台灣乳癌病患於診所與醫院中藥使用差異之世代研究

A Cohort Study of Chinese Medicine Utilization Among Breast Cancer Patients in Taiwan

目的：乳癌是台灣女性最常見的癌症，在台灣地區的乳癌病患除了接受西醫常規治療以外，亦有許多病患接受中醫治療。由於台灣絕大多數民眾均納入全民健康保險，在健保體制之下有關乳癌使用中藥的研究已所在多有。此外，中醫師絕大多數均在診所執業，而台灣尚未有關於醫院與診所之間的差異研究文章，故本研究針對乳癌病患在醫院與診所間使用藥物之差異。方法： 本研究採取世代研究的方法，對於2003-2012年全民健康保險研究資料庫所登錄之註記ICD-9-CM 174.0-174.9代碼的乳癌病患進行研究，排除男性與性別未明之病患，針對最後一次手術後的乳癌病患並追蹤五年，且經過中藥治療三次以上，最後再分析醫院與診所間用藥差異分析。結果：研究結果顯示在病患特質、醫師特質上，醫院與診所病患就醫喜好無顯著差異，但醫院就診病患年齡較高(p=.01)；醫院特質中醫院區域、醫院權屬別則有顯著差異(p<.001)。結論：有關用藥差異方面，方劑在醫院與診所之間使用上無顯著差異，但單味藥上在醫院中醫師較喜歡使用白花蛇舌草(p=.01)、酸棗仁(p<.001)治療乳癌病患。

Objectives: Breast cancer is a common cancer in Taiwan. The patients in Taiwan accept not only Western medicine therapies but also traditional Chinese medicine therapies. Most Taiwanese people are insured by the National Health Insurance, so there are already a lot of researches about breast cancer utilizing traditional Chinese medicine. Most Chinese medicine physicians work in clinics, but there is no research about the difference between hospital physicians and clinic physicians. This study is about Chinese herbal medicine utilization among breast cancer patients in Taiwan. Methods: This research was designed to be a cohort study. We investigated the breast cancer patients from 2003 to 2012 who were included in the National Health Insurance Research Database and were assigned the ICD-9-CM codes 174.0-174.9. Male and sex unknown patients were excluded. We followed up the patients who accepted breast cancer surgery and visited Chinese medicine physicians over 3 times for 5 years. The prescription patterns were analyzed between clinics and hospitals. Results: The results indicated that there is no difference between patient characteristics, physician characteristics, and patients’ preferences. But patients who saw Chinese medicine physicians in hospitals is older (p=.01). Moreover, there are significant differences in terms of medical service areas and hospital ownership in Taiwan (p<.001). Conclusions: There is no difference between hospitals and clinics about the utilization of Chinese medicine compounds. But Chinese medicine doctors who work in hospitals are more likely to prescribe single herbs: Hedyotis diffusa (p=.01) and Semen Ziziphi Spinosae (p<.001).