Patient-sharing relationship between Chinese medicine doctors and other physicians: costs and outcomes of breast cancer survivorship care.

PURPOSE: Breast cancer survivors represent a unique group of patients who need complex and continuous care after their cancer treatment. These patients often see several providers in various specialties. This study aimed to analyze how traditional Chinese medicine (TCM) integration within care networks of patients with breast cancer might be related to health care costs and patient outcomes under the National Health Insurance program in Taiwan. METHODS: We enrolled all patients who underwent definitive mastectomy for newly diagnosed breast cancer between 2007 and 2015. We analyzed the presence of TCM physicians and the patient-sharing relationship between TCM physicians and other physicians during the first year after mastectomy. The outcomes included all-cause mortality, avoidable hospitalization, and medical expenditures. RESULTS: There were 68,987 patients with breast cancer, with a median age of 53 years. After propensity score matching, patients whose TCM doctors had the highest connectedness with other physicians had the lowest odds of avoidable hospitalization (adjusted odds ratio 0.86; 95% confidence interval [CI], 0.78-0.96) and lowest hazard of mortality (adjusted hazard ratio, 0.82; 95% CI, 0.72-0.93), followed by those with TCM doctors with medium connectedness, then low connectedness, and lastly those patients with no TCM doctor in their care network. CONCLUSIONS: A dose-response pattern was observed regarding the relationship between TCM doctor's connectedness with other physicians within a patient's care network and patient outcomes. IMPLICATIONS FOR CANCER SURVIVORS: The findings demonstrated that stronger connectedness between TCM and other physicians could help improve the health outcomes of breast cancer survivors.

Psoriasis is not a risk factor for dementia: a 12-year nationwide population-based cohort study.

Studies investigating the risk for dementia in psoriatic patients remain inconclusive. There are a limited number of population-based studies on the association between psoriasis and dementia. This study aims to investigate the risk for dementia in psoriatic patients. This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Research Database between 2000 and 2012. A total of 111,825 patients with psoriasis and 111,825 age-, sex-, and index date-matched controls were recruited. The hazard ratio (HR) for subsequent dementia in patients with psoriasis was analyzed using a Cox model and a Fine-Gray competing risk model. During 1,358,774 person-years of follow-up, 2688 patients developed dementia in the psoriatic cohort, and 2062 developed dementia in the control cohort. In the multivariate adjusted Cox model, the hazard ratio (HR) of psoriatic patients for dementia was 1.02 [95% confidence interval (CI) 0.96-1.09] relative to the controls. Psoriasis did not increase the risk for dementia (both vascular dementia and degenerative dementia). In the competing risk model, the HR of dementia was 0.96 (95% CI 0.90-1.02) for psoriatic patients. Compared to psoriatic patients who had not received phototherapy or systemic treatment, those psoriatic patients receiving phototherapy or systemic treatment had a lower risk for dementia. However, this phenomenon was not observed in psoriatic patients who were observed for longer than 6 years. Psoriasis was not found to be a risk factor for dementia. Phototherapy and systemic treatment might not have a protective effect against dementia in psoriatic patients.

Variation in the 11-year trajectories of medical care seeking behaviors in diabetes patients under a single payer system: persisting gaps to be filled.

