| Summary: | 碩士 === 高雄醫學大學 === 醫務管理學研究所碩士在職專班 === 97 === Objective: To understand adherence to the Global Initiative for Chronic Obstructive
Lung Disease（GOLD）guideline of the physician who managed chronic obstructive
pulmonary disease（COPD）in Taiwan, whether adherence to the GOLD guideline is
associated with a long term benefit, and understand the factors that influence the
guideline adherence.
Methods: We used the claim data of the Bureau of National Health Insurance
(BNHI) from hospitals throughout Taiwan between January 2001 and December 2004
for secondary data analysis. One thousand and two hundred thirty patients with the
diagnosis of COPD who were regularly followed up at one hospital between January
2001 and December 2001 were eligible for the guideline intervention phase of the
study. The follow-up lasted 3 years. Primary end point was survival. A rating of
compliance with the guideline recommendations was calculated for each patient. The
Cox regression method was used to estimate and compare survival curves between
groups. The independent t test was used to compare the utilization of medical resource
and the medical expenditure.
Results: The adherence of each component of the GOLD guideline varies, ranging
from 6.3%（spirometry）to 92%（not to use systemic steroid regularly in patients with
stable COPD）. Generally, the adherence of GOLD guideline in Taiwan is lower than
other countries. Survival was not directly correlated with guideline adherence. The
variation of adherence of GOLD guideline is large among hospitals. The adherence is
highest in medical center and is lowest in the district hospital. Among the physicians,
the guideline adherence is higher in chest specialist and is lower in other specialist or
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general physician.
Conclusion: In Taiwan, the survival of the patients with COPD was not directly
correlated with guideline adherence. The COPD patients in the high guidelineadherence
group , were older then the low guideline-adherence group. They also had
more comorbid illness and higher health resource utility and the higher health
expenditure.
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