Lin Shun-Ku, Lo Pei-Chia, Chen Wang-Chuan, Lai Jung-Nien
Department of Chinese Medicine, Taipei City Hospital, Renai Branch.
Institute of Public Health, National Yang-Ming University.
Medicine (Baltimore). 2019 Feb;98(7):e14468. doi: 10.1097/MD.0000000000014468.
Reducing the need for advanced nursing care and medical expenses is an essential concern of dementia care. We investigated the impact of traditional Chinese medicine (TCM) on advanced nursing care and medical costs.We used Longitudinal Health Insurance Database to implement a cohort study of patients with dementia between 1997 and 2012 in Taiwan. Data from the onset of dementia to 1st advanced nursing care for the endotracheal tube, urinal indwelling catheterization, and nasogastric tube were assessed using Cox regression proportional hazards model, and independent t test was used to determine the difference of hospitalization costs and days. We also used ANOVA test to compare the hospital cost, hospital stay, and numbers according to different duration of TCM.We assessed 9438 new diagnosed patients with dementia without advanced nursing care were categorized into 2 groups: 4094 (43.4%) TCM users, and 5344 (56.6%) non-TCM users. In the TCM groups, 894 (21.8%) patients were declared as advanced nursing care, while 1683 (31.5%) patients were in non-TCM group. Cox proportional hazard regression indicated that using TCM may decrease the need for advanced nursing care (adjusted hazard ratio (aHR) = 0.61, 95% confidence interval [95% CI]: 0.56-0.66) compared to non-TCM. The TCM users have lower hospitalization costs and hospitalization time compared to non-TCM users.Integrating TCM healthcare into dementia care was found to be associated with a lower need for advanced nursing care, hospitalization costs, and admission time with more benefits from longer durations of TCM use.
减少对高级护理的需求和医疗费用是痴呆症护理的一个重要关注点。我们调查了中医对高级护理和医疗费用的影响。我们使用纵向健康保险数据库对1997年至2012年台湾地区的痴呆症患者进行了队列研究。使用Cox回归比例风险模型评估从痴呆症发病到首次进行气管插管、留置导尿管和鼻饲管等高级护理的数据,并使用独立t检验确定住院费用和天数的差异。我们还使用方差分析测试根据不同的中医使用时长比较住院费用、住院时间和次数。我们评估了9438名新诊断的无高级护理的痴呆症患者,分为两组:4094名(43.4%)使用中医的患者和5344名(56.6%)不使用中医的患者。在使用中医的组中,894名(21.8%)患者接受了高级护理,而在不使用中医的组中有1683名(31.5%)患者接受了高级护理。Cox比例风险回归表明,与不使用中医相比,使用中医可能会降低对高级护理的需求(调整后的风险比(aHR)=0.61,95%置信区间[95%CI]:0.56 - 0.66)。与不使用中医的患者相比,使用中医的患者住院费用和住院时间更低。将中医保健纳入痴呆症护理被发现与对高级护理的需求较低、住院费用和住院时间相关,并且使用中医的时间越长,受益越多。