BACKGROUND: Care-seeking behavior is widely acknowledged to have strong influences on health outcomes among individuals with chronic conditions including diabetes. Despite its dynamic nature, care seeking behavior are often considered as time invariant in most studies. The likelihood of patients changing their regularity and source of chronic care over time is often neglected. This study aimed to determine the long-term trajectories of care-seeking patterns of both care-seeking regularity and health provider choices; and their associated factors among patients with type 2 diabetes under the National Health Insurance (NHI) program in Taiwan. METHODS: We utilized population-based data from the National Health Insurance Research Database (NHIRD) in Taiwan. Three thousand, nine hundred and eighty-seven adult patients with newly diagnosed type 2 diabetes in 1999 were enrolled in the cohort. We assessed their trajectories of regular care visits and sources of diabetes care from 2000 to 2010. A group-based trajectory model was applied. RESULTS: Seven distinct groups of long-term care-seeking patterns were identified. Only 51.44% of patients with newly diagnosed diabetes had regularly visited their providers over time. Among them, 56.41 and 16.09% had persistently sought care from generalized and specialized providers, respectively. 27.50% had sought care from different levels of providers. Patients who were male, elderly, low-income, and had a higher baseline diabetes severity were significantly more likely to either continue with their irregular care-seeking behavior or fail to maintain their regular care seeking behavior over time. Those who were younger, had a higher socioeconomic status, and lived in an urban area were significantly more likely to persistently seek care from specialized care settings. CONCLUSIONS: This study is the first population-based assessment of long-term care-seeking behaviors of type 2 diabetes patients under a single-payer system with a comprehensive benefit coverage. The most alarming finding was that, despite the existence of the comprehensive universal health insurance coverage in Taiwan, almost 50% of patients did not seek or maintain regular visits to providers over time as recommended. Understanding variations in the long-term trajectories of care adherence and sources of care may help to identify gaps in diabetes care management.

Understanding the relationship between cesarean birth and stress, anxiety, and depression after childbirth: A nationwide cohort study.

BACKGROUND: Women who undergo cesarean birth might have an increased risk for poor mental health after childbirth, possibly because of maternal and neonatal physical problems, low parental confidence, and decreased levels of oxytocin. However, this relationship remains controversial and requires further examination. The study aimed to examine the effect of cesarean birth on postpartum stress, anxiety, and depression. METHODS: This nationwide population-based cohort study was conducted using the Taiwan National Health Insurance Database. A total of 12 619 women who underwent cesarean birth and 12 619 control women who underwent vaginal birth were matched by propensity score based on age, socioeconomic status, residential urbanicity, antepartum comorbidity, and index year of delivery. We compared the incidence of stress, anxiety, and depression during the first postpartum year between cesarean and comparison groups by calculating incidence rate ratios (IRRs). RESULTS: The cesarean group showed a significantly higher risk for stress symptoms (IRR 1.4 [95% confidence interval {CI} 1.02-1.92]), but not anxiety (IRR 1.14 [95% CI 0.95-1.38]) or depression (IRR 1.32 [95% CI 0.94-1.87]), although the IRRs were also greater than one. The cesarean group had a significantly higher risk of any of the above-listed three disorders than the comparison group (incidence 27.6 vs 23.4 per 1000 person-years; IRR 1.18 [95% CI 1.01-1.38]). CONCLUSIONS: Cesarean birth was associated with an increased risk of postpartum stress symptoms. Health professionals should avoid unnecessary cesarean birth, pay attention to women who deliver by cesarean, and intervene appropriately in an attempt to improve mental health among postpartum women.

Short- and long-term use of medication for psychological distress after the diagnosis of cancer.

PURPOSE: This study investigated the short- and long-term use of medication for psychological distress after the diagnosis of cancer. METHODS: Longitudinal data from the Taiwan National Health Insurance database were used to follow 35,137 cancer patients for 2.5 years after being diagnosed in 2006 and 2007. RESULTS: Among those patients who survived for at least 180 days, 20.9 % had used psychotropic medications; sedatives were the most frequently prescribed (14.3 %), followed by antidepressants (5.5 %), anxiolytics (3.6 %), and antipsychotics (2.7 %). Lung cancer, prostate cancer, and oral cancer showed a significant association with the regular use of medication in the first 180 days. Among patients who survived for at least 2.5 years, 4.8 % still used psychotropic medication on a regular basis. Lung cancer and prostate cancer were associated with such prolonged use. CONCLUSIONS: This longitudinal study found that the type of cancer was significantly associated with the use of psychotropic drugs after the diagnosis was made. It provided information about the trajectory of that use and found that a small number of patients were still using those medications after 2.5 years.

Seasonal variations of prescriptions for the major syndrome types and manifestations of upper respiratory tract infection in tradition Chinese medicine.

