- 期刊
社區高關懷與訪視需求族群分析
Analysis of High-Need Patients for Care and Home Visit in the Community
摘要
目的：透過「2016年台北市社區關懷醫師整合性照護－士林、北投區試辦計畫」篩選出關懷與訪視需求較高之族群，以提供社區健康照護及醫療資源分配之優先順序。方法：本研究對象為2016年5月至2016年12月間收案之關懷與訪視個案：居住於台北市士林區及北投區低收入戶、中低收入戶、獨居長者、身心障礙者與慢性疾病病人。由基層醫師進行整合性照護服務，包含院所內健康評估及居家訪視。以回溯性方式取得去身分連結及轉檔後之個案特質及接受關懷訪視（含健康評估及居家訪視）之次數，以描述性統計分析個案基本資料、專業人員關懷訪視次數，利用單變項與多變項邏輯迴歸分析，探討各項個案特質與關懷訪視性質之關聯性。結果：共收案5,770人，單純接受院所健康評估的個案5,078位、有接受居家訪視的個案692位。與單純接受院所健康評估的個案相比，有接受居家訪視的個案其教育程度較低、未與配偶同住的比例較高、有較多弱勢身分別、行動能力與生活功能較低及家庭功能較不全。多變項邏輯迴歸分析顯示行動不便（OR: 4.08, 95% CI: 2.65-6.26）、兩種及以上弱勢身分別（OR: 2.72, 95% CI: 1.99-3.70）、生活功能依賴（OR: 2.04, 95% CI: 1.32-3.16）、家庭功能不全（OR: 1.69, 95% CI: 1.36-2.10）及小學以下學歷（OR: 1.24, 95% CI: 1.12-1.37）者有較高的關懷訪視需求；然而，具國高中學歷者，其關懷訪視風險較大學以上學歷者低（OR: 0.81, 95% CI: 0.73-0.90）。結論：行動不便、社經地位弱勢、生活功能依賴、家庭功能不全及教育程度較低者，有較高的關懷訪視需求。建議醫療團隊、社政與社區單位持續發掘社區中較需關懷的個案，提供以人為中心的整合性醫療照護。
並列摘要
Purpose: To identify high-need patients through the analysis of the ＂2016 Pilot Project for Community-based Family Physician Integrated Care in Shilin and Beitou, Taipei＂ and apply the findings as priority concerns when providing community-based home care and distributing medical resources. Methods: The study recruited people living in Shilin and Beitou districts in Taipei City meeting any of the following criteria: from a low to middle-income family, elderly living alone, disabled, and with chronic diseases. Primary care physicians provided health evaluation at medical institutions (＂healthcare＂) and home visits during the period from May to December 2016. Anonymous data covering participants' demographic characteristics and frequency of healthcare and home visit were collected retrospectively. Univariate logistic regression analysis and multivariate logistic regression analysis were performed using SAS 9.4 to analyze the correlation between each patient's characteristic and the need for care. Results: A total of 5,770 participants were enrolled. Among them, 5,078 participants had received healthcare alone and 692 received home visit. Participants receiving home visits were at a lower education level, more likely to live without a spouse, more disadvantaged, less able to ambulate or perform daily activities, and of poorer family function. Multivariate logistic regression analysis revealed that participants physically disabled (OR: 4.08, 95% CI: 2.65-6.26), more disadvantaged (OR: 2.72, 95% CI: 1.99-3.70), having poorer self-care abilities (OR: 2.04, 95% CI: 1.32-3.16), of poorer family function (OR: 1.69, 95% CI: 1.36-2.10) and with an education level of elementary school or lower (OR: 1.24, 95% CI: 1.12-1.37) had a higher need for home visit. However, those with an education level of high school (OR: 0.81, 95% CI: 0.73-0.90) showed a lower home-visit need compared with those who graduated from college or above. Conclusion: People who are physically disabled, more disadvantaged, less able in terms of self-care, with a lower education level, and of poorer family function need more care. Medical and healthcare institutions and social welfare and community organizations are urged to seek out these high-need patients for patient-centered integrated care.