台灣地區學齡前智能障礙者門診利用情形初探

Survey of Outpatient Visits for Pre-school Children with Intellectual Disabilities in Taiwan

張剛準(Gang-Zhun Zhang) ； 江博煌(Po-Huang Chiang) ； 徐尚為(Shang-Wei Hsu)

《身心障礙研究季刊》 8卷4期 (2010/12) Pp. 214-226

https://doi.org/10.30072/JDR.201012.0001

摘要

目的：智能障礙者常合併其他障礙，因此對醫療的需求高於一般人口群，然而實際醫療利用之相關研究卻相當缺乏。本研究欲探討學齡前智能障礙者在1997至2007年悶在醫療利用土之差異，作初步醫療利用趨勢探討。方法：向國家衛生研究院申請1997-2007年學齡前智能障礙者全民健康保險資料，以統計軟體SPSS12.0進行串檔後歸人，並依照國際疾病分類(ICD-9-CM)區分為輕度、中度、重度、極重度與臨界智能障礙等五類分別探討就醫差異與分布情形。結果：1997-2007年間，儘管隨著學齡前智能障礙者人數逐年減少，總就醫次數呈遞減趨勢，但平均就醫次數呈現逐年增加的趨勢（26.4到47.8）；且男性高於女性，其總就醫人數約為1.76倍、總就醫次數約為1.82倍、及平均就醫次數的為1.03倍。重度智能障礙者歷年平均就醫次數約為45.3次，高於其他等級者。醫院層級方面，智能障礙者就醫醫院層級逐漸由基層院所轉移至區域醫院與地區醫院，但仍高達5成以上智能障礙者會選擇基層院所就醫。疾病類型方面，在2000年時後以呼吸系統疾病與精神疾病等為主的就聲疾病型態。就醫科別以小兒科最多，但有逐年減少的趨勢；復健科就醫次數比例逐年增加。結論：發現學齡前智能障礙者平均門診次數逐年增加，且高於全民之平均值。就醫場所以基層院所為主，疾病類型呼吸系統與精神系統為主，就醫科別以小兒科與復健科為主。影響門診利用情形之因素，需進一步分析探討。

關鍵字

智能障礙 ； 學齡前兒童 ； 醫療利用

並列摘要

Aim: This paper aims to describe the trend of outpatient visits for pre-school children with intellectual disabilities in Taiwan, years from 1997 to 2007. Method: Ambulatory care expenditures by visits files, subset of Taiwan's National health insurance c1aim data, of study subjects from 1997 to 2007 were comp1ied and analyzed. Data inc1uded gender, age, outpatient visit frequency, healthcare setting and service department, disease diagnosed according to the International Classification of Diseases, the 9th revision coding system (ICD-9). Results: The results showed the usage frequency of outpatient service was 25.6 visits in 1997, and was increased gradually to 40.6 visits in 2007; and the average visits of male were significantly higher than of female. The outpatient visits for severe mental retardation subjects was 30.8 visits in 1997, and was increased gradually to 63.9 visits in 2007, significantly higher than of others Private clinics were the main healthcare setting of outpatient service for mental retardation subjects. The Pediatrics service was principal, however, the Rehabilitation is on the rising. Diseases of the respiratory system, mental disorders and diseases of the nervous system and sense organs were the three major diseases diagnosed after year 2000. Conclusions: The study was first to present the outpatient service utilization, based on a nationwide data, for pre-school children with disabilities in Taiwan. The annually average outpatient visit of mental retardation subjects is higher than of general population (12.5-14.5 visits per year). The factors affecting outpatient service utilization for them needs further investigation.

並列關鍵字

People with intellectual disabilities ； pre-school children ； outpatient visits

參考文獻

內政部統計處(2001)。89年身心障礙者生活需求調查。台北市:內政部統計處。

內政部統計處(2007)。95年身心障礙者生活需求調查。台北市:內政部統計處。

江東亮(2000)。感情變負擔—談全民健保之下的三個矛盾。全民健康保險雙月刊。28，4-5。

李佩娜(1997)。智障者利用醫療照護情形及其影響因素(碩士論文)。國防醫學院。

林金定、吳佳玲、李志偉、嚴嘉楓、張茂榕、賴朝英()。,未出版。