探討臺灣地區廣泛性發展障礙患者醫療利用現況及其影響因素

The Determinants of Medical Utilization for Patients With Pervasive Developmental Disorders in Taiwan

李偲瑋(Szu-Wei Lee)

指導教授 ： 張秀如

臺北醫學大學/護理學院/護理學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00147

摘要

廣泛性發展障礙(Pervasive Developmental Disorder；PDD)為跨越一生的多重障礙疾病，發生共病之比率極高，國內罹病患者逐年遞增，使得家人與患者在醫療資源利用上有很大的需求與困難。近年來有關廣泛性發展障礙的研究越來越多，但是針對患者於醫療利用之研究仍甚少，且缺乏針對青春期以上患者及不同共病類型的探討，故本研究目的為探討臺灣地區廣泛性發展障礙患者，其醫療利用情形，並分析不同年齡層及不同共病類型在醫療利用上的情形，以瞭解廣泛性發展障礙患者在醫療利用的現況及影響因素。
本研究使用全民健康保險研究資料庫，自2006至2010年的門診檔(Ambulatory care expenditures by visits；CD)與住院檔(Inpatient expenditures by admissions；DD)，選取診斷碼為廣泛性發展障礙者，以描述性及推論性統計進行分析，使用負二項式迴歸(Negative binomial regression)探討門診與住院醫療利用之影響因素，及共變數分析(ANCOVA)探討不同共病類型在門診與住院的醫療利用之差異情形。
研究結果發現2006至2010年廣泛性發展障礙患者，在門診部分，就醫次數以學齡前期(每年平均11.3次)為最多，就醫科別以復健科(50.6%)為最多；在住院部分，住院次數以壯年期(每年平均2.9次)為最多，急性住院天數以壯年期(每年平均41.0天)為最多，慢性住院天數以學齡前期(每年平均296.6天)為最多，住院科別以精神科(69.1%)為最多。在不同共病類型部分，無論男性或女性，主診斷為PDD且有共病者，在門診就醫次數、住院次數、急性住院天數、慢性住院天數上，皆顯著高於次診斷為PDD之患者。
門診就醫次數之影響因素包含性別、年齡、共病類型、部分負擔、都市化程度、重大傷病卡、醫院型態、評鑑特約類別。住院次數之影響因素包含年齡、部分負擔、重大傷病卡。急性住院天數之影響因素包含性別、年齡、共病類型、部分負擔、都市化程度、重大傷病卡、醫院型態、評鑑特約類別。慢性住院天數之影響因素包含年齡、部分負擔、都市化程度、評鑑特約類別。
本研究結果可提供相關醫療單位照護廣泛性發展障礙患者之重要參考，例如考量患者年齡層與共病類型，規劃適合的醫療資源，並對相關
醫事人員規劃及進行在職教育訓練，促使廣泛性發展障礙患者與家人獲
得更合適的醫療資源利用。

關鍵字

廣泛性發展障礙、共病、全民健保、醫療利用

並列摘要

Pervasive Developmental Disorders (PDD) refers to a lifelong multiple disorders with an extremely high rates of comorbidity. The number of patients increases in Taiwan on a yearly basis, whereas the family and patients are encountering a high demand and difficulties in terms of medical resource use. The study aims to discuss the situations of medical utilization for patients with PDD in Taiwan in addition to analyzing the patients in different ages and the various types of comorbidity in terms of medical utilization, thereby to understand the current situations and influence factors of patients with PDD.
The study adopted data of outpatients data files (CD) and inpatient data files (DD) from the National Health Insurance Research Database between 2006 and 2010. The diagnostic codes identified as PDD were selected for data analysis. The Negative binomial regression was applied to explore the determinants of outpatient and inpatient medical utilization while the ANCOVA was applied to examine the differences of the outpatient and inpatient medical utilization among different types of comorbidity.
Results showed that the majority number of medical visits to outpatient is the preschool age while the most number of medical visits fall on the rehabilitation division. With respect to inpatient medical utilization, the number of hospitalization mostly falls on the adult of year. The most number of days for acute and chronic hospitalized patients falls on adult age and preschool age, respectively. Psychiatry accounts for the majority in the inpatient divisions. In terms of different types of comorbidy, the patients with primary diagnosis in PDD with comorbidity show higher number of outpatient medical visits, hospitalization, days for acute and chronic hospitalization, than patients with secondary diagnosis of PDD.
The determinants for the number of outpatient medical visits include gender, age, types of comorbidity, partial burden, degree of urbanization, catastrophic illness card, hospital patterns, and categories of special contract for evaluation. The determinants for the number of hospitalization include age, partial burden and catastrophic illness card. The determinants for the number of days for acute hospitalization include gender, age, types of comorbidity, some burden, degrees of urbanization, catastrophic illness card, hospital patterns, and categories of special contract for evaluation. The determinants for the number of days for chronic hospitalization include age, some burden, degrees of urbanization, and categories of special contracts for evaluation.
The study results can be provided as important reference for relevant medical units in terms of care for patients with PDD.

並列關鍵字

Pervasive Developmental Disorders (PDD), Comorbidity, National Health Insurance, Medical Utilization

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