First, our results show that Chinese medical services utilization rates varies significantly according to patient characteristics, attributes of diseases, geographical regions and adequacy of Chinese medical resources. To
determine the adequacy of Chinese medical services for patients with type 2 diabetes, attention must be paid not only to DM education, prevention, and treatment but also to their general health care. In the future, we hope to analyze and discuss the longitudinal NHI data of Chinese medicine utilization and costs, to provide us with evidence-based implications for future policy making.
Second, this is the first extensive survey examining the drug utilization patterns of Chinese herbal medicines in the treatment of type 2 diabetes.
Although the data were generated in Taiwan, the herbs and practices identified are likely to be widely generalizable wherever Chinese herbal remedies are used for type 2 diabetes. Tian-Hua-Fen and
Liu-Wei-Di-Huang-Wan family were commonly used. The baseline data generated should be of use in informing subsequent studies, including those aimed at a thorough evaluation of the herbs’ effectiveness. Safety issues and drug-herb interactions should be a priority for future research and more clinical trials and outcome research are needed to assess the effectiveness of new prescription patterns in utilization of TCM.
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Student: Yueh-Ting Tsai Advisor: Jaung-Geng Lin Ph.D.
Co-Advisor: Tsai-Chung Li Ph.D.
School of Chinese Medicine, China Medical University
Traditional Chinese medicines (TCM) utilization in patients with
Diabetes Mellitus (DM) by large-scale study is limited, only by a small-scale survey. This study analyzes utilization rate and factors associated with TCM utilization using entire DM population in Taiwan.
Besides, Chinese herbal medicine (CHM) has been commonly used in treating diabetes in Asian countries. Interest in the use of alternative
treatments for diabetes is increasing exponentially and is fairly common in Taiwan. We undertook a survey to define the drug utilization patterns of Chinese herbal medicines (CM) for diabetes in Taiwan.
This study used the National Health Insurance (NHI) complete datasets in 2002. The diagnosis of DM was extracted with ICD-9 Code of 250. In the first part, the two-part model logistic regression method was employed to estimate the odds ratios (ORs) for yearly utilization of TCM. A significance level of α= 0.05 was selected. In the second part, outpatients with primary diabetes and being treated with CM were studied. Core drug-use indicators were the dosing frequency and duration of CM prescriptions, the most common prescribed CM herbs and CM formulae used.
In the one side, the first part model estimates the odds of using TCM were higher in males (OR = 1.16; 95% CI: 1.13–1.20) and that of TCM increased with age to a peak in the 50–59-year-group (OR = 1.59; 95% CI:
1.52–1.66). The odds of TCM in the group with household income $NT 38,200-57,800 were higher than those in the low-income group (OR = 1.11;
95% CI: 1.05–1.17). Patients with DM in Central and Southern areas of Taiwan were more likely to use TCM. The comorbidity diseases that were associated with higher TCM utilization were nephritis, skin abscess, retinal defects and liver disease (OR = 1.25; 95% CI: 1.17–1.33 for nephritis; OR = 1.37; 95% CI: 1.26–1.50 for skin abscess; OR = 1.83; 95% CI: 1.66–2.02 for retinal defects and OR = 1.10; 95% CI: 1.06–1.15 for liver disease). As the degree of urbanization increased, the odds of using TCM increased (OR = 1.39; 95% CI: 1.26–1.52; for level II).
The second part model estimates the mean differences of the number of Chinese medicine uses were higher in males (beta = 0.59, P<0.001). Patients in Central Taiwan had a higher mean number of Chinese Medicine uses than in Eastern Taiwan (beta = 0.72, P=0.06), household income
$NT.16,500~36,300 had a lower mean number of Chinese Medicine uses than household income under $NT.15,840 (beta = -0.42, P<0.001 for
$NT.16,500~22,800; beta = -0.46, P<0.01 for $NT.24,000~36,300), patients with comorbidity including liver disease had lower mean number of Chinese Medicine uses than ones without comorbidity (beta = -0.40, P<0.001),
patients with DM who resided in urban levels of 3 had a higher mean number of Chinese Medicine uses than in urban levels of 6 (beta = 0.56, P<0.05), patients with DM who resided in 40~49 and >=60 physicians per 10,000 population had a higher mean number of Chinese Medicine uses than in <=9 physicians per 10,000 population (beta = 0.92, and 0.74, P<0.01 and <0.05, respectively), patients with DM who visited in medical centre had a higher mean number of Chinese Medicine uses than in district hospital (beta = 0.64, P<0.001).
In the other side, sixteen thousand nine hundred and four patients, using 735,411 CM herb items, were screened during the study period. The most often prescribed Chinese herbal products were Tian-Hua-Fen (Radix
Trichosanthis) and Liu-Wei-Di-Huang-Wan, which includes Rhizoma
Rehmanniae Praeparatae, Fructus Corni, Rhizarna Dioscoreae, Rhizonia
Alismatis, Cortex Moutan Radicis, Poria.
Not only Our results show that Chinese medical services utilization rates varies significantly according to patient characteristics, attributes of diseases, geographical regions and adequacy of Chinese medical resources.
But also this is the first extensive survey examining the drug utilization patterns of Chinese herbal medicines in the treatment of diabetes. Although the data were generated in Taiwan, the herbs and practices identified are likely to be widely generalizable wherever Chinese herbal remedies are used for diabetes. Multiple herbs and complex formulae were commonly used.
The baseline data generated should be of use in informing subsequent studies, including those aimed at a thorough evaluation of the herbs’
effectiveness.
Keywords: Traditional Chinese medicine, utilization pattern, diabetes mellitus, NHI, Taiwan.
誌謝
兩年的時間過得真快，我覺得相當充實，在診所業務之餘，有幸在 林老師帶領下，如沐春風。幸運地，在研究主題方面，我選擇使用台灣 全民健保的資料進行研究，讓我有機會接觸生物統計學、流行病學等研 究領域。
要感謝的人太多了。感謝我的父母一路以來對我在學習上的支持與 鼓勵；感謝我的妻子淑娟無怨無悔的全力支持；感謝我的女兒亞芝、瑞 禧，總讓我情緒低落時能開懷大笑；感謝指導教授林昭庚老師是我健保 研究的啟蒙老師；感謝李采娟教授帶我進入健保的研究領域並給我相當 多的指導，讓我學到學者的研究精神與風範。
在拿到碩士學位的同時，我也將進入陽明大學傳醫所博士班對全民 健保做更進一步的研究，希望未來能在服務、教學及研究方面有一番發 揮及成果。
蔡岳廷 謹誌
民國九十九年七月