目的：
探討具高血壓、高血糖或高血脂之慢性病患者其中醫醫療服務利用之相關因素，瞭解患有三高之慢性病人使用中醫醫療之特性，並分析影響其使用中醫門診次數的因素。
方法：
本研究以2013年之國民健康訪問調查(NHIS)，12-64歲及65歲以上之資料進行分析，依據問卷調查中疾病狀況是否曾患有高血壓或糖尿病或高血脂，且皆是由醫護人員告知者，篩選為三高之慢性病患者，排除資料不全者，最後本研究樣本為4,521人，其中一個月內有使用中醫門診為464人，使用邏輯斯迴歸分析(Logistic regression)有無使用中醫門診之勝算比，並排除未使用中醫門診者，使用負二項迴歸分析(Negative binomial regression)，探討影響使用中醫門診次數的因素。
結果：
經邏輯斯迴歸分析發現，較年輕者、居住於中區、無嚼檳榔習慣、有運動習慣、非高收入、教育程度較高、自評健康狀況差及非糖尿病患者較容易使用中醫，於負二項迴歸分析則發現，年紀較大及自評健康狀況較差者使用中醫門診之次數較高。
結論：
本研究發現年齡及自評健康狀況，不僅影響是否使用中醫門診，也影響其使用次數，另發現65歲以上者較不易使用中醫醫療，但於有使用者中，65歲以上使用中醫之次數反而較高，故未來在衛生保健政策擬定時應留意這部分之特性。

Objective:
This study is to explore the factors related to the utilization of traditional Chinese medicine for patients with chronic diseases of hypertension, hyperglycemia, or hyperlipidemia; also is to understand the characteristics of chronic patients who use traditional Chinese medicine and to analyze the factors that affect the frequency of going to traditional Chinese medicine clinics.
Method:
The data of this study was collected from the National Health Interview Survey (NHIS) in 2013. Individuals aged from 12-64 and over 65 years old were analyzed. According to the disease status in the questionnaire, patients who had suffered from hypertension, diabetes, or hyperlipidemia before and were informed by medical staff were selected as patients with chronic diseases; however, patients with incomplete data were excluded from the sample. Finally, a total of 4,521 samples was selected in this study; among these samples, 464 outpatients had gone to traditional Chinese medicine clinics. Logistic regression was used to analyze the odds ratio of using traditional Chinese medicine, and those who don’t use traditional Chinese medicine were excluded. Negative binomial regression analysis was used to explore the factors that affect the frequency of using traditional Chinese medicine.
Result:
Logistic regression analysis found that younger people who live in the central area, do not have the habit of chewing betel nut, have exercise habits, do not have a high income, have higher education, poor self-assessed health status, and are not diabetic patients are more likely to use TCM. Negative binomial regression analysis found that older people and individuals who have poor self-assessed health status used traditional Chinese medicine more frequently.
Conclusion:
This study found that age and self-assessed health status not only affect people going to traditional Chinese medicine clinics, but also affect the frequency of going to the clinic. It also found that people over 65 years of age are less likely to use traditional Chinese medicine; however, among those who have used traditional Chinese medicine, the patients over 65 years of age intend to use traditional Chinese medicine more frequently. Therefore, in the future, health care policies should pay attention to these features.

論文審定書 i
中文摘要 ii
Abstract iii
目錄 v
圖次 vii
表次 viii
第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究目的 3
第二章 文獻探討 4
第一節 高血壓、高血糖及高血脂之診斷定義 4
第二節 中醫醫療資源之現況 8
第三節 醫療服務利用行為之理論 10
第四節 影響中醫醫療利用行為之因素 14
第三章 研究方法 20
第一節 研究假說與架構 20
第二節 資料來源與研究樣本 22
第三節 研究測量變項與定義 24
第四節 研究流程 27
第五節 資料處理與分析方法 28
第四章 研究分析與結果 29
第一節 研究樣本之描述性統計分析 29
第二節 各自變項對中醫門診使用次數之描述 35
第三節 各自變項對中醫門診使用與否之影響分析 39
第四節 各自變項對中醫門診使用次數之影響分析 45
第五節 研究假說驗證 51
第五章 討論 52
第一節 中醫醫療利用情形 52
第二節 有無使用中醫門診之因素探討 53
第六章 研究結論與建議 56
第一節 研究結論 56
第二節 研究限制 58
第三節 研究建議 58
第四節 研究貢獻 59
參考文獻 60
附錄 65

中央健康保險署.(2018). 全民健康保險統計. 取自
https://www.nhi.gov.tw/Content_List.aspx?n=82B811CDE03526FB&topn=23C660CAACAA159D
中央健康保險署.(2015). 全民健康保險雙月刊第114期
行政院衛生署國民健康局.(2003). 高血脂防治手冊 國人血脂異常診療及預防指引. 取自http://www.tas.org.tw/upload/files/21447.pdf
行政院衛生署國民健康局.(2005). 高血脂紅色通緝令.取自 http://www.bhp.doh.gov.tw/BHPNet/Portal/file/ThemeULFile/20070820300000004/00 01.pdf.
