肝細胞癌病患之醫療資源地理可近性與診斷、求醫行為之關聯性研究

Identification of the Relationships among Geographic Accessibility of Healthcare Resources, the Diagnosis of HCC and Health-Seeking Behaviors of Patients with HCC

章殷超(Yin-Chao Chang)

指導教授 ： 賴美淑

共同指導教授 ： 溫在弘(Tzai-Hung Wen)

國立臺灣大學/公共衛生學院/流行病學與預防醫學研究所/博士(2011年)

https://doi.org/10.6342/NTU.2011.02692

摘要

前言：地理資訊系統(Geographic Information System)運用在公共衛生領域的角色日漸重要，本論文運用地理資訊系統所之空間資訊，進行醫療資源評估、並探討醫療資源與肝癌病患診斷及求醫行為之關聯。
方法：以「二階段浮動可近區位法」建立台灣鄉鎮「基層醫療資源地理可近性」；以「重力模式」建立「肝癌治療資源地理可近性」。以國家癌症登記資料庫之肝細胞癌(Hepatocellular Carcinoma)病患為例，進行醫療資源地理可近性與肝癌病患之早期診斷、跨區就醫與治療延遲之關聯性。
結果：地理可近性修正後之「基層醫療資源地理可近性」與傳統之評估方式有顯著的差異；肝癌病患居住鄉鎮之「基層醫療資源地理可近性」等級越高，病患診斷為早期肝癌之勝算比越大(OR=1、1.15、1.14、1.27)；早期肝癌病患居住鄉鎮之「肝癌治療資源地理可近性」等級與跨區就醫呈現非線性相關(OR=1、1.84、0.32、0.07)；早期肝癌病患居住鄉鎮之「肝癌治療資源地理可近性」等級、是否跨區就醫與治療延遲無關。
結論：提升鄉鎮基層醫療資源對於肝癌之早期診斷與防制有正面之效果；病患因醫療資源不足與追求醫療照護品質而選擇跨區就醫，對於早期肝癌病患跨區就醫所選擇醫院之治療預後，需進一步深入評估。

關鍵字

地理資訊系統 ； 二階段浮動可近區位法 ； 重力模式 ； 肝細胞癌 ； 跨區就醫 ； 治療延遲

並列摘要

Preface: The role of geographic information system is increasingly important in the field of public health. The study tries to use detailed spatial information to identify the relationships among Geographic accessibility of healthcare resources, the diagnosis of HCC and health-seeking behaviors of patients with HCC.
Method: Using "two-step floating catchment area method" to establish the "geographic accessibility of primary care", and "gravity model" to the "geographic accessibility of HCC specific treatment" of townships in Taiwan. Take patients with HCC for example to identify the relationships among geographic accessibility of medical resources, early diagnosis of HCC, cross district health seeking and treatment delay.
Results: The "geographic accessibility of primary care" of townships presents a lot of differences from traditional method. Higher rank of the "geographic accessibility of primary care" of patients with HCC has higher possibility to be patients with early HCC (odds ratio=1, 1.15, 1.14, and 1.27). There is non-linear relationship between the "geographic accessibility of HCC specific treatment" of patients with early HCC and cross-district health seeking behavior (odds ratio=1, 1.84, 0.32, and 0.07). However no relationship found between treatment–delay and spatial barriers of hospital-seek behavior in patients with early HCC.
Conclusion: This study employed GIS-based accessibility approach. We identify the geographic accessibility of medical resources significantly affected the stage diagnosed and hospital-seeking behavior of patients with HCC. Treatment patterns, treatment qualities and outcomes of cancer hospitals need to be considered further to explain cross-district hospital-seeking behavior more comprehensively.

並列關鍵字

Geographic Information System ； Two Step Floating Catchment Area Method ； Gravity Model ； Hepatocellular Carcinoma ； Cross District Health Seeking Behavior ； Treatment Delay

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