Hung Yen-Ni, Kuo Chian-Jue, Yang Shu-Yu, Huang Ming-Chyi, Chen Ying-Yeh, Lin Shih-Ku, Chen Kuan-Yu
School of Gerontology Health Management & Master Program in Long-term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan.
Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan.
J Psychosom Res. 2017 Nov;102:1-7. doi: 10.1016/j.jpsychores.2017.08.014. Epub 2017 Aug 24.
The aim of this paper was to analyze medical utilization patterns of female patients with anorexia nervosa before their first inpatient care visit for anorexia nervosa using the National Health Insurance Research Database (NHIRD) of Taiwan.
We selected female anorexia nervosa patients (n=239) and control participants hospitalized for peptic ulcers (n=478) or appendectomy (n=478) who were matched by age and incident year from two subsets of the NHIRD. The number of visits, specialists, diagnosis distribution, and selected procedures used in ambulatory services during the 2-year period before the index admission were identified and compared. Healthcare service expenditures were also analyzed.
Compared to the control groups, the female anorexia nervosa patients used more outpatient services (anorexia nervosa, 58.6±45.0 visits; peptic ulcers, 45.3±37.3 visits; appendectomy, 32.5±26.0 visits), mainly due to psychiatric visits. Anorexia nervosa patients were more likely to have received a diagnosis of digestive, endocrine/metabolic, and mental disorders than patients in the control groups. Although nearly equal percentages of patients in the three groups had obtained a diagnosis of a digestive disease, anorexia nervosa patients received digestive disease diagnoses with greater frequency.
We posit that the various physical symptoms of anorexia nervosa patients and physicians' low level of suspicion of anorexia nervosa led to delayed diagnoses and greater medical utilization than that of the controls groups. Education to raise awareness of anorexia nervosa and other eating disorders among physicians is warranted.
本文旨在利用台湾国民健康保险研究数据库（NHIRD）分析神经性厌食症女性患者首次因神经性厌食症住院治疗前的医疗利用模式。
我们从NHIRD的两个子集中选取了神经性厌食症女性患者（n = 239）以及因消化性溃疡住院的对照参与者（n = 478）或因阑尾切除术住院的对照参与者（n = 478），这些对照参与者在年龄和发病年份上进行了匹配。确定并比较了索引入院前2年期间门诊服务中的就诊次数、专科医生、诊断分布以及所选程序。还分析了医疗服务支出。
与对照组相比，神经性厌食症女性患者使用了更多的门诊服务（神经性厌食症患者，58.6±45.0次就诊；消化性溃疡患者，45.3±37.3次就诊；阑尾切除术患者，32.5±26.0次就诊），主要是由于精神科就诊。与对照组患者相比，神经性厌食症患者更有可能被诊断出患有消化系统、内分泌/代谢和精神疾病。尽管三组中获得消化系统疾病诊断的患者比例几乎相等，但神经性厌食症患者获得消化系统疾病诊断的频率更高。
我们认为，神经性厌食症患者的各种身体症状以及医生对神经性厌食症的低怀疑程度导致了诊断延迟以及比对照组更高的医疗利用率。有必要对医生进行教育，以提高他们对神经性厌食症和其他饮食失调症的认识。
