| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 102 === 1.
Utilization of physical therapy services among Osteoarthritis patients and its influencing factors: The role of provider characteristics
Background
Physical therapy (PT) has been recommended as an effective and first-line therapy for the initial stages of osteoarthritis (OA). However, a surprisingly low proportion of OA patients receive PT therapies. The barriers to PT services remain to be explored.
Objective
Our study aimed to assess PT utilization among the newly diagnosed OA patients and to identify significant individual and provider characteristics associated with PT utilization.
Design
A population-based cross-sectional study design was used.
Methods
10991 newly diagnosed OA patients were identified from the nationally representative sample of the National Health Insurance program enrollees in Taiwan during the years 2005 and 2006. The National Health Insurance Research Database was used as the main data source. The outcome variable of interest was the probability of undergoing PT within 1 year of OA diagnosis. Both individual and provider characteristics were investigated as possible factors influencing PT utilization. General Estimating Equations and stratification analyses were applied.
Results
Only 25.1% of the newly diagnosed OA patients were prescribed with PT treatments during the first year of their diagnosis. Significant gender and age disparities were observed: men (OR=0.771, 95%CI =0.685-0.866) and the elderly were significantly less likely to be prescribed with PT. Also, physician’s gender, age, and specialty were significant predictors of PT utilization. Also, it is observed that the higher accreditation level of the practice setting and in more densely therapists located areas, the higher the probability of PT utilization among patients.
Limitations
The cross-sectional nature and the limitations associated with claims data do not allow for causal inferences.
Conclusions
Despite minimal financial barriers to PT services in Taiwan, the PT utilization among newly diagnosed OA patients remain to be low. The significant influences of provider characteristics shall not be overlooked.
2.
Physical therapy reduces the osteoarthritis related complications: a nationwide database study
Background
Osteoarthritis (OA) is a high prevalent disease over the world. It cause pain, disability, and may be accompanied with many complications including cardiovascular disease, dyslipidemia, osteoporosis, and some drug related problems like GI ulcer and renal failure. Physical therapy (PT) has been proved as an effective therapy for pain release, and improved of disability in osteoarthritis patients. However, few studies evaluate the relationship between PT and complications related from OA.
Objective
Our study aimed to provide further empirical evidences on the effect of early PT on the reduction of OA related complications among OA patients.
Design
A population-based retrospective cohort study design was used.
Methods
13545 OA patients were identified from the National Health Insurance program enrollees in Taiwan during 2005 to 2006. One to one propensity score matching was applied to match 3403 patients who had used physical therapy in the first year of OA diagnosis as PT-group, to the same number OA patients who had not use any PT in the first year of OA diagnosis as non-PT group. The 5 year cumulative risk for mortality and each complication were estimated using the Kaplan-Meier method, and log rank test was used to compare the difference between PT and non-PT group. Cox proportional hazard regression was used to identify the dose response relationship between physical therapy and the risk of mortality and OA related complications.
Results
Of all the patients sampled, 3403 (25.1%) patients received PT in the first year of OA diagnosis. Kaplan-Meier analysis with log rank test showed that PT group had a significantly lower 5 years cumulative risk of CAD (PT group=19% compared with non-PT group =21.1%, p= 0.05) and osteoporosis (PT group=16.1% compared with non-PT group=19%, p=0.001). Cox proportional hazard regression analysis showed OA severity significantly increased the risk of mortality and every surveyed complication. More importantly, the higher the PT intensity led to a lower risk of CAD and osteoporosis.
Limitation
Miss coding and possible unobservable confounders may have influenced the results.
Conclusions
PT may have a protective effect on the OA related complication such as CAD or osteoporosis. Further studies are required to identify what kind of PT can decrease the risk of these complications on OA patients.
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