Observational research on medical treatment of chronic respiratory disease patients using the receipt database

Research Project

Project/Area Number	16K09188
Research Category	Grant-in-Aid for Scientific Research (C)
Allocation Type	Multi-year Fund
Section	一般
Research Field	Medical and hospital managemen
Research Institution	Nippon Medical School
Principal Investigator	Motegi Takashi 日本医科大学, 医学部, 講師 (30386205)
Research Collaborator	KIDA kozui TSURU satoko NAKAYAMA takeo
Project Period (FY)	2016-04-01 – 2019-03-31
Project Status	Completed (Fiscal Year 2018)
Budget Amount *help	¥2,990,000 (Direct Cost: ¥2,300,000、Indirect Cost: ¥690,000) Fiscal Year 2018: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000) Fiscal Year 2017: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000) Fiscal Year 2016: ¥780,000 (Direct Cost: ¥600,000、Indirect Cost: ¥180,000)
Keywords	COPD / レセプト / 医療の質 / 増悪 / 併存症 / 生活習慣 / 慢性閉塞性肺疾患 / 健康診断 / 身体活動性 / 性差 / 社会医学 / 慢性呼吸器疾患
Outline of Final Research Achievements	In order to understand the actual condition of medical care for chronic obstructive pulmonary disease (COPD), we used a database of receipts and medical examinations managed by JMDC.(1) In the medical condition survey at COPD exacerbation, 35.4% received systemic steroids, and steroids using were significantly less in the clinic than in the hospital.The median period of steroid administration was 5 days, shorter than the conventional guideline recommendation period. (2) Co-morbidity survey in patients of COPD; 1505 COPD pts, 4515 controls.In male patients of COPD, the frequency of coexistence with ischemic heart disease was significantly higher than control, but in female patients, this tendency was not observed. Gender differences were found in the frequency of co-morbidities. Concerning lifestyle habits, males showed significantly lower physical activity than the control group, but females showed significant weight gain after adulthood than control.
Academic Significance and Societal Importance of the Research Achievements	慢性閉塞性肺疾患（COPD）は呼吸器領域における生活習慣病の一つで，主に喫煙が関連している．大半がプライマリケアで診療されているが，国内COPD研究の大半は病院が主体であり，COPD全体の診療実態を反映しているとは言い難い．他方，レセプトデータベースを用いた研究では実際に行われた診療が医療機関や外来・入院を問わず全て記録されるため，個々の患者における診療実態が反映される可能性がある．本研究はレセプトを用いたCOPDの診療実態調査であり，よりリアルワールドの診療を捉えることができる点で従来研究と異なる．ガイドラインで推奨されている診療がプライマリケアではまだ不十分であることが明らかとなった．