疾病管理照護模式對氣喘病患牙醫醫療利用之影響

中文摘要有鑑於氣喘病患日益增加，中央健康保險局自90年11月進行推動氣喘疾病管理照護試辦計劃，提昇氣喘病患照護品質及使醫療資源有效利用，以建立持續性管理照護，氣喘疾病管理照護旨在加強衛生教育及增強病患自我照顧能力，期促進整體健康。口腔健康與全身健康息息相關，由於氣喘病患使用類固醇口內噴劑，部分文獻指出此類藥物對口腔健康有影響，而健保局進行之氣喘疾病管理照護包含醫療團隊定期追蹤病患就醫及施行口腔衛生教育，因此擬藉此瞭解氣喘疾病管理對牙醫醫療利用有哪些相關影響因素以及參與疾病管理照護與未參與疾病管理照護，兩組間牙醫醫療利用之差異性。本研究以健保局高屏區91年1-3月氣喘病患（主診斷碼493）為研究對象，照護組122人，非照護組28210人，另為避免兩組比較基礎差異過大，非照護組依照護組性別年齡配對，以1：10做等距抽樣抽出1220人，再行勾稽牙醫醫療費用明細資料，照護組49人非照護組469人，資料比較區間，介入前90年1月至90年12月，介入後91年1月至91年12月，資料分析利用描述性統計、卡方檢定、t檢定及複回歸分析加以探討。研究結果顯示：（1）照護組經介入後牙醫醫療費用較介入前高，而非照護組介入後無增加情形。（2）牙醫疾病別與診療項目，照護組牙周病罹病次數及牙周病診療處置次數於介入後較高，非照護組則無差異。（3）相關影響因素中，年齡群及牙醫疾病嚴重度對牙醫醫療費用有顯著影響。由此顯見，氣喘病患在疾病管理介入後更加注意口腔照護，本研究建議未來健保局在評估疾病管理西醫醫療利用及品質的同時，應思考牙醫所帶來的間接效應並將牙醫納入疾病管理醫療團隊及醫療品質指標，以達整體健康照護目的。

關鍵字

疾病管理；氣喘；牙醫醫療利用

並列摘要

Abstract Due to the increasing number of cases in asthma patients, the Bureau of National Health Insurance established an asthma disease management program in November, 2001. The aims of this management plan were to improve the quality of care and to make the best use of medical resources, and hence, to establish the sustainable management and care for asthma patients. It was also expected that through this program, the oral hygiene education and the ability of patients’ self care would be enhanced. Oral health is closely linked to the health of the whole body. Due to the use of Beclomethasone spray, some literature indicated its direct impact on oral health of asthma patients. The asthma disease management program included regular medical follow-ups and oral health education. The purpose of this study was to investigate the related factors for the differences of the dental utilization between the participants and non-participants of the asthma disease management program. We used the asthma patients listed in the data of Bureau of National Health Insurance Kao-Ping Branch (main diagnosis code: 493) from January to March, 2002. There are 122 persons and 28,210 persons in the participant and non-participant groups, respectively. To avoid the systematic effects due to sex and age distributions a 1:10 matched study was designed. There were 1220 non-participants randomly selected according to the sex and age of each subject in the program. The dental expense records were collected for the study subjects. There were 49 and 469, respectively, for program participants and non-participants who had non-zero dental expenses during January to December, 2001 and January to December, 2002. The statistical analyses methods included descriptive statistics, chi-square tests, t-tests and multiple linear regressions. The results indicated that: (1) the dental care expenses of the participant group after intervention was higher than that before intervention, but the non-participant group did not show this tendency; (2) in terms of the dental disease and the items of making diagnosis and giving treatment, the times of having and treating periodontal disease in the participant group increased after intervention; and there was no difference in non-participant group; (3) as far as the related factors were concerned, the expenses of dental treatment varied greatly according to age and the condition of the dental disease. As the result, the asthma patients had paid more attention to the oral health after the intervention of the disease management program. This research results recommended that the Bureau of National Health Insurance should consider the indirect effects from dental problems, and include dental health as an index of the quality of medical treatment in order to reach the goal of the health care of the whole.