Abstract
Doctor-shopping has caused an increase in medical expense, potential to receive duplicate medications, and suffer adverse drug reactions. We carried out a population-based retrospective study aimed at examining the user patterns of traditional Chinese medicine (TCM) ambulatory care in Taiwan. We retrieved complete TCM ambulatory visit datasets for the year 2007 from the National Health Insurance database in Taiwan. We defined the patients whose distribution of TCM physician numbers scored more than 97.5 percent (more than, or equal to, five TCM physicians) within one year as TCM doctor-shoppers. In total, 6,596,814 subjects (28.9%) paid TCM visits during that year. All 177,728 subjects (2.69%) who visited more than five (including) TCM physicians were classified as TCM shoppers. The most prevalent diagnostic grouping was upper respiratory infections (44.7%) and sprains and strains (44.0%). Men had a lower odds ratio (OR) among TCM shoppers than women (OR = 0.94, 95% confidence interval (CI) = 0.93–0.96). Younger people were less likely to be TCM shoppers than other people were. The ORs of TCM shoppers were higher among veterans and low-income patients (OR = 1.29 (1.23–1.35), and 1.33 (1.27–1.41)). In conclusion, health education on the potential of drug interactions and iatrogenic health risks incurred from doctor-shopping should be addressed to those high-risk patients.
Highlights
Doctor-shopping, which means changing doctors without professional referral for the same or similar illness conditions, is a worldwide phenomenon.The percentage of doctor-shopping varied and was dependent on the definition of doctor-shopping.There was no generally accepted definition of frequent attendance or doctor-shopping [1].The literatures showed that doctor-shopping has caused increases in hospitalization cost [2], wastes in medical resources [3], and declines in continuous medical care [4]
To analyze the utilization of traditional Chinese medicine (TCM) use in the population, we defined the patients whose distribution of TCM physician numbers scored more than 97.5 percent within one year as TCM doctor-shoppers [1]
We found that the odds ratio (OR) of TCM shoppers were lower among farmer or fisherman patients and were higher among veteran and low income patients (OR = 0.95 (0.93–0.97), 1.29 (1.23–1.35), and
Summary
Doctor-shopping (or hospital-shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is a worldwide phenomenon.The percentage of doctor-shopping varied and was dependent on the definition of doctor-shopping.There was no generally accepted definition of frequent attendance or doctor-shopping [1].The literatures showed that doctor-shopping has caused increases in hospitalization cost [2], wastes in medical resources [3], and declines in continuous medical care [4]. The percentage of doctor-shopping varied and was dependent on the definition of doctor-shopping. There was no generally accepted definition of frequent attendance or doctor-shopping [1]. Doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions [5]. Due to the small proportion of the patient population receiving ambulatory care with a high number of physicians during the year, doctor-shopping would lead to greater medical expenses. Identifying and understanding this type of frequent users may be useful in developing strategies to adopt more effective intervention and reduce overuse [6]
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