社團法人中華民國糖尿病學會. ( 2018). 2018糖尿病臨床照護指引. 取自
http://www.endo-dm.org.tw/DB/book/62/2018%E6%8C%87%E5%BC%95%E5%85%A8%E6%96%87(1071218%E4%BF%AE%E6%94%B9).pdf
吳就君. (1981). 臺灣地區居民社會醫療行為研究. 公共衛生, 8(1), 25-49.
李丞華, 周穎政, 陳龍生, & 張鴻仁. (2004). 全民健保中醫門診利用率及其影響因素. [Utilization of Ambulatory Chinese Medical Services under the National Health Insurance in Taiwan]. 臺灣公共衛生雜誌, 23(2), 100-107. doi:10.6288/tjph2004-23-02-02
施純全. (2014). 全民健保制度下臺灣中醫實施現況. 醫療品質雜誌, 8(5), 19-22.
洪錦墩, 郭慈安, 李卓倫, 陳文意, 黃光華, & 施雅文. (2010). 老年人於全民健康保險中醫門診醫療服務之利用分析. [Service Utilizations of Traditional Chinese Medicine among the Elderly: Data from the National Health Insurance in Taiwan]. 臺灣老人保健學刊, 6(2), 136-157. doi:10.29797/tjghr.201012.0002
張梅瑛, 張育嘉, & 徐尚為. (2012). 臺灣地區老人身體健康狀況與醫療利用之研究. [Relationships between Physical Health Status and Medical Services Utilization among Taiwan's Elderly People]. 臺灣老人保健學刊, 8(2), 130-152. doi:10.29797/tjghr.201212.0003
陳旺全. (2011). 中醫藥對慢性疾病與憂鬱症之治療. 北市中醫會刊, 17(4), 7-17. doi:10.6718/TJCMb.201112_17(4).0001
彭鳳美. (2001). 民眾生活型態、醫療資源利用與健康狀況之探討∼以新竹科學園區員工為例. 國立陽明大學. (2001年)
黃中瑀, 蔡岳廷, & 賴榮年. (2016). 糖尿病腎病變患者服用中藥與未服用中藥之發生率比較. [Renal Disease between Taking Traditional Chinese Medicine and Non-Taking Traditional Chinese Medicine in Diabetic Nephropathy Patients]. 中醫藥研究論叢, 19(2), 1-13. doi:10.6516/tjtcm.2016.19(2)01
蔡文正, & 龔佩珍. (2001). 中醫醫療利用成長與醫師數增加之關係. [Relationship Between Chinese Medical Utilization and Growth of Physicians]. 臺灣公共衛生雜誌, 20(6), 463-474. doi:10.6288/tjph2001-20-06-06
蔡岳廷. (2010). 2002年全民健保險糖尿病患者之中醫醫療利用. 中國醫藥大學. Available from Airiti AiritiLibrary database. (2010年)
魏廉鴻. (2015). 臺灣老年人中醫醫療利用行為之初探. 成功大學. Available from Airiti AiritiLibrary database. (2015年)
Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: does it matter? Journal of Health and Social Behavior, 36(1), 1-10.