OBJECTIVE: The aim of this study is to investigate the seasonal variations of prescriptions for the three most common syndrome types and the three major manifestations of upper respiratory infections (URIs) according to the theories of traditional Chinese medicine (TCM). DESIGN: This is a cross-sectional study. We examined a random sample comprising 1,000,000 beneficiaries from the National Health Insurance program in 2005. Primary diagnoses including International Classification of Diseases, Ninth Revision, Clinical Modification Codes 460-465 and 487 were regarded as URIs, for which 160,357 prescriptions of Chinese herbal medicine were analyzed. MAIN OUTCOME MEASURES: We estimated the adjusted odds ratios (ORs) of three categories of Chinese herbal formulae (CHF) used to treat the three most common types of URIs and another CHF used to alleviate manifestations of URIs throughout the four seasons. RESULTS: The OR for pungent-cool CHF used to relieve external syndromes was highest in the summer (OR=1.07). The OR for pungent-warm CHF used to relieve external syndromes was highest in the winter (OR=1.14). The OR for CHF used to alleviate cough and reduce sputum production was highest in the spring (OR=1.00). The OR for CHF used to alleviate nasal discharge and congestion was highest in the winter (OR=1.19). CONCLUSION: There are seasonal variations of prescriptions for the major syndrome types and manifestations of URIs in TCM. The results of this study may serve as a reference for TCM physicians in medical preparation and clinical practice.

The trends of utilization in traditional Chinese medicine in Taiwan from 2000 to 2010: A population-based study.

INTRODUCTION: There is no study exploring the trend of utilization in traditional Chinese medicine (TCM) from 2000 to 2010. The objective of this study was to investigate the trends of TCM utilization among 3 cross-sectional cohorts of 2000, 2005, and 2010. METHOD: This study was a cross-sectional analysis of TCM utilization over time. We compared the mean TCM visits among 3 cohorts of 2000, 2005, and 2010. We derived 3 randomly sampled cohorts of nearly 1 million representative beneficiaries in each of 2000, 2005, and 2010 from National Health Insurance Research Database for this research. Multivariate logistic regression was performed to evaluate the relative relationship in categorical variables correlating to TCM users. The percentage change (% change) in mean TCM visits between 2000 and 2005 (2010) was used to evaluate the trends of TCM utilization during the period. RESULTS: The ratio of TCM users increased throughout cohorts. The ratio of TCM users among women was more than that among men in all cohorts of 2000, 2005, and 2010 (adjusted odds ratio = 1.47; 1.52; 1.62). The mean TCM visits increased from 2000 to 2010. The percentage change in mean TCM visits among women was more than that among men. The group aged less than 20 years had the least percentage change in mean TCM visits (18.8%); nevertheless, the group aged 20 to 34 years had the largest change (30.2%). The high socioeconomic status group had the largest percentage change in mean visits to TCM, whereas the central region had the least percentage change. Neoplasms had the greatest increase in percentage change in mean TCM visits among all disease categories; in contrast, diseases of the respiratory system had the greatest decrease. CONCLUSION: Both the ratio of TCM users and mean TCM visits increased gradually from 2000 to 2005 and further to 2010. Women used TCM more than men, and this is expected to continue in the future. The high socioeconomic status group used TCM more and more over time. The picture of TCM need among different types of cancer patients should be explored in further research because of the substantial increase in TCM utilization for the disease category of neoplasms.

The Effect of Continuity of Care on Emergency Room Use for Diabetic Patients Varies by Disease Severity.

BACKGROUND: Although many studies have reported that high-quality continuity of care (COC) is associated with improved patient outcomes for patients with diabetes, few studies have investigated whether this positive effect of COC depends on the level of diabetes severity. METHODS: A total of 3781 newly diagnosed diabetic patients selected from the 2005 National Health Insurance database were evaluated for the period 2005-2011. Generalized estimating equations combined with negative binomial estimation were used to determine the influence of COC on the overall emergency room (ER) use and diabetes mellitus (DM)-specific ER use. Analyses were stratified according to diabetes severity (measured using the Diabetes Complications Severity Index [DCSI]), comorbidities (measured using the Charlson comorbidity score), and age. RESULTS: COC effects varied according to diabetes severity. Stratified analysis showed that the positive effect of COC on DM-specific ER use was the highest for a DCSI of 0 (least severe), with an incidence rate ratio (IRR) of 0.49 (95% CI, 0.41-0.59) in the high-COC group (reference group: low-COC group). Compared with the low-COC group, high-quality COC had a significant beneficial effect on overall ER use in younger patients (IRR 0.51; 95% CI, 0.39-0.66 for the youngest [18-40 years] group, and IRR 0.67; 95% CI, 0.59-0.76 for the oldest [>65 years] group) and those with a high number of comorbidities. CONCLUSIONS: The positive effects of high-quality COC on the treatment outcomes of patient with diabetes, based on the overall and DM-specific ER use, depends on the level of disease severity. Therefore, providing health education to enhance high-quality COC when the disease severity is low may be critical for ensuring optimal positive effects during diabetes disease progression.

