台灣高血壓門診診療型態之分析探討

Patterns of Diagnosis and Treatment of Hypertension in Taiwan

10.6288/TJPH2006-25-03-04

李宣緯(Hsuan-Wei Li)；葉玲玲(Ling-Ling Yeh)；黃達夫(Andrew T. Huang)

高血壓 ； 診療型態 ； 實證醫學 ； 診療準則 ； 醫療利用 ； hypertension ； evidence-based medicine ； practice guideline ； patterns of diagnosis and treatment ； medical utilization

台灣公共衛生雜誌

25卷3期（2006 / 06 / 01）

201 - 213

繁體中文

目標：藉由分析國內高血壓門診診療型態，進一步探討與高血壓實證醫學臨床診療準則之差異，以作為推動高血壓醫療品質相關衛生政策之參考。方法：本研究以2000年全國健保門診申報資料進行次級資料分析。針對主、次診斷碼符合自發性高血壓的門診人次，檢視其醫療利用與診斷檢查型態，並選擇其中具合併症的高血壓個案進行用藥型態分析，繼而與實證醫學臨床診療準則進行比較。結果：國內高血壓門診人次主要集中在醫學中心和基層醫療單位；以個案數而言，將近八成的高血壓個案固定於同一家醫療院所接受照護，且一年內平均每位個案門診次數為6.71次。若以高血壓實證醫學臨床診療準則為比較基礎，國內高血壓病人接受常規診斷檢查的比率偏低，且使用診療準則列為禁忌用藥的比率偏高。結論：國內高血壓疾病不論是診斷檢查型態或用藥型態，均與高血壓實證醫學臨床診療準則之建議有些差異。建議衛生主管機關應針對醫師與民眾進行宣導教育，而醫療服務提供者在診治病人時，亦建議參考實證醫學臨床診療準則，以提供病人更完善之醫療照護服務。

Objectives: By using evidence-based practice guidelines developed in the United States, Great Britain and recommended by the World Health Organization (WHO) as references, this study attempted to analyze the pattern of ambulatory diagnosis and treatment of hypertension in Taiwan in the hope that these findings will contribute to the development of future quality guidelines for Taiwan. Methods: The study examined the outpatient claims data of the Bureau of National Health Insurance (BNHI) in the year 2000 and applied them for secondary data analysis. Based on the evidence-based guidelines, we then made a comparison in the practice pattern of hypertension in Taiwan. In addition, we also investigated the drug utilization among patients who presented with co-morbidities to see whether suboptimal treatment was in anyway linked to the development of co-morbid conditions. Results: The utilization rates of the hypertensive ambulatory care took place at a higher frequency in medical centers and clinics that offered primary care than in the regional and district hospitals. Eighty percent of the hypertensive patients sought their care from the same hospital, and the average number of visits was 6.71 per annum. Compared with the evidence-based guidelines, the yearly utilization rates were lower, but the frequency of inappropriate drug prescriptions was significantly higher in Taiwan. Conclusion: The pattern of diagnosis or drug use in hypertensive patients in Taiwan was significantly different from the evidence-based guidelines developed in the United States, Great Britain and recommended by the WHO. We urge that physicians practice according to the established, evidence-based guidelines to treat ambulatory hypertensive patients in order to assure the quality of care. We also encourage the BNHI to monitor the adherence to the guidelines on an ongoing basis.

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