失去親人與否的921地震存活者之醫療利用探討

THE IMPACT OF NATURAL DISASTER ON MEDICAL UNTILIZATION BETWEEN 921 EARTHQUAKE SURVIVALS THAT LOST & DID NOT LOST THEIR FAMILY MEMBERS

烏斯馬(Usman Iqbal)

指導教授 ： 許怡欣

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2012年)

https://doi.org/10.6831/TMU.2012.00095

摘要

背景：地震災害對是否失去親人之存活者的影響甚少被注意。另外，災難對那些最直接的主要受害者-他們的家人的影響常常被忽視。
目的：本研究目的為探討災難性地震對那些失去或沒有失去親人的存活者之長期性影響，瞭解地震發生之後其醫療服務利用的情形。
研究設計：本研究為一項前瞻性、以台灣集集大地震之後10年人口群為基礎的研究，並連結戶政資料與全民健保資料做為本研究之醫療利用資料依據。
研究資料：研究資料包含地震發生後，從1999年9月22日到1999年12月31日共四個月當中，共有1,183人在921地震中失去親人，另有48,651人並沒有失去他們的親人。
研究方法：本研究採用之研究方法包含：1）失去與沒有失去親人的地震存活者，在醫療利用上是否有顯著差異，2）失去與沒有失去親人的地震存活者，在住院、門診與精神科醫療服務利用的情形。控制變項包含年齡與性別。
結果：在地震發生後十年間，失去親人的存活組與呈現上升趨勢的精神科服務量有統計上顯著差異(P<0.01)。而在十幾年間，那些沒有失去親人的存活者與不穩定之門診服務量及費用有統計上顯著差異(P<0.001)。另外，失去或沒有失去親人的921地震存活者之間的差異顯示，在醫療服務量上沒有顯著差異，但在精神科醫療利用的之費用呈現統計上顯著差異(P<0.001)。
結論：我們應對那些失去親人與那些曾經目睹災難的存活者多加以關懷。

關鍵字

地震 ； 地震存活者之醫療利用 ； 自然災害 ； 喪親家庭

並列摘要

Background: The impact of earthquake disasters on survivors who either lost or didn’t lose family members is largely unknown. Moreover, it is often overlooked how disaster affects those closest to the primary victims, their family members.
Objective: The objective of this study was to examine the long-term effects of a catastrophic earthquake on survivals that lost or didn’t lose family members and how they utilize healthcare services after the earthquake.
Research Design: We conducted a retrospective, population-based study covering 10-years after Chi-chi earthquake in Taiwan. Utilization data were extracted from Household registry and BNHI (Bureau of National Health Insurance) in Taiwan.
Subjects: Subjects consisted of 1183 survivals that lost their family members by 921 earthquake, 48651 survivals those who didn’t lose their family members by earthquake during 4 months duration, after earthquake from September 22nd 1999 to 31st December 1999.
Measures: As outcome measures, we studied 1) the significant difference between survivals that lost or didn’t lose their family members by earthquake in relation to medical utilization. 2) Medical care utilization between survivals that lost or didn’t lose their family members by earthquake with respect to Inpatient, Outpatient and Psychiatric medical utilization. All analyses control for age, gender.

Results: Bereaved survival group was found significant (P<0.01) with increased number of Psychiatric visits with inconstancy throughout ten-years after earthquake. Those survivals that didn’t lose their family members by earthquake was found significant (P<0.001) with respect to outpatient visits and expenditures also with instability during ten years. The difference between surviving groups bereaved and those who didn’t lose their family members by 9/21 earthquake was not significant with respect to visits but was found significant (P<0.001) with respect to expenditures for psychiatric medical utilization.
Conclusion: Attention should be paid to the bereaved individuals and those who have witnessed the disaster.

並列關鍵字

Earthquake ； Medical Utilization of Earthquake Survivals ； Natural Disaster ； Bereaved individuals

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