Amiodarone-Associated Optic Neuropathy: A Nationwide Study.

PURPOSE: To investigate whether amiodarone use is associated with an increased risk of optic neuropathy. DESIGN: Retrospective population-based cohort study. PARTICIPANTS: Patients newly treated with amiodarone between 2005 and 2009 were identified from the Taiwan National Health Insurance Research Database. For each case patient, the study also included 4 age- and gender-matched control subjects who did not receive amiodarone treatment. METHODS: Cox multivariate regression analysis was used to assess the association between amiodarone and the occurrence of optic neuropathy. MAIN OUTCOME MEASURES: Hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: The analysis included 6175 amiodarone-treated patients and 24 700 controls. The mean age was 66.7 years and 55.3% of subjects were male. The mean follow-up was 688 days. During the observational period, optic neuropathy developed in 17 amiodarone-treated patients (0.3%) and 30 control patients (0.1%; P = 0.006). Multivariate Cox regression analysis showed that amiodarone-treated patients had a 2-fold increased risk of optic neuropathy (HR, 2.09; 95% CI, 1.13-3.85; P = 0.02). After stratification by gender, amiodarone use remained a significant factor for optic neuropathy development among male subjects (HR, 3.05; 95% CI, 1.42-6.55; P = 0.004), but not among female subjects (HR, 1.15; 95% CI, 0.38-3.47; P = 0.81). Among amiodarone-treated patients, male gender was associated with a nearly 3-fold increased risk of optic neuropathy development compared with female gender (HR, 2.91; 95% CI, 0.94-9.01; P = 0.06). We also detected a trend of increased cumulative incidence of optic neuropathy with longer treatment duration (>41 vs. ≤41 days; HR, 3.46; 95% CI, 0.99-12.07; P = 0.05). However, higher daily dose did not increase the risk of optic neuropathy (HR, 0.96; 95% CI, 0.91-1.00; P = 0.07). CONCLUSIONS: These results demonstrated a higher risk of optic neuropathy in patients treated with amiodarone, especially in males and possibly in patients with longer duration of treatment.

Characteristics Associated with Utilization of Asthma-Related Traditional Chinese Medicine Services among Asthma Children in Taiwan: A Nationwide Cohort Study.

Introduction. Previous studies have demonstrated the advantages of TCM use among asthmatic children. However, there is a paucity of epidemiologic reports on features of TCM users among asthmatic children. This cohort study aimed to investigate child's, parent's, and provider's characteristics associated with the use of asthma-related TCM services among newly diagnosed asthmatic children. Materials and Methods. A nationally representative cohort of one million National Health Insurance beneficiaries was used. The newly diagnosed asthma children who received asthma medication from western medicine providers from 2005 to 2010 were selected as our sample for analysis. Generalized estimating equation was applied to identify the child's, parents', and provider's characteristics associated with the use of asthma-related TCM among the newly diagnosed asthmatic children. Results. Of 20,080 children who were enrolled and followed up for one year, 4,034 children used TCM for asthma-related treatment. Children with prior experience of TCM, pre-school and school aged children, boys, those with more severe asthma or poorer health, with higher income parents were more likely to use asthma-related TCM. Herbal medicine was the most common modality among asthmatic children. Conclusions. There were only 20% newly diagnosed asthmatic children using TCM. The findings may shed light on possible integration of TCM with western medicine services.

