居家慢性病患健康服務利用之探討---以新竹市高血壓及糖尿病病患為例

Exploring health services utilization among chronically ill outpatients-a study on patients with hypertension and diabetes in Hsin-Chu city.

戴幼平(Yu-Ping Tai)

指導教授 ： 林恆慶

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(2004年)

摘要

本篇係應用Andersen-Newman 醫療利用行為模式，旨在暸解新竹市高血壓、糖尿病等居家慢性病患利用健康服務之情形及其相關影響因素。研究工具採用結構式問卷，內容包括基本資料、身體功能評估表、自覺健康狀況量表、社會支持量表及憂鬱量表五部份。以新竹市1997至2003年北、東、香山三區衛生所管案之居家高血壓或糖尿病個案，其中包括有香山衛生所255例、北區衛生所546例、東區衛生所721例，共1522人為研究母群體，依三區收案人數比例採1:2:3分層隨機抽樣抽出樣本共253例，接受面訪共200例(香山33人、北區67人、東區100人) 接受率達79%，有效問卷200例達100%，正式研究前特請產官學界代表共5位專家，針對問卷五大部份進行內容效度檢定，另抽30份做預測（Pilot Test）並進行問卷內部一致性分析各部份評量表所得之Cronbach’s α值達0.84~0.96（自覺健康量表Cronbach’s α=0.84；社會支持量表Cronbach’s α=0.94；身體功能評量表Cronbach’s α=0.96；憂鬱量表Cronbach’s α=0.91）。問卷是透過8位訪視員以家庭訪視面對面與個案訪談方式蒐集資料。研究資料以描述性統計、皮爾森積差相關分析(Pearson’s correlation coefficient)、多變項迴歸(Multiple Regression analysis)、邏輯斯迴歸(Logistic multipal regression)等統計方法分析之。研究結果顯示（1）慢性病患平均罹患2種慢性疾病；其選擇就醫地點時主要考慮的因素依序為：┌治療成效好┘、┌離家近 ┘、┌醫院設備齊全┘與┌醫護人員態度┘（2）慢性病患之「罹病時間」、「疾病總數」與門診就診次數間具相關性；即「罹病時間愈長」、「疾病總數愈多」，則門診就診次數愈多。且影響新竹市慢性病患門診就醫次數個人傾向、能力、需求三項因素中以需求因素對門診就醫次數的解釋力最大，可解釋變異量達14﹪。（3）慢性病患需求因素中「身體功能」、「自覺健康」、「憂鬱程度」、「疾病總數」、「罹病時間」、能力因素中之「社會支持」、「就業狀況」、傾向因素中之「年齡」、「教育程度」與住院次數間具相關性；且影響新竹市慢性病患住院量之因素中，也以需求因素對住院次數的解釋力最大，可解釋變異量達21﹪。（4）約有1/4受訪慢性病患無定期就醫，平日未定期就醫的主要原因依序為「無不適」、「自行購買成藥」、「自行飲食控制」、「沒時間」等；影響受訪慢性病患定期就醫行為之主要因素為┌性別」、「就業狀況」及「自覺健康」；以男性、無工作者、自覺健康差者較能定期就醫。

關鍵字

高血壓 ； 糖尿病 ； 居家慢性病患 ； 健康服務利用

並列摘要

This study was to explore the utilization patterns of health service and the influence factors among the community patients of chronic disease such as hypertension and diabetes mellitus in Hsin-Chu City.The study was based on Anderson-Newman behavior model, and the study outcomes were measured by structured home-interview questionnaire. The content of the questionnaire was consisted of five sections that were personal information, the subscales of physical function assessment, self-awareness of health status and social support, and the level of depression.The data was collected during 1997 to 2003 and the research population was consisted of 1522 clients, who have been listed under the control of three local health stations as North, East and Xiang-Shan health stations. A random sample of 253 patients from the population was selected for interview, and the response rate was 79% (200/253). Before the study commenced, 5 experts of nursing research field were invited for revising the contents of questionnaire, which focused on the content efficacy of 5 sections. A pilot test of 30questionnaires were also distributed for the analysis of the content consistence, Cronbach’s α value for each section was between 0.84 to 0.96 (Cronbach’s α =0.84 for self-awareness of health status; Cronbach’s α = 0.94 for social support, Cronbach’s α = 0.96 for physical function; Cronbach’s α = 0.91 for the level of depression).A total of 200 questionnaires were returned and the response rate of interview questionnaire was 100% (200/200).The data was collected by 8 investigators with the methods of family visiting and face to face interview.Descriptive statistics, Pearson’s correlation, multiple regression and logistic multiple regression were used for data analysis.The study outcomes presented: 1. Chronically ill outpatient had 2 different chronic diseases in average, and the factors that influenced the utilization of hospital included: A, the efficacy of medical treatment, B. the facilities of the hospital, C. the service attitude of medical staff. 2. There were correlations among the time of illness, the number of disease, and the rate of OPD follow up that resulting in increased rate of OPD follow up due to both increased illness time and disease number. 3. The demand factors of chronically ill outpatients included physical function, self-awareness of health status, the level of depression, the number of disease and the time of illness. The ability factors included the social support and the status of employment. The trend factors included age, the level of education and the rates of hospitalization. The correlations among the factors as above were positive. 4. Approximately 25% interviewers did not follow OPD treatment regularly, the factors included nil uncomfortableness, self-purchase of medication, self-control of diet, and no time for OPD follow up. Furthermore, the influence factors for regular OPD follow up included gender, the status of employment, and the self-awareness of health status.

並列關鍵字

Hypertension ； Diabetes ； Chronically ill outpatient ； Health services utilization

參考文獻

中文部份: 于漱(1994)。基隆市居家老人健康服務利用行為及相關因素研究。護理雜誌，41(3)，27-39。

石曜堂(1994)。台灣地區或民自付醫療費用調查︰1992年國民醫療保健支出調查之初步發現。中華衛誌，13，473-483。

李碧玉(1994)。時間價格對門診醫療需求之影響。國立陽明大學衛生福利研究所碩士論文。 宋鴻樟(2000)。高血壓才是第一大死因。中華衛誌，19(1)，16-190

邱宛瑜(2001)。北台灣社區老人健康相關生活品質探討。國防醫學院碩士論文。 邱啟潤、郭素娥、陳惠珠(1994)。高雄市有慢性健康問題的老人利用社區醫療資源情形的探討。Kaohsiung J Med Sci，10，583-591。

徐慧娟、吳淑瓊、江東亮(1996)。跌倒對社區老人健康生活品質的影響。中華民國衛生雜誌，15(6)，525-531。