北區健保特約中醫門診肝炎患者療治用藥頻率及型態之探討

Frequency and Pattern of TCM Use on Hepatitis: an Evidence-based Approach

本研究探討2004~2007年中央健康保險局臺北分局特約醫療院所申報肝病患者之年齡層分佈、處方及服藥天數，以瞭解台北區中醫門診肝炎患者之用藥頻率及型態。本研究以2004-2007年中央健康保險局臺北分局特約中醫院所申報資料為主要研究對象，以中醫院所申報ICD-9-CM主、次診斷前三碼為070、571、572、573之所有患者共57,418人，並以其服用之單味中藥及方劑資料為擷取條件，分析上述肝病患者年齡層之分佈、處方用藥頻率與型態及服藥天數。結果顯示（1）因肝病就診患者之年齡層分佈，不論男女均落在20歲至59歲之間；男性就醫人數較女性為多，約為女性之1.8倍。（2）每次看診處方開立複方數以二至三方佔最多，所用單味藥材數以一至五個佔最多；每次處方在不分單、複方之總藥味數以三至七個品項最為普遍，平均約為五項。每次就診醫師處方天數約10天以上。（3）在常用之前十味單方中，「丹參」及「茵陳蒿」在分年及四年總排名均分別位居第一及第二名；而常用之前十味複方，「加味逍遙散」、「龍膽瀉肝湯」及「小柴胡湯」在分年及四年總排名均分別位於第一、第二及第三名。本研究結果統計及分析北區健保特約中醫門診十大常用複方及單方之用藥頻率及型態，可提供中醫師臨床治療慢性肝炎之參考。

Purpose: This study intended to explore the age distribution, prescription frequency and pattern of hepatitis patients clinically treated by TCM (traditional Chinese medicine). Methods: This study collected 57,418 hepatitis patients who treated with TCM from the 2004-2007 data base of the National Health Insurance Bureau Taipei Branch. The patients, mainly based on the ICD-9-CM reported by TCM institutions, included all those with second diagnosis first three codes of 070, 571, 572, and 573. We analysed the age distribution, prescription frequency and pattern of hepatitis patients. Results: The age distribution was mainly between 20 to 59 years old in both men and women. Men outnumbered women in seeking medical treatment by about 1.80 times. The top five most used TCM prescription drugs for chronic liver diseases regardless of their international terms are Jia-Wei-Xiao-Yao-San, Long-Dan-Xie-Gan-Tang, and Xiao-Chai-Hu-Tang. The single prescription is mostly used in combinations of three to seven ingredients while the prescription is mostly used in combinations of one to three prescriptions. In case of prescriptions neither of single drug or plural prescriptions, the total ingredients of the prescriptions are mostly three to seven ingredients, and on average 5 ingredients. Conclusions: This study provided TCM doctors with the frequency and pattern of clinical treatment of chronic hepatitis. The results could be used as references to clinical TCM drug prescription. Promoting evidence-based medicine can further improve clinical study, medical care quality, and offer high quality care to reduce unnecessary waste of medical resources by the development of empirical clinical treatment guidelines.