| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所 === 97 === Background and objective
Osteoarthritis which is generally turned up in the aged is induced by ageing muscle and bones problem. According to the 2007 annual report by the National Health Insurance, the arthropathies and related disorders is about 12.1%. Plus, 30% among them is over 65 years old. In addition, the prevalence of the disorder is 35.8%. Furthermore, patients who undergo medical treatment in arthropathies and related department are up to 2.7%. Therefore, the cost of arthropathies and related patients are obviously more than other diseases. So far intra-articular Hyaluronic Acid is the only effective treatment by 70% cases without side effect. In Taiwan, patients have been treated by intra-articular Hyaluronic Acid more than a decade. However, up to now there is no study related to the HA treatment even the three-year study used by Taiwan’s National Insurance. As a result, this research is made of the database of Taiwan National Insurance to discover the condition of medical resources of OA patients with HA treatment from 2005 to 2008 June.
Method
The research is cross-sectional study. The resource is based on the information of OA patients with HA treatment from 2005 to 2008 which include the points of outpatient service and medical orders of outpatient service. During 2005, the study has been used to analyze the condition of treatment and medical resources in OA patients accept HA treatment.
Result
The condition of OA patients accept HA treatment
Up to 60% patients totally accept HA treatment, and over 30% patients haven’t finished the treatment and over-dosage. Male, serious syndrome, five dosages, and department of Rehabilitation are affected by unfinished treatment and over-used injection. There are some patients who finish the treatment, and 55.3% patients with analgesic, 12.3% with rehabilitation, and 8.8% both have done; otherwise, 4.5% patients have HA injections in other hospitals, and 24.5% patients are illegally over-used with HA. During the later treatment, 10% patients keep using four-time HA treatment, including female, five- dosage, departments of Orthopedics, Rehabilitation, and Rheumatic, metropolitan hospitals, local community hospitals, Kao-ping and Taipei Branch of Bureau of National Health Insurance are significant. However, in the condition of using analgesic, nearly 67% patients keep using fourth step analgesic. Female, CCI 1 point and 2 points, departments of Orthopedics, metropolitan hospitals, local community hospitals, clinics, and Bureau of National Health Insurance of Central Region, Southern Region, Kao-ping, and Eastern Region Branches are significant.
The condition of OA patients finish the HA treatment resources
In forecasting model of OA patients with annual average outpatient and Orthopedics outpatient, the people who are older, get one point and up to two points at CCI, five-dosage, and clinics cause the outpatient frequency to increase. In addition, you could discover the same costing condition between them.
Compare the direct and indirect cost of different dosages, five-dosage(14,523 dollars, 10,263 dollars) average HA cost and registration fee are more significant than three-dosage(11,899 dollars, 1,723 dollars)( P<0.001、P=0.004). But, X-ray cost on three-dosage is more then five-dosage(1,685 dollars, 1,568 dollars)( P<0.001).
Conclution
The outcome of the research discover the age, the gender, the dosage, the medical department and organization have a great effect upon the OA patient with HA treatment, middle-term and long-term medical resources. Moreover, with different HA dosage and the huge expense, 5-dosage treatment has higher financial burden and higher medical resource consumption.
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