Exploring the role of multiple chronic conditions in traditional Chinese medicine use and three types of traditional Chinese medicine therapy among adults in Taiwan.

INTRODUCTION: Numerous people with chronic conditions like to use traditional Chinese medicine (TCM) treatment, or integrated treatment of TCM and Western medicine (WM). Our study explored the associations between multiple chronic conditions (MCC) and TCM use and the use of specific types of TCM therapy among adults in Taiwan. In addition, we explored the TCM use of adults with seven common types of chronic conditions. METHODS: In our study, a national representative sample in 2005 was used. The Chronic Condition Indicator and the Clinical Classifications System created by the U.S. Agency for Healthcare Research and Quality were used to define the number of chronic conditions of adults. Logistic regressions adjusted for demographic characteristics were used to analyze the associations. The frequency of TCM use among adults with different numbers of chronic conditions was quantified. RESULTS: TCM use for adults with ≥5 chronic conditions (odds ratio [OR] 1.86) was higher than TCM use for adults with 2-4 chronic conditions (OR 1.51) and TCM use for adults with one chronic condition (OR 1.48). The increase in the OR of the use of Chinese herbs and traumatology manipulative therapy according to the number of chronic conditions was not as substantial as that of acupuncture-moxibustion. The frequency of TCM use exhibited an increasing trend with the increase in the number of chronic conditions (p<.001). Among the seven common types of chronic conditions for adults, TCM use for adults with arthropathy (OR 2.01) was the highest. CONCLUSION: The probability and frequency of TCM use increased as the number of chronic conditions increased. The probability of Chinese herbs use, traumatology manipulative therapy use, and, particularly, acupuncture-moxibustion use increased as the number of chronic conditions increased. We suggest that government policy makers emphasize administering integrated TCM and WM care to people with chronic conditions or MCC.

Receipt of physical therapy among osteoarthritis patients and its influencing factors.

OBJECTIVE: To explore major patient and provider characteristics influencing the receipt of physical therapy (PT) among patients newly diagnosed with osteoarthritis. DESIGN: A population-based, cross-sectional study on outpatient PT for patients newly diagnosed with osteoarthritis within the period of 2005 to 2010. SETTING: Sample of 1 million National Health Insurance enrollees. PARTICIPANTS: People aged ≥18 years with an incidence of osteoarthritis and receiving initial outpatient treatment. A total of 29,012 patients were included (N=29,012). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The outcome variable of interest was the probability of receiving PT within 1 year of osteoarthritis diagnosis. Both individual and provider characteristics were investigated to determine their influence on PT receipt. RESULTS: Of the 29,012 included patients with osteoarthritis, only 24.8% of them received PT within the first year of diagnosis. Men and older adults were less likely to receive PT. In addition, low-income patients with osteoarthritis were less likely to receive PT. Furthermore, PT receipt was increased in patients treated by physicians who were women and by physicians who specialized in rehabilitation medicine. In addition, we observed a pattern indicating that the lower the accreditation level of the practice setting, the greater the probability of receiving PT. CONCLUSIONS: Because of the National Health Insurance program in Taiwan, direct medical costs of PT have been substantially reduced; however, variations are still observed among different patient and provider characteristics. The major role of providers in PT receipt for patients with osteoarthritis should not be ignored.

Risk factors for developing glaucoma among patients with uveitis: a nationwide study in Taiwan.

