Utilization Patterns of Chinese Medicine and Western Medicine for Hypertension under The National Health Insurance Program in Taiwan, A Population-based Study from 2002 to 2007

Background:
Hypertension is an important risk factor of cardiovascular disease. Heart diseases, cerebrovascular diseases, diabetes and nephritis/nephrotic syndrome/nephrosis, ranked 2nd, 3rd, 5th and 10th leading causes of deaths in Taiwan, are related to hypertension as stated in the report from Department of Health, Executive Yuan, R.O.C. in 2009 in Taiwan. The hypertension prevalence rate in our population in 2002 was 21.5% in those aged 15 years and elder, 35% in those aged over 40, or 60% with age ≧ 60. Although western medicine is the mainstream in the world, it is estimated that complementary and alternative medicines are still used by more than 30 % of people all over the world. Chinese medicine is the main therapy of complementary and alternative medicine in Chinese society. When combining with western medicine and Chinese medicine, it not only can enhance the effect of western medicine, but also can increase the risk of herb-drug interaction.
Objective：
In view of the preceding background, three aims of this research will be investigated:
1. To explore the characteristics of patients and physicians during utilization of western medicine, Chinese medicine and combination of two for hypertension control.
2. To understand the the characteristics of medical institutions during utilization of western medicine, Chinese medicine and combination of two for hypertension control.
3. To analyze the odds ratio of utilitation patterns among the patients, physicians and institutions’ characteristics.
Method:
Using the database of National Health Research Institutes, we analysised 2002-2007 Longitudinal Health Insurance Database 2005 (LHID2005) which contains all the original claim data of 1,000,000 beneficiaries, randomly sampled from the year 2005 Registry for Beneficiaries (ID) of the National Health Insurance Research Database (NHIRD). The study subjects will be identified using the first three digit ICD-9 codes as 401-405, and A26 (A-code) during 2002 to 2007. Utilization patterns are characterized by four features including: western medicine only, Chinese medicine only, combination of western and Chinese medicine for hypertension, and western medicine for hypertension combining with Chinese medicine for any conditions.
Result：
The proportion of utilization pattern of Chinese medicine is about 2.8%, but the proportion of western medicine for hypertension combining with Chinese medicine for any conditions increased to 28.9%. The younger group of patients is, the more odds ratio of utilization of Chinese medicine is. The odds ratio of utilization of Chinese medicine is higher in medical institutions’ characteristics of local medical department, private institute and higher urbanization level. Beside, the odds ratio of the same medical institution is higher in the group of combining with western medicine and Chinese medicine for hypertension than the group of western medicine for hypertension combining with Chinese medicine not for hypertension.
Conclusion:
The major therapy for hypertension is still western medicine, but the majority of Chinese medicine is used for treating or preventing other conditions. Maybe it can improve the efficiency of hypertension control when combining western medicine and Chinese medicine, but the risk of herb-drug interaction is increasing. So there is competitive advantage when medical institute can provide both of western medicine and Chinese medicine at the same time.