台灣下背痛診斷性造影之過度利用趨勢-2002-2010

Abstract

Objective: Overuse of diagnostic imaging in patients with low back pain (LBP) is common and costly. This study examined the trends of overuse of diagnostic imaging in LBP patients from 2002 to -010, and explored the factors attributing to its change. Methods: With a retrospective cohort study design, we used a longitudinal sample consisted of 8% ( about 2 millions) randomly sampled National Health Insurance beneficiaries from 2002 to 2010. We excluded LBP patients aged under 18 years, having an initial episode of LBP within 6 months, and patients whose claims indicated neurologic deficit, trauma, low impact injuries, cancer, infection disease.Patients with primary diagnosis of LBP who had an imaging study (x-ray, MRI, or CT scan) within 30 days after first LBP diagnosis was defined as overuse. The difference in patient, physician and hospital factors between overuse and non-overuse was examined using Chi-square and T test. Poisson regression was then applied to quantify the incidence rate ratio within a factor attributd to overuse. Results: The estimated overuse rate of diagnostic imaging increased from 12.0% in 2002 to 14.2% in 2010.In 2002, the rate of overuse was higher in patients with Charlson ‘s index more than 1, visiting doctor 5 times or more in one year, more often having a physician with male gender, aged under 34, or with neurosurgical pecilty, or visiting medical center or foundation-owned hospital. Conversely, patients with male gender, aged 18-34 , or visiting regional hospitals more often had higher overuse rate in 2010. Conclusion: The trends of overuse in diagnostic imaging for patients with LBP had significantly increased over recent 9 years.Other type of overuse should be explored to estimate the scale of overuse in the overll health services industry as the basis of future policy intervention.