| Summary: | 博士 === 國立臺灣大學 === 健康政策與管理研究所 === 104 === Background and Objectives: Stroke poses a great threat to public health internationally and in Taiwan. Previous studies indicated that hospitalized stroke patients receiving in-hospital adjuvant Traditional Chinese Medicine (TCM) therapy could have health benefits, including lower risk of urinary tract infection, pneumonia, epilepsy, gastrointestinal bleeding and death. This study aims to examine the effects of different level of stroke-related TCM utilization and acupuncture on health outcomes of hospitalized stroke patients one year after their admission.
Materials and Methods: Retrospective analyses were conducted by linking National Health Insurance (NHI) claims data to Death Registry data. Incident stroke patients aged 18 years old and above during 2003-2010 were identified. Patients who had re-stroke in the first 3 months after initial stroke (n=23,800), died at initial stroke admission (n=32,616) , had no stroke-related medical utilization after stroke (n=66,673), epilepsy medical history before stroke (n=1,500), and without western medical (WM) utilization in the study period (n=278) were excluded. The level of TCM outpatient visits was identified by the utilization of stroke-related TCM outpatient visit between initial stroke and the occurrence of any event. Patient’s age, gender, year of having stroke diagnosis, type of stroke, Elixhauser comorbidity scores, TCM outpatient visit in the last year, length of stay of initial stoke, length of stay of Intensive care unit, whether or not being low-income, catastrophic disease, concomitant drugs, urbanization of residence, local number of TCM and western medicine doctor were also gathered. Cox proportional hazard models were used to adjust for the baseline characteristics.
Results: Among the 230,477 incident stroke patients who were identified during the study period, 58.66% of them were male and patients aged 70-79 years old has the highest percentage (29.74%). Most of them (78.10%) were ischemic stroke. The incidence of epilepsy, pneumonia, re-stroke and 1-year mortality were 4.45%, 7.41%, 5.23% and 8.09%, respectively. We found that there are interactions between stroke-related WM utilization and TCM utilization. Compared to the group of non-TCM and low WM utilization, the group of high TCM utilization had lower risk of epilepsy, pneumonia, re-stroke and 1-year mortality after stroke. Furthermore, high TCM utilization combined with WM has complementary effect on reducing risk of pneumonia and 1-year mortality.
Conclusions and Recommendations: After post-acute care, different level of TCM outpatient visit had a significant influence on one-year health outcomes of stroke patients. The competent health authority is recommended to establish a complete post-acute care cooperative model containing both TCM and WM treatment for stroke patients to ensure the best medical care.
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