Analysis of Referral Source, Severity, and Return among the Elderly in Rural Primary Care

鄉村基層醫療之老年人轉診資源、嚴重度、及回診之研究

許文燦(Wen-Chain Hsu) ； 蔡佩玲(Pei-Ling Tsai) ； 李文成(Wen-Cheng Lee) ； 余幸司(Hsin-Su Yu) ； Isaiah Lee

《慈濟醫學雜誌》 10卷2期 (1998/06) Pp. 111-118

https://doi.org/10.6440/TZUCMJ.199806.0111

摘要

由於台灣鄉村老年人口比率的增加以及較複雜的疾病，因而鄉村基層醫療醫師對於年老照顧問題更加關心。本研究之目的是釐清轉診資源主動性及疾病嚴重度之關係並探討年老病人回到鄉村基層醫療醫師之傾向如何。研究樣本包含65歲及以上病人364位在1987~1994間被診斷且由68位基層醫師轉診至二及三級教學醫院之內科部門。轉診動機及回診傾向由醫師及訪問者分別收集。對所有鄉村基層醫年老病人，有20.29%之轉介是來自病人或家屬，有79.71%則是由基層醫師轉診而來。由醫師或病人轉診而來的疾病之BADL(Basic Activities of Daily Living)或IDAL(Instrumental Activities of Daily Living)，並無統計上差異。醫師轉診與較高的GDS(Geriatric Depression Scale)及較低的MMSE(Mini-Mental State Examination)評分有所相關。在年老者，疾病較嚴重者與由病人主導之轉診有相關。在控制了婚姻狀態、庭型態、醫療保險、心智與憂鬱狀態、及嚴重度，本鄉村基層醫療研究顯示若在二或三教學醫院轉介是由醫師主導，年老病人較可能回到原鄉村基層醫師。(慈濟醫學1998;10:111-118)

關鍵字

轉診 ； 老年人 ； 鄉村基層醫療 ； 邏輯迴歸

並列摘要

With the increasing population of older people and their more complicated illnesses, physicians in the rural community are becoming more concerned about the care of older patients. This study was designed to determine the association between referral source and illness severity as well as the tendencies of older patients to return to their primary care physicians in rural areas. The study sample in cluded 364 patients aged 65 and older who had been diagnosed from 1987 through 1994. The patients were referred to the department of internal medicine of 18 secondary and 5 tertiary teaching hospitals by 68 primary care physicians. Type of referral source and return tendency data were collected from the physician and an independent trained interviewer, respectively. Of all the referrals for the older patients, 20.29% were initiated by the patient or their families and 79.71% were initiated by primary care physicians. No statistical significance was found in difference in Basic Activities of Daily Living (BADL) or Instrumental Activities of Daily Living (IADL) between physician- and patient-initiated referrals. Both high Geriatric Depression Scale (GDS) scores and low Mini-Mental State Examination (MMSE) scores were associated with physician-initiated referrals. Severe illness was associated with patientinitiated referrals in the older population. After controlling for marriage, family type, source of medical payment, mental status, depression, and severity of illness, this study showed that if the referrals were initiated by physicians, the older patients were more likely to return to their primary care physicians, a finding which was significant for both secondary and tertiasry hospital referrals.(Tzu Chi Med J1998;10:111-118)

並列關鍵字

referral ； elderly ； rural primary care ； logistic regression