「兒童牙齒預防保健」服務對牙醫醫療利用之影響

Effect of Fluoride Application on Dental Care Utilization -Results from the Preventive Dental Health Service for Children in Taiwan

陳淑芬(Shu-Fen Chen)

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(2007年)

https://doi.org/10.6831/TMU.2007.00079

摘要

背景：
過去研究顯示「預防性之醫療利用」與牙科利用有顯著相關，兒童早期牙科門診可預防疾病並降低費用，有使用早期預防性牙科門診之學齡前兒童，其較易使用後續的預防性門診服務且牙科相關醫療費用較低。氟化物已被證實能有效預防齲齒，本研究目的為了解塗氟對牙醫醫療利用之影響。

目標：台灣2004年7月1日全民健康保險實施「兒童牙齒預防保健」服務，提供未滿5歲兒童每年2次氟化防齲處理口腔項目。本研究之目的在了解使用「兒童牙齒預防保健」服務對牙科醫療利用之影響，並針對齲齒及齒髓炎醫療利用之影響加以分析。

方法：本研究為有對照組之世代研究，定義之塗氟者為2004年7月1日至12月31日有使用「兒童牙齒預防保健」服務者共50,655人為研究對象，並選取同時期未塗氟者共50,655人為對照組，觀察期間為每人塗氟前後各一人年，以差異中之差異法(difference in difference method)測量。

結果：研究結果顯示塗氟後一年牙醫整體門診醫療利用變化呈下降情形，受到齲齒及齒髓炎之醫療利用顯著下降之影響；而牙醫急診利用則無顯著差異。

結論：使用「兒童牙齒預防保健」服務，降低牙醫整體門診醫療利用，尤其在齲齒及齒髓炎之醫療利用有明顯之下降。本研究只檢驗塗氟對醫療利用之短期(一年)影響，至長期影響尚待後續之追蹤與監測。

關鍵字

兒童 ； 牙齒預防保健 ； 牙齒塗氟 ； 牙科門診利用 ； 差異中之差異法

並列摘要

Background:
Previous research has shown that early intervention has the potential to reduce future dental caries and translate into significant cost savings for dental care among preschool-aged children. Preschool children who had an early preventive dental visit were more likely to use subsequent preventive services and experienced less dentally related costs. However, the economic implications of fluoride application to prevent early childhood caries are not well understood.

Objective:
A service of dental fluoride application for children under 5 years old twice a year in the “Preventive Dental Health Service for Children” by the BNHI began in July 2004. During these two prevent dental visits, physician provide fluoride application and counseling on infant oral hygiene. Therefore, the purpose of this study was to examine the effect of fluoride application on dental utilization.

Methods:
An experimental study with control group and fixed effect model were used. Two groups of people were observed from 2003 to 2005: (1) the study group (n=50,655), and (2) the control group (n=50,655). The unit of observation was person-year. In order to obtain more precise estimates and control for possible confounders, the difference-in-difference (DD) method were conducted.

Results:
Decreases in dental care utilizations were observed after dental fluoride application. In terms of disease-specific utilization, a decrease in the dental care utilizations for dental caries and pulpitis diseases has been detected after dental fluoride application.

Conclusion:
Preschool children who had fluoride application were experienced less dentally related costs. One limitation in the study that we only examined the short-term(one year) effects of dental fluoride application on dental care utilization, so it is important for future study to further investigate possible long-term effects of dental fluoride application on utilization.

並列關鍵字

Children ； Preventive Dental Health ； Fluoride gel application ； dental care utilization ； difference in difference (DID)

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