全民健保牙髓病科轉診原因之分析研究－以新竹為例

Causes of Endodontic Referral under the National Health Insurance in Hsinchu City, Taiwan

劉季煒(Ji-Uei Liou) ； 杜博仁(Bor-Ren Duh)

《中華牙醫學雜誌（中文版）》 26卷1期 (2007/03) Pp. 61-68

https://doi.org/10.7106/CJD.200703.0061

摘要

自民國八十八年一月起實施牙醫門診總額支付制度專科轉診加成作業。為建立良好之轉診制度使全民健保更趨完善，本研究針對馬偕紀念醫院新竹分院牙髓病科的全民健保牙醫轉診病例共228顆牙齒加以分析，以瞭解一般基層院所醫師對牙髓病科轉診的原因。依據全民健康保險牙醫門診轉診單內容將牙髓病科轉診的原因項目分為:重新治療、根管鈣化、器械斷裂殘留、症狀不消、彎曲根管、穿通牙根管、根尖成形術、手術及其他等做為統計之依據。結果顯示轉診的原因以『根管鈣化』64顆(28.1%)、『症狀不消』50顆(21.9%)以及『重新治療』(21.1%)為最主要之轉診原因。以轉診齒位而言，上顎共115顆中最多的是第一大臼齒40顆(34.8%)；下顎共113顆中較多的是第一大臼齒45顆(39.8%)及第二大臼齒41顆(36.3%)。本研究發現一般臨床醫師對於『根管鈣化』、『重新治療』的處理及診斷能力的不足，希望能提供學術單位教育課程設計安排時之參考，以利牙科醫療品質的提升。

關鍵字

根管治療 ； 轉診原因

並列摘要

The Dental Outpatient Total Payment System was implemented in January 1999 for the purpose of completing a proper referral system for the National Health Insurance. The purpose of this study was to understand the referral factors associated with dental endodontic treatment. The analytical data were from the Department of Dentistry, Hsinchu Mackay Memorial Hospital, Hsinchu, Taiwan. The variables of the statistical analysis included retreatment, canal calcification, blocked instrument, symptoms and signs present, a curved canal, canal perforation, apexification, surgery, and others. The results indicated that more referral cases were for canal calcification (64; 28.1%), symptoms and signs present (50; 21.9%), and retreatment (48; 21.1%). As to the tooth site, the maxillary accounted for 115 teeth, with 40 cases of the first molar (34.8%); while the mandible accounted for 113 teeth, with 45 cases of the first molar (39.8%) and 41 cases of the second molar (36.3%). We found that general practitioners have limited experience in treating cases with canal calcification or retreatment and diagnosis. This information should be noted by educational departments so as to improve the medical quality of dental clinics.

並列關鍵字

endodontic treatment ； referral factor