PURPOSE: To investigate the incidence and risk factors for developing ocular hypertension or glaucoma needing treatment among uveitis patients in Taiwan. METHODS: The nationwide database-derived retrospective cohort study was designed using Taiwan's National Health Insurance Research Database. From 1 million representative samples randomly selected from the beneficiaries of the National Health Insurance program, all patients with a diagnosis of uveitis were identified. Only newly onset uveitis patients who were diagnosed after January 1, 2002 and had no prior diagnosis of glaucoma were included in the study, and were followed up until December 31, 2008 or the last day that they were covered by the program. A patient was defined as having glaucoma as soon as both a diagnosis of glaucoma or ocular hypertension as well as a claim for medical or surgical treatment of glaucoma was found. Risk factors for developing glaucoma at the time of, or after the uveitis incidence were evaluated and discussed. RESULTS: Initially, 5757 newly diagnosed uveitis patients were enrolled in the study. Of these patients, 488 (8.5%) were also diagnosed with glaucoma at the time of uveitis incidence. Patients aged 17 to 64 years, of male sex and diagnosed with anterior uveitis were more likely to have glaucoma at the time of the uveitis incidence. Among the remaining 5269 patients, 351 (6.7%) patients developed glaucoma during the follow-up period. Significant risk factors included increasing age, having been diagnosed with anterior uveitis, having more than an average number of ophthalmic claims within the first 3 months, and complications with corneal edema. A stratified analysis showed that having a history of receiving intraocular surgery is also a risk factor for the development of glaucoma among adult patients. CONCLUSIONS: The development of glaucoma in uveitis patients is noteworthy and is associated with several demographic and clinical factors. To minimize the visual impairment caused by uveitis-related glaucoma, clinicians should pay more attention to those uveitis patients who are at high risk for developing glaucoma.

Persistence of topical glaucoma medication: a nationwide population-based cohort study in Taiwan.

IMPORTANCE: Medication persistence is an important factor for treatment effect in patients with glaucoma. Evaluating risk factors for refill discontinuation might be helpful for improving persistence and preventing blindness in patients with glaucoma. OBJECTIVES: To estimate the persistence rate with topical glaucoma medication 2 years after diagnosis and evaluate risk factors for nonpersistence among patients in Taiwan with open-angle glaucoma and ocular hypertension. DESIGN, SETTING, AND PARTICIPANTS: A retrospective population-based study using claims data from the National Health Insurance Research Database. One million patients were randomly selected from the registered beneficiaries of the National Health Insurance Research Database in 2000. All patients with newly diagnosed open-angle glaucoma and ocular hypertension were included and followed up until December 31, 2008. Patients were included in the analysis only if they had follow-up data for more than 2 years after diagnosis. MAIN OUTCOMES AND MEASURES: Nonpersistence was defined as the patient not refilling any topical glaucoma medication for more than 90 days. Patient characteristics, prescription-related clinical factors, and physician and hospital characteristics were identified and considered in the analysis. The rate of persistence was estimated and risk factors for nonpersistence were investigated using Cox proportional regression models. RESULTS: A total of 3134 patients were identified and observed in the study. After a 2-year follow-up, 759 patients (24.2%) persisted with their glaucoma medications. Multivariate analysis showed that patients' living or working areas (P < .001), number of glaucoma medications (P < .001), prescription of pilocarpine hydrochloride (adjusted ratio of persistence = 0.72; 95% CI, 0.59-0.88) or prostaglandin analogs (adjusted ratio of persistence = 2.04; 95% CI, 1.82-2.33), the year in which glaucoma diagnosis was made (adjusted ratios of persistence for patients whose condition was diagnosed after 2004 = 1.18; 95% CI, 1.09-1.27), sex of the main physicians (adjusted ratios of persistence for male ophthalmologists = 0.82; 95% CI, 0.74-0.90), treatment in hospitals (P < .001), and continuity of care index (P < .001) were associated with patients' persistence with glaucoma medications. CONCLUSIONS AND RELEVANCE: The rate of persistence for glaucoma medications is low in Taiwan, although health care costs, including the cost of medication, are mostly covered by the nationwide health insurance system. This study suggests that factors other than cost, such as physician-patient relationship and patient education, may play an important role in the persistence of topical glaucoma medication.

Statin use and incident dementia: a nationwide cohort study of Taiwan.

