身心障礙者在某特殊需求者口腔照護中心之就醫狀況及照護者的滿意度調查

目的：調查某醫院特殊需求者口腔照護中心，身心障礙者的就醫狀況(交通、門診需求)與最主要照護者對此中心的滿意度調查。研究方法：研究對象為身心障礙者與最主要照護者，採門診方便取樣，有效樣本共325份，為橫斷面研究，針對研究對象與就醫狀況進行卡方分析，照護者人口學變項與醫院滿意度因素進行ANOVA分析。研究結果：照護與陪伴就醫以父母居多，患者年齡19~44歲佔73.8%，障礙類別以多重障礙46.5%佔最多，合併類別以智能障礙佔84.8%，障礙等級極重度24.3%、重度佔34.8%、中度33.2%、輕度7.7%最少。交通工具以醫院巡迴車22.5%、公車21.8%，30分鐘可到達46.5%，30分鐘 ~ 1小時佔44.9%，認為前往就醫交通工具與搭乘困難者佔27.7%。回診間隔1~2個月以上佔54.5%，87.7%的照護者希望增開門診時間及診次， 85.2%需要醫院提醒回診。身心障礙者安撫下可治療佔34.5%；肢體抑制佔28.4%；能完全合作者佔22.1%；有做全身麻醉佔14.5%。52%照護者希望以行為誘導方式進行口腔治療，41.5%可接受肢體抑制下的牙科醫療行為，只有4%的照護者可接受全身麻醉。障礙等級與口腔預防項目沒有顯著性差異，有定期洗牙者佔68.6%，三個月/次佔32.6%，六個月/次佔36%；有定期塗氟佔72.8%，三個月/次佔31.7%，六個月/次佔41.1%。門診滿意度(設備環境、方便性、牙醫師、口腔衛生人員)與照護者、年齡、職業，有顯著性差異(P＜0.001)，性別與學歷並無顯著性差異。整體滿意評分以機構照護者最高平均93.0分，父母82.63分，家屬81.79分。佔94.8%照護者認為需要設置此特殊需求者口腔照護中心。結論：本研究調查的樣本數中，三成的照護者認為交通問題的選擇及搭乘有困難。大多數需要醫院定期提醒回診就醫與增加門診時間。大部分患者不需要全身麻醉，且照護者對於全身麻醉的接受度很低。並研究發現，到此中心大多數是中度以上的患者，都能定期回診達到例行性的口腔預防照護，故擁有定點與可集中身心障礙者牙科門診，對不同患者與照護者來說，可達到永久性與便利性的醫療場所。

關鍵字

特殊需求者口腔照護中心；特殊需求者；滿意度

並列摘要

Objectives: This study investigated the medical conditions of people with disabilities (the traffic and the demand for outpatient services) and the satisfaction of the main caregivers in a disabled patient oral health care center. Methods: The research subjects were the people with disabilities and their main caregivers. This study was based on convenience sampling and the valid samples included 325 questionnaires. Moreover, this research was a cross-sectional study, which conducted the χ2 analysis to the research subjects and the medical conditions and proceeded ANOVA tests to the demographics and the satisfaction of the main caregivers. Results: Among the caregivers, “parents” accounted for the most part. Among the patients, those aged 19-44 years old accounted for 73.8%. For type of disability, multi-disabled patients were the most (46.5%) and for the combined disabled types, the retarded-disable accounted for 84.8%. For the disabled scales, the extremely disabled, the severely disabled, the moderately disabled, and the slightly disabled were 24.3%, 34.8%, 33.2%, and 7.7%, respectively. For the transportation vehicles, taking the hospital bus was 22.5%, taking the bus was 21.8%. The commuting time within 30 minutes was for 46.5% and the commuting time between 30 minutes to 1 hour was for 44.9%. There were 27.7% of the participants who thought it was difficult to commute. The period of recall beyond 1-2 months was the most (54.5%). About 87.7% of the participants hoped that the center could increase the period and the number of outpatient services. And there were 85.2% of the participants who needed a reminder from the hospital to return. There were 35.5% or 28.4% of disabled people could be treated after they were pacified or body-constrained .Those who completely cooperated were 22.1%. Those having a general anesthetic were 14.5%. Among all the participants, 52% of the wished to receive oral treatment under behavior processing, 41.5% will accept body - constraint and only 4% would accept a general anesthetic. There was no significant difference between the disabled scales and the oral preventive items. Cleaning the teeth routinely, cleaning every three months, and cleaning every six months were for 68.6%, 32.6%, and 36%, respectively. Applying fluoride routinely, applying every three months, and applying every six months were for 72.8%, 31.7%, and 41.1%, respectively. There were significant differences among the satisfaction of outpatient services ( including the devices and the surroundings, convenience, the dentists, and the oral hygiene personnel ), caregivers, ages, and occupations (p<0.001), while there was no significant difference between sex and educational level. The highest in overall scores was the institutional caregivers, whose average was 93.0 ; in addition, the parents got 82.63 , and the family members got 81.79 . And there were around 94.8% of the candidates who had the need for this center. Conclusions: In this study, one third of caregivers thought that it was difficult for their commute. Most of the participants needed to be reminded from the hospital to return and increase the period and the number of outpatient services. Most of the participants did not need to accept a general anesthetic and caregivers had a low acceptance for a general anesthetic. The results revealed that most patients going to this center were beyond the moderately disabled, and they all returned routinely for oral preventive care. For those various patients and caregivers, the dental clinics with fixed location and services for the disabled are the ideal permanent and convenient medical places.