安寧共同照護計畫對安寧療護利用之影響

The impact of hospice combined care on the utilization of hospice services

葉青宜(Ching-Yi Yeh)

指導教授 ： 楊哲銘

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.2010.00191

摘要

癌症為我國十大死因之首已20多年，不僅死亡人數持續增加中，且耗用許多醫療資源，世界衛生組織早已證實，安寧療護為癌症病患最佳的照顧方式。我國推動安寧療護多年，但成效仍不佳，故國民健康局於2005年推動「安寧共同照護計畫」，希能提升安寧療護之涵蓋率。本研究的目的即在探討該計畫對於全國及六分區別其住院及居家安寧療護利用之影響程度。
本研究對象為2003年至2007年間，利用住院及居家安寧療護之癌症病患，統計方法使用時間序列方式，建立全國及六分區別住院及居家安寧療護利用之ARIMA模式，再以介入分析檢定該計畫的推動，對全國及六分區別各項安寧利用之影響程度。
研究結果顯示，安寧共照政策對於全國住院安寧療護利用之人次、人數及總住院人日有顯著之影響，但對於居家安寧療護利用之人次、人數及平均住院日部份，則不顯著，且各項安寧利用在不同分區別，有不同之影響程度。對住院安寧療護利用之影響，或許與各分區安寧醫療資源分布相關，對居家安寧療護利用部份，或許與醫護人力、癌症病患的病情與自身選擇以及支付點數偏低相關，其推動仍有待加強。
對於無法治療的癌末病患而言，安寧療護可以有效緩解疼痛等其他症狀，並能減少家屬遺憾與悔恨，最終達到提高病患的生命品質。此外，停止非必要的醫療處置和急救，所節省下來的醫療資源，將可用於其他有治癒機會且需要積極治療的病患，是一項有利自己，同時也有利社會的選擇。

關鍵字

癌症 ； 安寧療護 ； 安寧共同照護計畫 ； 時間序列 ； 介入分析

並列摘要

Objective:Cancer has been the leading cause of death in Taiwan for more than 20 years, not only the casualty continues to increase, and consumes many medical resources. The World Health Organization had already confirmed hospice care is the best attendance way for cancer patients. Hospice care has been practiced in Taiwan for many years, but the result is not still good. Therefore the Department of Bureau of Health Promotion has launched a hospice combined care project since 2005 to promote the hospice care covering rate.The purpose of this study is to explore the impact of this project on the utilization of hospital-based hospice care and home hospice care in national and six districts.
Methods:The study subjects were terminal cancer patients who had used hospice care and home hospice care between 2003 and 2007. The statistical method of the study is time series models.By selecting the appropriate ARIMA models in the utilization of hospice care and home hospice care, then intervention analysis was used to examine the impact on the utilization of hospice services when hospice combined care projec was implemented in national and six districts.
Results: The outcome of intervention analysis found that hospice combined care project had a significant impact on the utilization of hospice care (including visits, persons and length of stay), but had a insignificant impact on the utilization of home hospice care(including visits and persons) and average length of stay.This policy produce different impact in various districts. The impact on the utilization of hospice care is perhaps related with various districts medical service resources distribution. The impact on the utilization of home hospice care is perhaps related with nursing manpower, cancer patient's condition and their own choice as well as the lower payment. Utilization of home hospice care still waited for strengthening.
Conclusion: Hospice care may alleviate the ache effectively, reduce the family member to regret and the lamentation and finally improve end-of-life quality for cancer patients. In addition, stops non-essential medical intervention and use of cardiopulmonary resuscitation, saves down the medical resources, might use in other having the cure opportunity, and needs the aggressive treatment patients, is item of advantageous, simultaneously also advantageous society's choice.

並列關鍵字

cancer ； hospice care ； hospice combined care ； time series ； intervention analysis

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