智能障礙是一種終身的身心障礙,他們的心智障礙導致認知與自我照顧能力的不足,以致於在社會中處於較弱勢的地位,也因先天健康不平等,導致他們帶給家庭、社會及整個醫療體系巨大的負擔。胃食道逆流在臨床上是智能障礙者常見的疾病之一,但其病情卻很常被低估,而誘發此疾病的因素為脊椎側彎、腦性麻痺、服用抗癲癇藥物、或服用苯二氮平類(benzodiazepines)這類鎮靜藥物,胃食道逆流若未接受治療,恐引發嚴重的併發症,如:氣喘、慢性咳嗽、肺纖維化及食道腺癌等。 本研究利用國衛院2004-2007年健保資料庫進行探討人口特性與誘發因素對於罹患食道疾病之風險,進一步來了解智能障礙者合併食道疾病之門診醫療利用趨勢分析。 研究結果顯示,2007年智能障礙者合併食道疾病之1,684人,盛行率為1.6%。障礙程度為極重度者、年齡越高、有重大傷病、有服用抗癲癇或鎮靜劑藥物者合併食道疾病之風險較高;智能障礙合併食道疾病者每年平均總醫療費用為2,767元,就醫次數平均為2.6次。 伴隨人口老化、平均餘命之延長,未來於策劃智能障礙者健康促進照護計畫時應有全方位之考量,建議決策者可針對專業間進行相關教育訓練,且針對高風險的族群主動進行食道疾病之篩檢;照顧者對於食道疾病應有認知之外,更應主動告知醫療單位病患之實際情況,以提升智能障礙者之健康照護品質。
Intellectual disabilities are a type of lifelong disabilities. Patients’ mental handicap will cause the insufficiencies of their cognition and self-care ability, resulting in being in vulnerable position in society. Also, due to the innate health disparity, they bring a huge burden to their families, the society and the entire health care system. Gastroesophageal reflux disease (GERD) is clinically a disease often seen in patients with Intellectual disabilities, but its severity is usually underestimated. Factors inducing the disease include scoliosis, cerebral palsy, and taking anti-epileptic drugs or sedatives like benzodiazepines. If not treated, GERD will probably lead to serious complications, such as asthma, chronic cough, lung fibrosis and esophageal adenocarcinoma. This research used the health insurance database of National Health Research Institutes from 2004 to 2007, to explore the risk of causing esophageal diseases by demographic characteristics and inducement factors, and further analyze the medical utilization trend of the outpatient services for patients with both intellectual disabilities and esophageal diseases. The results indicated that in 2007, there were 1,684 patients with intellectual disabilities having esophageal diseases. The prevalence was 1.6%. Patients with profound intellectual disabilities, older, Catastrophic Illness, and taking anti-epileptic drugs or sedatives had a higher risk of getting esophageal diseases. The average annual medical cost of patients with both intellectual disabilities and esophageal diseases was NT$2,767, and the frequency that each of them went to the doctor was averagely 2.6 times a year. As the population age and life expectancy extends, there should be comprehensive consideration in planning the health promotion care project for patients with intellectual disabilities in the future. We suggest that decision-makers receive educations and trainings for related professions, and conduct esophageal disease screening to high-risk groups; caregivers should have cognition to esophageal diseases, and more importantly, inform medical units of patients’ actual conditions, to promote the health care quality of patients with intellectual disabilities.
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