臺灣成年人急診使用預測因子探討

Predictors of Emergency Department Utilization Among Adults in Taiwan

溫采薇(Tsai-Wei Wen)

指導教授 ： 蔡佩珊

臺北醫學大學/護理學院/護理學研究所/碩士(2014年)

https://doi.org/10.6831/TMU.2014.00081

摘要

急診為一個提供急性及重症患者緊急治療與照護的場所，當非屬急、重症患者來急診就醫時，健康照護資源的使用就變得無效率且不適當，也相對提高了急診使用率。故，本研究目的為探討影響台灣成年人急診使用之預測因子。
本研究為橫斷式、敘述相關性之研究設計(Cross-sectional and Descriptive Correlational Design)，採用行政院衛生署國民健康局提供之「民國九十四年國民健康訪問暨藥物濫用調查」資料庫進行次級資料分析，以18歲以上至64歲的成年人為研究對象，將問卷收集之資料一一編碼並輸入電腦，以SAS 9.3版統計套裝軟體進行資料處理與統計分析，其中包括描述性分析、卡方檢定（Chi-square analysis）、單因子變異數 ( One-way ANOVA)、及多變項邏輯式迴歸分析（Multiple logistic regression analysis）。
研究對象共14,649名介於18-64歲之成人，其中包括12,786位過去一年內無急診使用、1,799位有1-3次急診使用及64位有≧4次之急診使用。研究結果顯示急診使用次數之不同組別間，年齡、教育程度、婚姻狀況、家戶總所得、抽菸、吃檳榔、罹病史與過去一個月西醫門診就診次數以及生、心理構面之生活品質有顯著的差異性。在校正所有可能會影響急診使用次數的變項之後，(1)在比較過去一年內急診使用次數為1-3次和急診使用次數為0次之成人患者中，35-49歲和50-64歲的患者比18-34歲的患者有較低的急診使用次數風險 (Odds Ratio (OR) = 0.68，95% confidence interval (CI) = 0.59-0.78；OR = 0.65，95% CI = 0.54-0.78)，而有抽菸比上沒有抽菸的患者(OR = 1.32，95% CI = 1.17-1.48)、有共病≧兩種比有共病一種(含)以下的患者(OR = 1.95，95% CI = 1.64-2.23）、及在生、心理構面之生活品質中較差的患者比上較好的生心理生活品質患者(OR = 2.15，95% CI = 1.91-2.42；OR = 1.35，95% CI = 1.20-1.52)，均有較高的急診使用次數風險 ；(2)在比較過去一年內的急診使用次數≧4次和急診使用次數為0次之成人患者中，只有35-49歲年齡層比18-34歲之患者有顯著的急診使用次數低風險比(OR = 0.68，95% CI = 0.59-0.78)，而有吃檳榔比沒有吃檳榔者(OR = 2.06，95% CI = 1.02-4.14)、共病≧兩種比有共病一種(含)以下者(OR = 2.11，95% CI = 1.10-4.02)、及生理構面之生活品質較差比生理生活品質好的患者(OR = 11.84，95% CI = 5.81-24.12)，有較高的急診使用次數風險比。此外，過去一年內急診使用次數為1-3次和過去一年內的急診使用次數≧4次的患者較急診使用次數0次的患者，在過去一個月有至西醫門診就診，均有較高的急診利用風險(OR = 1.08，95% CI = 1.04-1.12 and OR = 1.23，95% CI = 1.13-1.33)。
本研究盼能提供專家學者及衛生主管機關單位關注高急診醫療使用與醫療照護之議題，更能提升與改善急診擁塞的狀況，並且能夠及早針對民眾之所需給予最適切且完善的醫療照護，以減少不必要的健保資源浪費。

關鍵字

醫療使用 ； 急診使用預測因子 ； 生活品質

並列摘要

As a major component of the health care delivery system, emergency department (ED) is intended to provide critical services to those who in need of immediate medical and nursing attention, and sometimes life-threatening conditions. When patients who are not experiencing emergent conditions seek for medical help at the ED, health care resources are utilized inefficiently and inappropriately. The purpose of this study was to identify predictors of emergency department utilization among adults in Taiwan.
This cross-sectional study used a descriptive, correlational study design. A secondary analysis of 14,649 adults with age from 18 to 64 was as conducted. All data were retrieved from the 2005 National Health Interview Survey (NHIS) and were analyzed using the SAS computer software, version 9.3. Descriptive statistics of distributions of the demographic and clinical characteristics of participants in the continuous data are presented as mean and standard deviation, and in the categorical data are presented as the number and frequency of observations. Group differences were analyzed using Chi-square analysis and one-way ANOVA. Multinomial logistic regression was conducted to investigate predictors of the ED utilization. The dependent variable was ED utilization, defined as 0, 1-3, or ≧4 ED utilization in the previous 1 year. Independent variables included age, educational level, marriage status, family income, smoking/ betel nuts eating, comorbidity, the number of outpatient visits in the previous month, and the quality of life.
Results showed that in the previous year, when ED utilization between 1 to 3 times was compared to ED utilization = 0, participants with age from 35 to 49 and from 50 to 64 had lower odds (odds ratio [OR], 0.68; 95% confidence interval [CI], 1.64-2.23 and OR, 0.65; 95% CI, 0.54-0.78, respectively) of ED utilization compared with those whose age was from 18 to 34. Participants who had the experience of smoking compared with those who had not (OR, 1.32; 95% CI, 0.59-0.78), participants with comorbidity≧2 compared with those who with comorbidity≦1 (OR, 1.95; 95% CI, 1.64-2.23), and participants who had poor physical or psychological quality of life compared with those who had better quality of life (OR, 2.15; 95% CI, 1.91-2.42 and OR, 1.35; 95% CI, 1.20-1.52, respectively) had higher odds. When ED utilization≧4 times was compared to ED utilization = 0, only participants with age from 35 to 49 had significant lower odds (OR, 0.68; 95% CI, 0.59-0.78) than those whose age was from 18 to 34. Participants who were betel nuts users compared with those who were not (OR, 2.06; 95% CI, 1.02-4.14), participants with comorbidity≧ 2 compared with those who with comorbidity≦1(OR, 2.11; 95% CI, 1.13-1.33), and participants who had poor physical quality of life compared with those who had better quality of life (OR, 11.84; 95% CI, 5.81-24.12) had higher odds. Moreover, the number of outpatient visits predicted ED utilization (OR, 1.08; 95% CI, 1.04-1.12 and OR, 1.08; 95% CI, 1.04-1.12, respectively).
Emergency department utilization among adults in Taiwan differed significantly according to age, smoking, betel nuts eating, comorbidity, the number of outpatient visits, and quality of life.

並列關鍵字

medical use ； predictors of emergency department ； quality of life

參考文獻

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