三年僅住院費用手術治療組顯著高於藥物治療、藥物及復健治療，第五年門診次數、費用皆以藥物及復健治療最多次和花費最高，第五年住院住院次數和費用手術治療組顯著高於藥物治療、藥物及復健治療。門診次數：第一年至第五年門診次數影響因素中，皆有顯著影響者為性別、年齡、投保金額、共病症、就醫醫院是否為教學醫院；住院次數：第一年至第五年住院次數影響因素中，年齡、共病症、醫院所在地都市化程度第三層以下有顯著影響；住院天數：第一年至第五年住院天數影響因素中，年齡、共病症有顯著影響；住院費用：第一年至第五年住院費用影響因素中，年齡、共病症中等程度有顯著影響。
結論：本研究手術治療組在短期門住診醫療利用高於另外兩組但在長期第五年門診醫療利用情形手術治療低於藥物及復健治療組。提供臨床醫療人員治療下背痛病人在不同治療模式下，短期及中長期醫療利用及費用實證資料，能輔助醫病共同決定最適治療模式。
Background：Surgical treatments have advanced in progressing medical technologies of patients with low back pain.Most studies have investigated on pharmacologic and rehabilitation treatments for improving low back pains.Few studies explore follow-up of medical utilization after low back pain patients under surgical and pharmacologic treatments.Aim to investigate short and long-term medical utilizations in low back pain patients under treatments.
Method：A total of one million Registry from 1996 to 2013 data collection for beneficiaries files in 2005. ICD-9-CM including 720,721,722,724,737,738,756,805,806,846,847,922 and 926 are defined as low back pain patients. It will further use of Intention-To-Treat（ITT）cases in one year treatment pattern and be grouped into surgical, pharmacologic, pharmacologic and rehabilitation three treatments.Exploring different individual, disease and hospital personality to analyize short-term and long-term medical utilization. Use SAS version 9.4 statistical software for data collection and analysis.
Results：There are total 17,865 low back pain cases of medical utilization in one year follow up period, there are 16,708 cases in three year follow up period, and there are 15,125 cases in five year follow up period. Number of outpatient visits：From one year to five year outpatient visits of influence factors, there are significant different factors having sex,age, insurance amout, comorbidities, whether the hospital is a teaching hospital. Number of hospitalizations: From one year to five year number of hospitalizations of influence factors, there are significant different factors having age, comorbidities, the hospital degree of urbanization. Inpatient days and Hospitalization costs：From one year to five year of influence factors, there are significant different factors having age, comorbidities.
Conclusion：The surgical treatment group in this study had a higher utilization rate of short-term outpatient frequency than other two groups. In long-term of outpatient medical utilization; surgical treatment was lower than pharmacologic treatment and rehabilitation groups. Provide clinical caregivers to treat patients with low back pain under different treatment modes including short-term, long-term medical utilization and cost empirical data which can aid the disease to determine optimal treatments. |
