憂鬱症患者經精神科確診並介入治療前後一年非精神科之門診醫療
資源耗用
The Changes of the Use in Medical Care among Depressive Patients before and after Their Psychiatric Treatment
中文摘要
患有憂鬱症的病人，有很多臨床症狀，與內外科病人的症狀不同；因此沒有精神 醫學專業訓練的醫師，比較不容易診斷出來。臺灣憂鬱症的病人，發病時，常常 以身體症狀做主訴呈現。本研究主要探討，憂鬱症患者經精神科確診並介入治療 前、後一年非精神科之門診醫療資源耗用的變化。
本研究設計採回溯性的研究設計，研究資料來自 2004 至 2006 年國家衛生研究院 之全民健康保險學術資料庫之門診處方及治療明細檔 (CD 檔)、門診處方醫令明 細檔 (OO 檔)、藥品主檔 (DRUG 檔)。研究對象為 2005 年當年被診斷為憂鬱症 (ICD-9-CM 296.2、296.3、300.4、311)的病患，且次診斷無其他精神科疾患並開 立抗憂鬱劑，且看過三次精神科視為接受精神科治療，並排除 2004 年曾被診斷 為憂鬱症的病患後，進一步排除小於十歲以下及七十歲以上者，所得 1,543 位為 本研究對象。所得資料以描述性統計、one way ANOVA、卡方檢定、配對 t 檢定、
GEE 模式分析後發現，憂鬱症患者經精神科確診並介入治療後，在就診科別方 面，不分科、家醫科及內科等 17 科，就診次數明顯下降。顯示在精神科介入治 療後，明顯降低病患逛醫院 (hospital shopping) 的情形。另外，藥物種類方面在 抗組織胺劑、抗感染劑、鎮咳劑，袪痰劑及痰液溶解劑、腸胃道藥物、維生素類 的使用，亦顯著減少。在醫療費用方面，非精神科總醫療費用、非精神科門診藥 費均較接受精神科治療前一年低。因此，本研究結果顯示憂鬱症患者經精神科確 診並介入治療後將有效降低非精神科之門診醫療資源耗用。說明憂鬱症患者接受 正確診斷及抗憂鬱劑治療，可有效降低對於其他科別之醫療利用。
本研究建議衛生主管機關未來可根據各不同年齡層族群的醫療藥費耗用，在考量 各項因素之後，評估採行重度憂鬱症分年齡層族群論人計酬的可行性。
醫院部分也應加強醫護人員對憂鬱症的認識與辦別訓練課程同時加強轉介精神 科，以減少其他醫療資源的耗用。建議醫院未來可建立臨床治療指引與門診、住 院照護臨床路徑。
英文摘要 Objectives:
Patients with clinical depression have many symptoms which are different from those seen in nonpsychiatric clinics. They are difficult to be diagnosed correctly by
nonpsychiatrist physicians. In Taiwan, 70% of depressive patients use physical
symptoms as major complaints in their early stage of the illness. In this study, we intended to investigate whether the psychiatric treatment would reduce the medication uses among the depressive patients who could have the chance to be on antidepressant therapy.
Methods:
We chose the samples from the National Health Insurance data base, and picked up electronically the patients who were diagnosed as the depressive patients in 2004 to 2006. We selected 1,543 patients with diagnosis codes of 296.2, 296.3, 300.4 and 311 of ICD-9-CM.
We used the treatment of depression as the interval variables. Then, we used the information of patients’ age, sex, primary diagnosis and secondary diagnosis as the control variables to categorize the sample into antidepressant-treated and non-treated groups. The dependent variables included medical uses including the presence of other diseases, clinic visit numbers, prescribed drugs, medication days, medicine cost and medication fees.
Results:
The results of our study showed that psychiatric treatments reduced the clinic visits especially those for family medicine and internal medicine, and that and they also reduced the clinical visit times, and that they reduced the use of medications such as antihistamines, antibiotics, antitussives, gastroentectinal drugs, and vitamins.
Furthermore, nonpsychiatric medications and medication cost were also found to be reduced.
Conclusion:
The study suggests that the medication prescriptions from nonpsychiatric clinics were decreased if the depressive patients could be recognized and treated with
antidepressants immediately.
