比較有無整合醫療第四階給付之居家氧氣治療現況（初步研究）

長期持續氧氣治療應用於慢性阻塞性肺部疾病(Chronic Pulmonary Obstructive Disease)患者合併嚴重低血氧(severe hypoxemia)症已是臨床準則，於休息或活動時間歇使用氧氣亦已證明具生理成效並能改善生活品質。目前歐美國家皆有政府補助居家氧氣治療(oxygen therapy)，然而國內仍未有關於居家氧氣病患使用現況及有無健保整合照護制度(Fourth-stage of Integrate delivery system)第四階之差異比較。故此問卷是調查北區台灣居家氧氣病患基本特質、呼吸照護及器材使用現況、對醫療人員及維修服務看法、最近一年內再入院次數，並比較上述項目有無健保整合照護制度第四階之差異。此研究是針對台灣北區居家氧氣治療病人作橫斷式調查，有效問卷共136份，第四階個案63名，非第四階個案73名。我們發現兩組呼吸道疾病(Airway disease)比例皆佔最高，第四階36人(57.1%)，非第四階50人(68.5%)，其次爲心血管疾病(Cardiovascular disease)，疾病分類呈顯著差異。第四階皆用呼吸器而非第四階僅佔32.9%，非侵入型呼吸器佔最多有36人(61.9%)而非第四階僅20人(27.4%)，呼吸器有顯著差異。兩組氣源設備有顯著差異，第四階全部病人皆單獨或合併使用製氧機，非第四階65位(89.1%)；第四階無個案單獨使用液態氧，而非第四階8位病人(10.9%)。第四階因有健保給付，該組醫療人員及儀器維修服務顯著較佳，氧氣治療期間較長且最近一年內再入院次數較高。本研究發現第四階皆有呼吸器且居家治療期間亦較長，兩組疾病種類亦有差異，所以最近一年內再入院次數較高。然而健保第四階給付確實有利於醫療人員及儀器維修服務。所以我們建議健保制度能規劃呼吸治療師(Respiratory Therapist)早期介入所有居家氧氣治療病患照護，以能改善照護品質並有效利用氧氣設備。

關鍵字

健保整合照護制度第四階；製氧機；液態氧；長期氧氣治療；居家氧氣治療

並列摘要

The application of long-term oxygen therapy in patients with chronic pulmonary obstructive disease with severe hypoxemia has been the standard clinical practice. Moreover, the intermittent use of oxygen during resting or active hours has been proven physiologically effective and to be able to improve the quality of life. Currently, governments in Europe and America subsidize the home-care oxygen therapy; however, there is still no comparison of the current use of home-care oxygen therapy in patients and the fourth-stage integrated health insurance care system in our country. Therefore, the present questionnaire was aimed to investigate the basic characteristics of the home oxygen therapy patients in northern Taiwan, the current uses of respiratory care and devices, the opinions on respiratory therapist and repair service, the re-hospitalization frequency within one year, and the comparison of the above and their incorporation into the fourth-stage integrated health insurance system. The present case is a research on home-care oxygen therapy patients in northern Taiwan using cross-section survey. There were 136 questionnaires, 63 fourth-stage cases, and 73 non-fourth-stage cases. We found that 2 groups with airway disease represented the highest percentages with 36 fourth-stage patients (57.1%) and 50 non-fourth-stage patients (68.5%), followed by the cardiovascular disease patients. The disease categories were found to show significant difference. Among the fourth-stage patients using respiratory devices, 32.9% of the patients were non-forth-stage. 36 patients used non-invasive ventilator, representing the highest percentage (61.9%). Only 20 patients (27.4%) were non-fourth-stage. There were significant difference in the ventilator utilization. There were significant difference in the two gas source devices. All fourth-stage patients used the oxygen concentrator alone or in combination. There were 65 non-fourth-stage patients (89%). There was no fourth-stage case using liquid oxygen alone while 8 non-fourth-stage patients did (11%). As the fourth-stage is covered under the health insurance, the respiratory therapist and device repair service were found to be significantly better, with a longer oxygen therapy duration and a higher re-hospitalization frequency within one year. We found that the fourth-stage patients all had ventilator with longer home oxygen therapy duration. The disease characteristics of the 2 groups were also significantly different. As a result, the re-hospitalization frequency within one year was higher. However, the health care coverage of the fourth-stage indeed benefited the respiratory therapist and device repair service. Therefore, we suggested the health insurance system could allow the arrangement of the respiratory therapist to be involved in all home-care oxygen therapy for the patients in the early stage in order to improve the healthcare quality and effectively utilize the oxygen device.

並列關鍵字

Fourth-stage of Integrated delivery health insurance system ； concentrator ； liquid oxygen ； long-term oxygen therapy ； home oxygen therapy

國際替代計量

比較有無整合醫療第四階給付之居家氧氣治療現況（初步研究）

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