A Study on the Use of a Community Hospital Emergency Room by Diabetic Patients

糖尿病患在社區醫院急診處的使用情形之分析

傳振宗(Chen-Chung Fu) ； 羅世慧(Su-Huey Lo) ； 陳鴻銘(Hong-Ming Chen) ； 戴東原(Tong-Yuan Tai)

《中華民國公共衛生學會雜誌》 8卷1期 (1988/03) Pp. 1-11

https://doi.org/10.6288/JNPHARC1988-08-01-01

摘要

爲了明瞭糖尿病患在一個社區醫院急診處的使用情形及醫療費用，我們從民國七十五年七月一日至民國七十六年六月三十日，在省立桃園醫院急診處收集了全部糖尿病急診個案的資料，總共有332位，占所有急診個案的1.05形，病患以中老年人居多，平均年齡爲63.6歲，其中34.9%爲七十歲以上老人；所有病患以距離醫院最近且交通方便的桃園市及中壢市居民最多占43.0%。332個病例中，眞急診的比例非常高，占84%，所以臨床醫師在急診處碰到糖尿病患時應該特別留意病人情況。
糖尿病患的急診，除了4.5%屬於外科，其餘皆爲內科；急診問題以新陳代謝、腸胃和泌尿系統的問題最常見、其中低血糖是病患來診最常見的原因，有65.1%是發生在服用口服降糖劑的病人，未來對於病人的衛教應加強這一方面的預防及症狀的認知與處理。在所有病患中，有33.4%由急診轉入病房接受進一步治療，而其平均醫療費用也比只在急診處接受治療的病患高出甚多（83856元比3634元）。來急診的糖尿病患中，有18.7%根本沒有接受藥物治療，即使是接受治療的患者，高達40.1%沒有規則治療，因此醫護人員應努力研究如何提高病患的遵囑性。

並列摘要

In order to find out the frequency and cost of diabetic patients visited the emergency room (ER) of a community hospital, we collected data of Provincial Tao-yuan Hospital from July 1, 1986 through June 30, 1987. There were 332 visits of diabetic patients, which occupied 1.05% of the total ER visits. The mean age of patients was 63.6 years and 34.9% of them were above the age of 70. About 43.0% of diabetics in this study resided in Tao-yuan and Chung-li cities, where the transportation between these two cities and the hospital was very convenient. The true emergency rate was extremely high among diabetic patients (84%), especially in the older age group. It reminded the doctors to pay more attention to the diabetic patients in the ER service. Among the diabetics, except 15 cases (4.5%) of surgical problem, the remaining 317 cases (95.5%) were related with problems of internal medicine. Metabolic, gastrointestinal and urological disorders were the three most important disease categories led diabetic patients to visit ER. Hypoglycemia was the first leading diagnosis of visits and 65.1% of them occurred in the patients treated with oral hypoglycemic agents. Health education in this field including prevention, recognizing symptoms, early detection and management should be strengthened. About 33.4% of patients were admitted to ward for further care and their medical cost was significantly higher than those treated at ER only. Among the diabetics visited ER, 18.7% did not receive any treatment before, and 40.1% of the diabetic patients having treated with oral hypoglycemic agent or insulin did not receive regular follow-up. How to upgrade the compliance of diabetic patients is a challenging issue to all of the medical personnels.

並列關鍵字

diabetes mellitus ； emergency service ； community hospital