口腔疾病及其他疾病就醫行為差異之分析-以屏東縣山地離島地區整合式篩檢為例

Investigating the Difference between Dental and Medical Visits among Remote Communities-an Example of Integrated Screening in Ping-Tung County

盧惠美(Hui-Mei Lu)

指導教授 ： 楊奕馨 ； 何佩珊

高雄醫學大學/口腔醫學院/口腔衛生科學研究所碩士在職專班/碩士(2006年)

https://doi.org/10.6832/KMU.2006.00144

摘要

中文摘要
研究背景：
綜觀國內健康狀況之統計報告發現，原住民健康狀況大多不如漢民族。而健康的維護與提升有賴於平日的保健工作及正確的就醫行為；但一般人的就醫態度往往受疾病類型所影響，對一些不會立即引起身體不適或危及生命的疾病，往往容易忽略而延遲就醫(如口腔疾病)，影響治療成效。緣此，本研究乃著重於探討原住民就醫行為的影響因素，希作為日後執行健康照護的參考依據。
研究目的：
了解原住民在不同疾病之就醫行為狀況及其影響因素。
研究方法：
本研究對象為參加屏東縣94年山地離島整合式篩檢的民眾，有效問卷共2029件，篩檢地區包括4個山地鄉（原住民）及1個離島地區（漢民族）。研究問卷設計，主要收集居民的基本資料及就醫行為。就問卷與健康檢查（一般疾病及口腔疾病篩檢）之資料進行交叉分析，以了解當地居民對疾病自知情形、控制情形及就醫的影響因素；採JMP 5.12版進行資料分析。
研究結果：
疾病自知率：高血壓（48.5%）、糖尿病（21.8%）高於其他樣本疾病（0.2~5.2%）。疾病控制率：口腔黏膜病變（2人佔66.0%）及牙周病（28人佔51.9%）高於其他樣本疾病；但基於個案數太少，恐有假性偏高的疑慮。就醫率：一般慢性病(糖尿病86.6%、高血壓84.3%、高血脂78.7%)高於口腔疾病(牙周病52.9%、口腔黏膜病變50.0%)。值得注意地，糖尿病與高血脂的就醫率都在78%以上而控制率卻16.7%以下。
口腔疾病患者求醫間隔時間約3至6個月，醫療資源的利用以鄰近鄉鎮之診所居多。而一般慢性病患者求醫間隔時間約1星期至1個月，且醫療資源的利用以鄉內衛生所為主。
就人口學因素對就醫行為的影響而言，牙周病患者就醫行為受教育程度及族別的影響，糖尿病受教育程度及年齡的影響，而痛風受性別及年齡的影響。
研究結論：
本次研究地區居民在口腔疾病及一般慢性病的自知率、控制率普遍很低；而就醫率方面，口腔疾病比一般慢性病低。導致口腔疾病自知率、就醫率偏低的主要原因，包括：牙科醫療資源匱乏、牙科醫療服務方式缺乏彈性、居民對口腔疾病的認知度偏低及就醫行為態度偏差。在一般慢性病（糖尿病、高血壓、高血脂）之就醫頻率上，原住民顯著高於漢民族；而就醫頻率偏高的主要原因之一乃為疾病控制不好，需有較頻繁的門診醫療照護。
醫療資源的可近性、疾病的類型、人口學的特性及疾病的認知
度，皆影響民眾就醫行為甚鉅，故提供醫療照護或制訂相關醫療政策時，應多方考量當地醫療資源及族群的特殊性，方能落實醫療照護業務的推動，有效改善居民健康。

關鍵字：口腔疾病、一般慢性病、自知率、就醫率、控制率

關鍵字

口腔疾病 ； 一般慢性病 ； 自知率 ； 就醫率 ； 控制率

並列摘要

Abstract

Background:
According to government statistics, the health status of the Taiwanese aborigines is generally worse than that of Han people in Taiwan. Maintaining and improving health rely on health care as well as appropriate seeking medical care behavior. However, patients tend to have different attitude toward different types of diseases. People tend to ignore or delay seeking medical advices for diseases that do not cause immediate discomfort or pose an immediate threat to life, such as oral diseases, and thus hamper the therapeutic effect of the treatment. Therefore, this study focused on factors that influence medical care-seeking behaviors of Taiwanese aborigines, and to serve as future reference for health care.

Objectives:

This study investigated people’s different attitudes toward medical care-seeking behaviors of the Taiwanese aborigines.

Methods:

The participants of this study are those who took part in the Community-based Integrated Screening Project for mountain areas and remote islands of the Pingtong County in 2005. A total of 2029 questionnaires were collected from four mountain areas (aboriginal communities) and one remote island (a Han community) where the screening project was carried out. The research questionnaire was designed to gather basic information as well as information concerning medical care-seeking behaviors of the participants. The study conducted a statistical analysis to examine data collected through the questionnaires and the physical examination reports (screening for diseases and oral diseases ) in order to explore factors influencing disease awareness, disease control rate and medical care-seeking behaviors of the participants. JMP 5.12 was utilized for data analysis.

Results:
The participants have higher disease awareness for hypertension (48.5%) and diabetes (21.8%) than for other sample diseases (0.2~5.2%). The control rates for oral mucosal diseases (66.0%) and periodontal disease 51.9%) are higher than other diseases. However, it must be pointed out that not enough cases in this analysis may lead to spuriously high values.
The participants show higher visit rate when suffering from general chronic diseases (diabetes 86.6%, hypertension 84.3%, hyper lipemia 78.7%) than from oral diseases (periodontal disease 52.9%, oral mucous membrane diseases 50.0%) Notably, while the medical visiting rates for diabetes and hyper lipemia are above 78%, the disease control rate for both is 16.7%.
The oral disease patients in this study visited clinics with time interval of 3 to 6 months, and mostly utilized medical resource of clinics in the nearest towns or counties. Whereas general chronic patients made medical visits with one week to one month time interval, and most frequently visited local health stations.
In terms of demographic influence, medical care-seeking behaviors for periodontal disease sufferers differ by education and race, diabetes sufferers by education and age, and gout sufferers by sex and age.

Conclusion:
The study found that oral disease and general chronic disease sufferers among the participants from the communities showed low disease awareness and control rates. In addition, oral disease patients made fewer clinic visits than general chronic disease sufferers did. Primary reasons for low awareness and clinic visits for oral disease patients are as follows: lack of medical resources for dental treatment, lack of flexibility in dental service, lack of knowledge on oral diseases and incorrect medical care-seeking behaviors. Also, the aborigines suffering from general chronic diseases (diabetes, hypertension, and hyper lipemia) tend to make more frequent clinic visits than the Han people do. But, the frequent clinic visits by the aborigines is the result of poor control of the diseases.
Close proximity of medical resource, types of diseases, demographic features, and knowledge of diseases are all important factors on medical care-seeking behaviors. When providing medical care or formulating medical policies in the future, it is advised to take into consideration of availability of local medical resource and characteristics of the community so as to carry out proper medical care and improve health status for all.

Keywords: oral disease, general chronic disease, disease awareness, clinic visit rate, disease control rate

並列關鍵字

oral disease ； general chronic disease ； disease awareness ； clinic visit rate ； disease control rate

參考文獻

參考文獻

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