宜蘭縣三星鄕綜合地段健康管理成果評估

Evaluation of Integrated Health Care in the Rural Township of San-Shing, Ilan County

季瑋珠(Wei-Chu Chie) ； 張淑芬(Shu-Fen Chang) ； 張美惠(Mei-Huei Chang) ； 簡大任(Ta-Ren Chien) ； 周金章(Chin-Chang Chou)

《中華民國公共衛生學會雜誌》 10卷1期 (1990/03) Pp. 53-65

https://doi.org/10.6288/JNPHARC1990-10-01-07

摘要

為了在偏遠地區藉由基層醫療保健達成「公元2000年全民健康」的理想，宜蘭縣三星鄉衛生所根據試辦有成之「基層保健服務中心」模式，在全鄉推行「綜合地段健康管理」。自1987年3月至次年2月，為期一年。主要的結果為：人口外流嚴重，但扣除空戶後，孕產婦、嬰幼兒，和慢性病防治三項服務的篩檢涵蓋率各占目標人口的89.9%，100%與46.6%，三項服務的收案率，則分別為孕產婦70.6%，嬰幼兒55.9%，慢性病51.8%。在對孕產婦及慢性病的個案健康管理方面，分別以McNemar氏卡方檢定，比較各項管理項目在管理前後的差異，一般而言，大部分的健康管理都有顯著效果，而孕產婦健康管理對個案學得新知及採取新行為的效果較佳。孕產婦及慢性為個案均有一些項目，如「擬餵母奶」、「生產地點選擇」、「少菸酒實行」等大部分個案在管理前已有正確的認知及行為，亦有一些項目，如「按時就診」、「接待服藥」等，有較多個案管理前從均沒有得到正確的認知及行為，本研究肯定了此一模式對社區及高危險群的貢獻，也提供了日後修訂個案健康管理內容之建議。本文亦討論了研究的限制和政策上的涵義。

並列摘要

In order to achieve the goal of ”health for all by the year 2000”, in the area of primary health care, the Health Station of San-Shing Rural Township, Ban County, carried out a comprehensive district health care project based on the ”primary health care center model”. After a previously successful trial, the project was carried out, using public health nurses to provide high risk screening and personal health care services from March 1987 to February 1988. After adjusting for Ban County's serious emigration problem, the main achievements were a coverage rate for high risk screening of maternal health, infant health, and chronic disease control of 89.9%, 100% and 46.6%, respectively. The follow-up rates for eligible high risk cases of these three services were 70.6%, 55.9% and 51.85%, respectively. McNemar's Chi-square test was used to determine whether or not the personal health care of high risk cases had improved after educational efforts by health care providers. In general, most of the educational items demonstrated significant improvement, with those items dealing with maternal health care showing even better results. For some of the maternal health care items, such as ”planning to breast feed”, ”choice of place of delivery”, and ”reduced smoking and alcohol consumption”, many of the subjects had acquired correct information and were following it even before receiving educational and personal health care services. However, for other items, such as compliance in chronic disease patients, many of the cases did not have correct information, nor were complying with it either before or after educational efforts and personal health care services. This study further supports the effectiveness and contribution of the ”primary health care center model”, and provides suggestions on the content of personal health care for high risk cases.

並列關鍵字

Delivery of Health Care ； Maternal and Child Health ； Chronic Disease