BACKGROUND: Statins are widely used in clinical treatment. However, an U.S. Food and Drug Administration issued health alert has raised concerns for the adverse effects of statin-associated confusion and memory loss in the elderly people. It is necessary to clarify the relationship between statin use and risk of incident dementia as well as whether class effects exist. METHODS: In this population-based retrospective cohort study, total 33,398 patients aged ≥ 60 years were selected from a subset of the Taiwan National Health Insurance Research Databases and followed up for tracking the occurrence of any type of dementia from 2000 to 2010. The Cox proportional hazards models were used. RESULTS: Compared to nonusers, statin users had a significantly lower risk of incident dementia (hazard ratio [HR], 0.78; 95% CI, 0.72-0.85, p<0.001). The potency and the cumulative duration of statin utilized were associated with the reducing risk of dementia. After stratifying by gender, the risk of incident dementia was lower in female statin users (HR, 0.76; 95% CI, 0.68-0.85, p<0.001) than in male statin users (HR, 0.86; 95% CI, 0.75-0.98, p=0.024). Higher potency and longer cumulative duration of statin use were required for reducing the risk of incident dementia in male patients than in female patients. CONCLUSION: Statin use was associated with a significantly lower risk of dementia in the elderly patients in Taiwan. The potency and the cumulative duration of statin utilized played critical roles.

Trends, correlates, and disease patterns of antipsychotic use among children and adolescents in Taiwan.

PURPOSE: We used Taiwan's population-based National Health Insurance database to investigate the trends, correlates, and disease patterns of antipsychotic use among children and adolescents. METHODS: The National Health Research Institutes provided a database of 1,000,000 random subjects for study. We chose subjects who were aged 18 years or younger during 1997-2005. In this sample, subjects who were given at least one antipsychotic prescription, including first-generation antipsychotics (FGAs) or second-generation antipsychotics (SGAs), were identified. Trends, prevalence, and associated factors of antipsychotic use were determined. The proportion of antipsychotic use for psychiatric and medical disorders was also analyzed. RESULTS: The 1-year prevalence of SGA use increased from 0.00 % in 1997 to 0.09 % in 2005, whereas the 1-year prevalence of FGA use ranged from 2.24 to 3.43 % during this same period, with no significant change. Age and male gender were associated with higher SGA use. Among SGA users, the greatest proportion suffered from psychiatric disorders, including tics, hyperkinetic syndrome of childhood, schizophrenia, affective disorders, and autism. Among FGA users, a larger proportion was for medical conditions, including diseases of the digestive and respiratory systems. CONCLUSION: The prevalence of pediatric SGA use increased greatly from 1997 to 2005. Among pediatric subjects using antipsychotics, SGAs were mostly used for psychiatric disorders, whereas FGAs were mostly prescribed for medical conditions. Future research will focus on indication, dosage, frequency, duration, adverse effects, and off-label use of antipsychotics in the pediatric population.

Increased risk of chronic obstructive pulmonary disease in patients with schizophrenia: a population-based study.

OBJECTIVE: We investigated the prevalence and incidence of chronic obstructive pulmonary disease (COPD) among patients with schizophrenia in Taiwan. METHODS: From the database provided by the National Health Research Institute, we obtained a random sample of 766,427 subjects aged ≥18 years in 2005. Subjects with a primary or secondary diagnosis of COPD during 2005 were identified. We compared the prevalence of COPD in schizophrenic patients with that in the general population. We also detected new cases of COPD from 2006 to 2008. RESULTS: The prevalence of COPD in patients with schizophrenia was higher than that in the general population (3.83% vs. 2.88%, odds ratio [OR] 1.66; 95% confidence interval [CI]),1.42-1.94) in 2005. Compared with the general population, patients with schizophrenia had a higher prevalence of COPD in individuals <50 years old and ≥70 years old; among both sexes, and among insurance amount of a fixed premium and an amount less than US$640. Patients with schizophrenia had a higher annual incidence of COPD than that in the general population (2.21% vs. 1.43%, risk ratio 1.83; 95% CI, 1.62-2.07). The higher incidence of COPD in patients with schizophrenia was associated with increased age and male sex. CONCLUSIONS: Patients with schizophrenia had a higher prevalence and incidence of COPD than individuals in the general population in Taiwan. Younger adults and men with schizophrenia had a much higher prevalence of COPD compared with those groups in the general population, a result deserving further study.

Factors associated with subsequent eye care for children in Taiwan: a population-based historical cohort study.

