| 摘要: | 中文摘要
研究背景與目的：
近來，精神疾病患者有日漸增加的趨勢，而國內外文獻指出精神疾病患者有可能是高度急診醫療利用族群，因此本研究乃欲針對台灣精神疾病患者進行急診醫療利用分析。
研究方法：
本研究以回溯性研究採用Aday and Andersen之醫療服務利用行為模式為主要研究架構，使用全民健康保險資料庫2002-2007精神疾病住院病患歸人檔，共得到95,435筆研究對象，並使用描述性統計、Student t-test、單因子變異數分析、邏輯斯迴歸、複迴歸進行精神疾病住院病患急診醫療利用分析。
研究結果：
本研究精神疾病住院病患之急診醫療利用比率為16.11%，平均每人每年急診醫療次數為0.43次，急診醫療費用為1,184.50元。女性、年齡為20歲以下者、投保身份為雇主者、投保金額為17,281元-36,300元與72,801元-131,700元者、每萬人口急診醫師數為0.30名以下者、每萬人口精神科醫師數0.31-0.61名以上，利用急診醫療服務的機率較高。此外，女性、年齡為31-50歲者、投保金額為17,280以下者、每萬人口精神科醫師數0.31-0.61名以上、免部分負擔者、有慢性疾病者，高度利用急診醫療服務的機率較高。在醫療費用方面，男性、年齡為31-61歲以上者、投保金額為17,280元以下者、每萬人口急診醫師數為0.30名以下者、每萬人口精神科醫師數0.61名以上、免部分負擔者、有慢性疾病者之急診醫療費用較高。
研究結論與建議：衛生主管機關應以多元方式加強宣導精神疾病患者及家屬急診使用時機、推廣家庭醫師制，醫護人員應告知其家屬或病患急診就診後如何自行照護與持續觀察，醫療機構應加快將病患轉至門診或住院治療、並建立急門診，使不危急的病患移至急門診就診，後續可搭配社區醫療做整合性的照護。
關鍵詞：精神疾病、急診、醫療服務利用、醫療次數、醫療費用、全民健康保險
Abstract
Background and Purpose
Recently, the numbers of psychiatric patients have grown increasingly. Many researches indicated that psychiatric patients might be frequent emergency department users; therefore, the purpose of this study was to analyze the utilization of emergency department by psychiatric patients.
Methodology
This study adopted the retrospective study design and also used Aday and Andersen’s health behavior model as a main research structure. 95,435 samples were collected from psychiatric inpatient medical claim dataset of National Health Insurance Research Database from 2002 to 2007. Descriptive statistics, student t-test, one-way ANOVA, logistic regression, and multiple regression were used to analyze the utilization of emergency department by psychiatric patients.
Results
In this study, 16.11% of all samples have utilized emergency department. The average number of emergency department visits was 0.43 and average expenditure of emergency department services was NTD 1,184.5 per person per year. The likelihood of using the emergency medical services would be higher when the samples were women under 20 years old, insurance status as employers, the premium-based monthly salary of NTD17,281- NTD36,300 and NTD72,801 - NTD131,700 per person, the number of emergency physicians per 10,000 population was under 0.30, the number of psychiatry physician per 10,000 population was 0.31-0.61 or more. In addition, there would be higher likelihood of intensive using the emergency medical services when the samples were 31-50 year-old women, the premium-based monthly salary of NTD$17,280 or less, the number of psychiatrists per million population was more than 0.31-0.61, non co-payment policy, with chronic diseases. In medical expenses, there would be higher emergency medical costs when the samples were men aged 31-61, the premium-based monthly salary of NTD17,280 or less, the number of emergency physicians per 10,000 population was under 0.30, the number of psychiatrists per 10,000 population was over 0.61, non co-payment policy, with chronic diseases.
Conclusion and Suggestions
Government should take effort to promote the timing of using emergency service and Family Physician System to psychiatric patients and their families by different ways. Medical care personnel should inform psychiatric patients and their families how to take care by themselves after emergency department visits. The medical institutions should transfer the patients to outpatient or inpatient departments as soon as possible and establish emergency clinics so that non-urgent patients could transfer to emergency clinics. In addition hospitals also should accompany with community medical services to develop integrated cares for psychiatric patients.
Keyword: psychiatric patients, emergency department, utilization of medical service, frequency of health care use, expenditure of medical services, National Health Insurance. |