Chang, L. C., Huang, N., Chou, Y. J., Lee, C. H., Kao, F. Y., & Huang, Y. T. (2008). Utilization patterns of Chinese medicine and Western medicine under the National Health Insurance Program in Taiwan, a population-based study from 1997 to 2003. BMC Health Services Research, 8, 170. doi:10.1186/1472-6963-8-170
Chen, F. P., Chen, T. J., Kung, Y. Y., Chen, Y. C., Chou, L. F., Chen, F. J., & Hwang, S. J. (2007). Use frequency of traditional Chinese medicine in Taiwan. BMC Health Services Research, 7, 26. doi:10.1186/1472-6963-7-26
He, C., Fu, P., Zhang, K., Xia, Q., Yang, Y., & Xie, L. (2018). Chinese herbal medicine for dyslipidemia: protocol for a systematic review and meta-analysis. Medicine (Baltimore), 97(44), e13048. doi:10.1097/md.0000000000013048
Liao, Y. H., Lin, C. C., Li, T. C., & Lin, J. G. (2012). Utilization pattern of traditional Chinese medicine for liver cancer patients in Taiwan. BMC Complementary and Alternative Medicine, 12, 146. doi:10.1186/1472-6882-12-146
Liu, Z. L., Liu, J. P., Zhang, A. L., Wu, Q., Ruan, Y., Lewith, G., & Visconte, D. (2011). Chinese herbal medicines for hypercholesterolemia. Cochrane Database of Systematic Reviews(7).
Lo, W.-C., Ku, C.-C., Chiou, S.-T., Chan, C.-C., Chen, C. L., Lai, M.-S., & Lin, H.-H. (2017). Adult mortality of diseases and injuries attributable to selected metabolic, lifestyle, environmental, and infectious risk factors in Taiwan: a comparative risk assessment. Population Health Metrics, 15(1), 17. doi:10.1186/s12963-017-0134-4
MacLennan, A. H., Myers, S. P., & Taylor, A. W. (2006). The continuing use of complementary and alternative medicine in South Australia: costs and beliefs in 2004. Medical Journal of Australia, 184(1), 27-31.
Mechanic, D., & Volkart, E. H. (1961). Stress, Illness Behavior, and the Sick Role. American Sociological Review, 26(1), 51-58. doi:10.2307/2090512
Rosenstock, I. M. (1974). Historical Origins of the Health Belief Model. Health Education Monographs, 2(4), 328-335. doi:10.1177/109019817400200403
Shih, C. C., Lin, J. G., Liao, C. C., & Su, Y. C. (2009). The utilization of traditional Chinese medicine and associated factors in Taiwan in 2002. Chinese Medical Journal (Engl), 122(13), 1544-1548.
Suchman, E. A. (1965). Stages of Illness and Medical Care. Journal of Health and Human Behavior, 6(3), 114-128. doi:10.2307/2948694
Tong, X. L., Dong, L., Chen, L., & Zhen, Z. (2012). Treatment of diabetes using traditional Chinese medicine: past, present and future. American Journal of Chinese Medicine, 40(5), 877-886. doi:10.1142/s0192415x12500656
Tsai, M. C., Kuo, Y. H., Muo, C. H., Chou, L. W., & Lu, C. Y. (2019). Characteristics of Traditional Chinese Medicine Use for Carpal Tunnel Syndrome. International Journal of Environmental Research and Public Health, 16(21). doi:10.3390/ijerph16214086
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., DePalma, S.M., Gidding, S.J., Kenneth, A., & Jones, D. W. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248.
Xiong, X., Yang, X., Li, X., Yue, G., Xing, Y., & Cho, W. C. (2019). Efficacy and safety of Chinese herbal medicine for patients with postmenopausal hypertension: A systematic review and meta-analysis. Pharmacol Res, 141, 481-500. doi:10.1016/j.phrs.2019.01.018
Xiong, X., Yang, X., Liu, Y., Zhang, Y., Wang, P., & Wang, J. (2013). Chinese herbal formulas for treating hypertension in traditional Chinese medicine: perspective of modern science. Hypertension Research, 36(7), 570-579. doi:10.1038/hr.2013.18
Yang, S. T., Lin, Y. R., Wu, M. Y., Chiang, J. H., Yang, P. S., Hsia, T. C., & Yen, H. R. (2018). Utilization of Chinese medicine for respiratory discomforts by patients with a medical history of tuberculosis in Taiwan. BMC Complementary and Alternative Medicine, 18(1), 313. doi:10.1186/s12906-018-2377-4