偏遠地區緊急醫療救護站的效能評估： 台北縣緊急醫療救護站計畫的經驗

Efficacy of the Physician-Operated Emergency Medical Station in a Rural Area: An Experience from Physician-Operated Emergency Medical Station Program in Taipei County

陳建榮(Chien-Jung Chen)

指導教授 ： 季瑋珠

國立臺灣大學/公共衛生學院/預防醫學研究所/碩士(2004年)

https://doi.org/10.6342/NTU.2004.02512

摘要

背景：
過去針對緊急醫療救護系統所做的研究，未討論偏遠地區建立緊急醫療救護站對於急症病人的效益。
目標：
本研究主要目的在探討緊急醫療救護站，以及緊急醫療救護站計畫對於偏遠地區急症病人死亡率之影響。
病人與方法：
本研究是以不同醫院前照護系統的急症病人族群為基礎的回溯性流行病研究。比較三個鄉鎮、兩種不同的醫院前照護系統：貢寮鄉和雙溪鄉為緊急醫療救護站計畫的鄉鎮，平溪鄉只有傳統的到院前救護系統。研究對象為1031名台北縣貢寮鄉、雙溪鄉和平溪鄉使用台北縣緊急醫療救護系統轉診至後送醫院的急症病人，資料收集期間為2001年3月1日至2003年3月31日。同時獲得上述三個鄉鎮的死亡登記以了解死亡情形。以邏輯式迴歸分析，探討在控制可能之干擾因子估計緊急醫療救護站介入與否，及緊急醫療救護站涵蓋與否鄉鎮的死亡危險比。
結果：
控制相關變因後，對於緊急醫療救護系統轉診的急症病人經緊急醫療救護站的介入，死亡危險比為0.26(95% CI:0.09-0.7)；緊急醫療救護站計畫涵蓋的鄉鎮，並未能證明對於存活有較佳的效益。
結論：
本研究發現緊急醫療救護站的介入對於死亡是有改善，緊急醫療救護站計畫涵蓋的鄉鎮並未顯示出有較佳的效益。

關鍵字

緊急醫療救護系統 ； 醫院前照護 ； 偏遠地區 ； 緊急醫療救護站 ； 效益分析

並列摘要

Background
Previous studies addressing the impact of the emergency medical service system did not assess the effectiveness of the Physician-Operated Emergency Medical Station (POEMS) installed in a rural area.
Objectives
To evaluate the effectiveness on the acutely ill mortality of the Physician-Operated Emergency Medical Station (POEMS) and the Physician-Operated Emergency Medical Station plan in a rural area.
Patients and Methods
This retrospective cohort study compared two types of prehospital care systems : Gongliao Township and Shuangsi Township; where Physician-Operated Emergency Medical Station plan implanted ; Pingsi Township ; where was conducted traditional emergency medical service without the Physician-Operated Emergency Medical Station plan implanted. A total of 1031 acutely ill patients who resided in Gongliao Township , Shuangsi Township and Pingsi Township and received Taipei County emergency medical service with transferal to hospital were included in this study between 1 March 2001 and 31 March 2003. These Townships mortality registry were obtained to assess the acute illness mortality. Logistic regression which to evaluate the effectiveness of the Physician-Operated Emergency Medical Station and the Physician-Operated Emergency Medical Station plan was used to calculate adjusted odds ratio of mortality after controlling for possible confounders.
Results
After controlling for confounding factors, the Physician-Operated Emergency Medical Station intervention can lead reduction of mortality (Adjusted OR: 0.26(95% CI: 0.09-0.7)). However, the Townships which the Physician-Operated Emergency Medical Station plan implanted didn’t have significantly better survival.
Conclusions
The retrospective cohort study revealed that the e the Physician-Operated Emergency Medical Station intervention can improve survival of the acutely ill patients in a rural area. The system with the Physician-Operated Emergency Medical Station plan can not obtain better survival on all cause of acutely ill patients in a rural area.

並列關鍵字

rural area ； Physician-Operated Emergency Medical Station ； effectiveness ； prehospital care ； emergency medical service

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