台灣地區兒童急診醫療利用及其相關因素之研究

Factors Associated with Emergency Medical Care Utilization among Children in Taiwan

沈希哲(Hsi-Che Shen) ； 胡鎮如(Cheng-Ju Hu) ； 李中一(Chung-Yi Li) ； 柯明中(Ming-Chung Ko) ； 陳楚杰(Chu-Chieh Chen)

《台灣公共衛生雜誌》 34卷1期 (2015/02) Pp. 50-60

https://doi.org/10.6288/TJPH201534103108

摘要

目標：本研究旨在探討我國兒童急診醫療利用情形，及影響兒童急診醫療利用及成為經常利用急診醫療者的相關因素。方法：使用國家衛生研究院發行之全民健康保險研究資料庫的2005年百萬人抽樣歸人檔，以得到兒童急診醫療利用的資料。使用複邏輯斯迴歸分析影響兒童急診醫療利用及成為經常利用急診醫療者的因素。結果：2005年我國全民健康保險的被保險人中兒童共計有233,382位，有43,976人(18.84%)共使用急診醫療65,839人次。在利用急診醫療方面，男童、都市兒童、有重大傷病兒童及門診次15次以上兒童利用急診醫療的機率較高，相較於未滿1歲兒童，1歲至6歲兒童利用急診醫療的機率較高，但7歲以上兒童則較低。在成為經常利用急診醫療者方面，男童、未滿1歲兒童、有重大傷病兒童、門診次15次以上兒童、都市兒童成為經常利用急診醫療者的機率較高。結論：男童、有重大傷病兒童、門診利用次數多的兒童、都市兒童，其利用急診醫療及成為經常利用急診醫療者的機率較高。

關鍵字

兒童 ； 急診醫療利用 ； 全民健康保險研究資料庫

並列摘要

Objectives: This study aimed to determine emergency medical care (EMC) utilization among children in Taiwan and factors associated with EMC utilization. Methods: This was a populationbased study using the Longitudinal Health Insurance Database of 2005 (LHID 2005), which was released by the National Health Research Institutes. All emergency department visits among children ＜18 years of age in 2005 were analyzed to determine the rates and factors associated with EMC utilization. A multivariate logistic regression model was used to assess the independent effect of various characteristics on the risk of EMC utilization. Results: Of 233,382 children, 43,976 (18.84%) had emergency department visits accounting for 65,839 emergency department visits. Compared with girls, boys were more likely to utilize EMC. Compared with children ＜ 1 year of age, children 1-6 years of age had a higher risk of utilizing EMC. Compared with children living in urban areas, children living in suburban areas were less likely to utilize EMC. Children with catastrophic diseases were more likely to use EMC. Children with ≤ 15 outpatient department visits had a lower risk of EMC utilization compared to children with 16-20 and ≥ 21 outpatient department visits. Boys were more likely to have frequent EMC utilization. Compared with children ＜ 1 year of age, children 7-11 or 12-17 years of age had a lower risk of frequent EMC utilization. Children with catastrophic diseases were more likely to have frequent EMC utilization. Children with ≤ 15 outpatient department visits had a lower risk of frequent EMC utilization than children with 16-20 and ≥ 21 outpatient department visits. Conclusions: Boys, children with catastrophic diseases, children living in urban areas, and children with more outpatient department visits were more likely to utilize EMC and have frequent EMC utilization.

並列關鍵字

children ； emergency medical care utilization ； National Health Insurance Research Database (NHIRD)

參考文獻

衛生福利部：衛生統計系列，2011。http://www.mohw.gov.tw/。引用2011/10/06。Ministry of Health and Welfare, R.O.C. (Taiwan). Health statistics. Available at: http://www.mohw.gov.tw/. Accessed October 6, 2011. [In Chinese]

Garcia, TC,Bernstein, AB,Bush, MA(2010).Emergency department visitors and visits: who used the emergency room in 2007?.NCHS Data Brief.38,1-8.

Mustard, CA,Kozyrskyj, AL,Barer, ML,Sheps, S.(1998).Emergency department use as a component of total ambulatory care: a population perspective.CMAJ.158,49-55.

Tang, N,Stein, J,Hsia, RY,Maselli, JH,Gonzales, R.(2010).Trends and characteristics of US emergency department visits, 1997-2007.JAMA.304,664-70.

Burt CW, McCaig LF. Staffing, Capacity, and Ambulance Diversion in Emergency Departments: United States, 2003-2004. Advance Data from Vital and Health Statistics: No 376. Hyattsville, MD: National Center for Health Statistics, 2006