家庭醫學門診常見診斷之比較

A Comparative Study of Common Diagnoses in the Ambulatory Care

陳慶餘(Ching-Yu Chen) ； 郭斐然(Fei-Ran Guo)

《The Kaohsiung Journal of Medical Sciences》 11卷3期 (1995/03) Pp. 170-180

https://doi.org/10.6452/KJMS.199503.0170

摘要

門診醫療診斷分佈的研究對了解病人疾病型態、就醫習慣、疾病流行、醫師工作內容有很大的幫助，為醫師教育訓練重要的參考資。本研究調查台大醫院家庭醫學部門診及社區疾病診斷之分佈，並選擇文獻所發表國內三所教學醫院及國外三個大型研究之結果為比較對象“臺大醫院家庭醫學部自民國79年11月1日至82年10月31日，門診共143 , 123人次，211 , 962了國診斷魷診數。社區門診以石碇鄉為代表，石碇鄉群體醫療中心自民國81年11月1日至82年10月31日門診18 , 711人次，34 , 018了個診斷就診數。以Schneeweiss 和Rosenblatt發展之diagnosis cluster重新編碼，並加入國人常見的病毒性肝炎、結核病、脂肪代謝異常等三個新代碼。結果顯示國內外屬於內科常見疾病的差異性不大，台大及社區門診的病人便能涵蓋犬部分的範圍，但是其他專科疾病國外的法層醫師接觸的比國內多，合J 如急性拉傷、骨折脫臼、產前產後檢查、鼻竇炎、中耳炎、陰道子宮頸炎等，顯示國內外病人就診的習慣不同。台大社區門診的病人偏向高年齡層，與醫學中心的診斷差異可能來自年齡的關係，但是外傷、皮膚炎／濕疹、結膜／角膜炎等病人較國內醫學中心多，接近國外基層醫療的趨勢，顯示其教育訓練的價值。
今後改進之道應增加社區醫學訓練場所並加強各專科常見疾病的訓練，同時導正民眾就醫習慣，呼籲政府推動分級醫療，以利家庭醫學制度在國內生根。

並列摘要

The study compared common diagnoses obtained from two ambulatory teaching sites from the department of Family Medicine with the corresponding data of three domestic teaching hospitals and three foreign large scale studies, derived from a literature review. We collected a total of 143,123 patients with 211,962 clinical diagnoses at the OPD, covering a period from Nov. 1, 1990 to Oct. 31, 1993 and 18,711 patients with 34,018 clinical diagnoses at the Shue-Ting group practice center, one of our community teaching centers, over the period from Nov. 1, 1992 to Oct. 31, 1993. The diagnosis cluster method developed by Schneeweiss and Rosenblatt was modified by adding three new clusters of diseases common in Taiwan, i.e. viral hepatitis/carrier/liver cirrhosis, tuberculosis and lipid metabolism disorders. The results revealed there was little difference between countries for the diseases belonging to internal medicine, but more patients with problems of

other specialties visited primary care doctors in the United States, such as acute strain and sprain, dislocation and fracture, prenatal and postnatal care, sinusitis, otitis inedia, vaginitis and cervicitis. Although the training of family doctors in Taiwan covers a broad spectrum of diseases in primary care, this obvious internal medicine oriented practice was due to a particular style of help-seeking behavior of people. The study also showed several minor diseases seen in the community were not present in the teaching hospitals, e.g. laceration, dermatitis, eczema, conjunctivitis.
In conclusion, to improve family physician training, it is necessary to increase teaching sites in the community to make physicians familiar with first contact care of different disciplinary problems. In addition it is also important to promote the family physician system by providing health education to change people¡¦s behavior and to strengthen primary care.

並列關鍵字

family practice ； clinical diagnosis