牙醫師對於提供牙科就診病患牙周病治療之意願

Dentists’ Willingness to Treat Patients with Periodontal Diseases

洪慧君(Hui-Chun Hung)

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(2010年)

https://doi.org/10.6831/TMU.2010.00158

摘要

本研究目的在於探討牙醫師提供牙科就診病患牙周病治療之意願與其影響因素。
本研究為橫斷性研究，研究內容包括質性與量性研究兩部份。在質性研究方面，分別於2009年10月與2010年4月，在中華民國牙醫師公會全國聯合會舉辦兩場焦點團體座談會，目的在於瞭解牙醫師治療牙周病意願的看法。在量性研究方面，以自填式結構性問卷為主要研究工具，採分層系統抽樣之抽樣方式抽取615家牙科診所之診所負責醫師做為接受問卷調查的對象。目的在於探討牙醫師提供牙科就診病患牙周病治療之意願。總共發出615份問卷，有效回收問卷為113份，回收率為18.37%。採描述性統計、t檢定、單因子變異數分析和複迴歸進行統計分析。
本研究之主要結果如下：
一、62.8%牙醫師表示有意願與非常有意願提供病患治療牙周病，23.0%牙醫師對於治療意願表示為普通，13.2%牙醫師表示沒意願與非常沒意願提供病患治療牙周病。
二、影響牙醫師提供牙周病治療意願的因素
(一)描述性統計
複選題影響牙醫師提供牙周病治療意願的前五項因素依序為「病患對牙周病治療後維護與接受衛教的心態」(71.7%%)、「病患接受治療的意願」(67.3%)、「病患穩定持續就醫的配合度」(65.5%)、「健保支付點數高低」(58.4%)與「有無牙周病專科訓練的背景」(40.7%)。
(二)推論性統計
1.牙醫師個人人口學特性之各變項與牙醫師治療意願間的關係，除了牙醫師之性別外，牙醫師有無受過牙周病專科訓練、相關訓練、過去有無治療牙周病之經驗與自認為治療牙周病之能力皆與牙醫師提供牙科就診病患牙周病治療意願達統計上顯著差異。
2.牙醫師執業場所之健保分局與治療牙周病意願未達統計上的顯著差異。
3.牙醫師的執業年資、牙周病專科訓練、牙周病相關訓練、治療牙周病能力與治療牙周病經驗是影響牙醫師治療牙周病意願之因素，其中以治療牙周病能力有顯著的預測能力。
根據研究結果，本研究提出下述建議：
一、建議衛生主管機關能考量提高健保支付點數，以增加牙醫師治療牙周病之意願。
二、建議牙科醫療團體能調整申請牙周病統合照護計畫之程序與培養牙周病專科醫師，並深入探討目前牙周病專科醫師人力之供需現況與分佈。
三、建議牙醫診所負責人應加強醫師的溝通能力，或許能減少醫病雙方的紛爭。
四、建議後續研究者可在牙周病統合照護計畫推行一段時間後，針對此議題進行不同時間牙醫師治療牙周病意願之變化分析。

關鍵字

牙醫師意願 ； 牙周病 ； 牙科診所病患

並列摘要

The purposes of this study was to understand dentists’ willingness to treat patients with periodontal diseases and their related factors.
This cross-sectional study employed both qualitative and quantitative methods. In qualitative study, two focus groups of dentists were held in Taiwan Dental Association in October 2009 and April 2010 separately in order to well understand the opinions of dentists by the representatives of dental clinics. In quantitative study, 615 dental clinics were stratified systematic sampled to answer structured questionnaires about dentists’ willingness to treat patients with periodontal with diseases. 113 questionnaires were returned with 18.37% response rate. Descriptive statistics, t test, ANOVA, and multiple regression analysis were used in data analysis.
The results of the study are as follows:
1. Dentists’ willingness to treat patients with periodontal diseases: 62.8% of dentists were willing or very willing to treat patients. 23.0% of dentists were neutral to treat patients. 13.2% of dentists were unwilling or very unwilling to treat patients.
2. In multiple-choice questions or items (choose two or more answers from those answers): The factors affecting dentists’ willingness included patients’ attitudes of hygiene education compliance after periodontal disease treatment (71.7%), patients accept willingness to treat(67.3%), the degree of the patient’s coordination continuity (65.5%), NHI reimbursements were too low (58.4%), and whether had subspecialty training (40.7%).
3. The inferential result of according to t test, ANOVA, and regression
(1) The dentists’ willingness to treat patients with periodontal diseases was found significantly related to the subspecialty training, other periodontal diseases train, ever experience in treating patientss, and the ability to provide adequate treatments for patientss.
(2) The dentists’ willingness to treat patients with periodontal diseases was no significantly related to dentists’ work location of National Health Insurance.
(3) In the multiple regression model, including seniority of dentists’, specialty train, other periodontal diseases train, ever experience in treating patientss, and treat ability, the significant influencing factors was adequately equipped to provide patientss with periodontal diseases.
According to the findings in the thesis, some suggestions are concluded as follows:
1.The department of health can adjust NHI reimbursements, increase dentists’ willingness to treat patients with periodontal diseases.
2.Dental medical organization can correct review procedure and in cultivating dentists of periodontal diseases and realize further the distribution and supply of dentists manpower.
3.Dental clinic superintendent should enhance communicative competence between dentists and the patientss, maybe can reduce the dispute.
4.It is suggested the further researches may be focused on the dentists’ treat willingness analysis of periodontal diseases care plan implantation.

並列關鍵字

Dentists’ Willingness ； Periodontal Diseases ； Dental Clinic Patients

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