PURPOSE: To investigate patterns and factors associated with subsequent eye care for Taiwan's children. METHODS: We conducted a population-based historical cohort study of 2464 children aged between 3 and 12 years old from the 2005 National Health Interview Survey (NHIS). Participants' ocular conditions were identified based on 2005 NHIS questionnaire answers given by caregivers. Subsequent eye care data was obtained from 2006 and 2007 National Health Insurance claim data. Eye care related to these children's ocular conditions was defined by physician's diagnosis using the International Classification of Diseases version 9 clinical modification codes. Poisson regression with robust variance estimation was used to determine factors associated with eye care use. RESULTS: Of the 2464 children, 712 (28.9%) had ocular conditions in 2005, and 56.5% and 44.7% of them didn't receive eye care during the subsequent 1- and 2-year periods, respectively. Among those with ocular conditions, the 3-4-year-olds were least likely to receive eye care in the subsequent 1 and 2 years. Children with highly educated fathers were more likely to receive eye care in the subsequent 1-year period. Sex, family income, level of mother's education, residential area and eye care resources were not significant factors for children with ocular conditions receiving subsequent eye care within either 1 or 2 years. CONCLUSIONS: Despite the fact that Taiwan has a National Health Insurance Program, lack of subsequent eye care remains high, even when a child's ocular condition is known by the caregiver. Determinants associated with follow-up eye care must be considered when designing eye care enhancing programs for children.

Which domain of self-rated health best predicts medical care utilization among Taiwanese adults?

BACKGROUND: We attempted to identify the domain of self-rated health (SRH) that best predicts medical care utilization among Taiwanese adults. In addition, we examined the association between SRH and different measure of medical care utilization. METHODS: We analyzed data on 11 987 community-dwelling adults aged 18 to 64 years from the 2005 Taiwan National Health Interview Survey (NHIS). NHIS data were linked to the 2006 National Health Insurance (NHI) administrative database. Then, medical care utilization in 2006, including all outpatient visits, hospitalizations, and mental health outpatient visits, was identified. Domain-specific health ratings were measured by using the Short Form-36 (SF-36) health survey questionnaire. Negative binominal models were used to estimate the contribution of the health domains to medical care utilization. Incidence rate ratios (IRRs) are presented. RESULTS: The IRR for the physical component scale showed that those with the highest scores had 77% of the outpatient visits of those with the lowest scores. The importance of mental health domains was markedly higher in estimating mental health outpatient visits. Those with mental health scores above the median had only 61% of mental health outpatient visits of those with scores below the median. CONCLUSIONS: A person's medical care utilization is reflected in the different domains of general health. Domain-specific measures of subjective health are not interchangeable with global general health ratings, because different domains have independent effects on medical care utilization. Our results are potentially important for medical resource allocation because they identify different health domain experiences that require improvement.

Prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder in Taiwan, 1996-2005: a national population-based study.

PURPOSE: We used National Health Insurance (NHI) database to examine the prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder (ADHD) diagnosis in Taiwan. METHODS: The National Health Research Institute provided a database of 10,00,000 random subjects for study. A population-based random sample of 372,642 patients aged younger than 18 was obtained as a dynamic cohort. Those study subjects who had at least one service claim from 1996 to 2005, with a principal diagnosis of ADHD, were identified. RESULTS: The cumulative prevalence of ADHD diagnosis increased from 0.06 to 1.64 % from 1996 to 2005. The annual incidence of ADHD diagnosis increased from 0.02 to 0.34 % from 1997 to 2005. The highest incidence rates of ADHD diagnosis for both males and females were in the 6- to 11-year age group. Higher incidence was detected in males (HR 3.76, 95 % CI 3.48-4.07), those who lived in northern region (HR 1.35, 95 % CI 1.07-1.71) and urban area (HR 1.53, 95 % CI 1.40-1.66). The percentage of stimulant use in children with ADHD diagnosis increased from 39.6 to 54.0 % from 1997 to 2005. CONCLUSIONS: Our findings suggest increases in the prevalence and incidence rates of ADHD diagnosis in Taiwan, which was in line with those studies of Western countries. However, the prevalence of ADHD diagnosis in the NHI program was still much lower than in the community studies. The percentage of stimulant use in children with ADHD diagnosis also has an increasing trend, which warrants further study.