接受個案管理對愛滋病感染者之醫療資源耗用分析

研究目的愛滋病視為全世界最重要的傳染病之一，經由HAART(雞尾酒療法)及個案管理，能有效降低死亡率及延長存活年限，但由於感染者年齡層逐漸下降，在國內又因健康保險支付的制度規定下，面臨醫療費用虧損的窘境，本研究係藉由資料整合分析接受個案管理趨勢、醫療資源耗用及醫療品質相關影響因素，了解感染者接受個案管理後是否能有效降低醫療資源為主要目的。研究方法本研究針對國內愛滋病感染者，採回溯式縱貫性研究，以全民健保資料庫的次級資料進行研究，運用獨立樣本T檢定、卡方檢定、線性迴歸、McNemar檢定、COX比例風險分析、Kaplan-Meier Survival Curve存活分析等方法探討感染者接受個案管理的趨勢分析、醫療資源耗用及醫療品質相關影響之因素。研究結果愛滋病感染者接受個案管理從2005年佔20.46%到2013年已攀升至60.08%，平均年齡為31.37±8.94歲(p= .019)，且在就醫次數22.65±24.02次(p<.001)、門診總費用NT88,689±163,127元(p=.005)、住院天數19.03±25.65天(p=.041)、住院總費用NT448,497±375,838元(p=.002)、存活時間101.99±1.22月(p<.001)皆達顯著性差異。研究結果說明接受個案管理，提供完善的專業醫療照護，使得達到有效的監控及管理，進而改善整體的健康狀況，發揮降低醫療相關耗用。結論與建議目前愛滋病除了藥物治療外，還配合個案管理，透過專業整合性照護，有效控制病情、降低伺機性感染的發生及死亡率，透過此研究更能印證。建議政府與醫療相關機構持續整合並平行推廣愛滋病個案管理模式，有效運用醫療資源，降低醫療費用，提高感染者的生活品質並回歸於社會，達到雙贏之局面。

關鍵字

愛滋病；個案管理；醫療資源耗用

並列摘要

Purposes AIDS is the most important infectious diseases in the heal-care issues in the world. It is effective in reducing mortality and prolonging life through the HAART therapy (cocktail therapy) and case management. However, due to the gradual decline in the age of patients with AIDS which paid in our public health insurance system, we will face the challenge of limited for those patients. Hence, the main purpose of this study is that those patients with AIDS received case management can effectively reduce the medical resources. Methods This population-based longitudinal study was analyzed by using the National Health Insurance Research Dataset in Taiwan. The statistical analyses were included independent T test, Chi-square test, linear regression, McNemar test, Cox proportional risk analysis and Kaplan-Meier survival curve survival analysis. Results The patients with AIDS received case management were 20.46% in 2005 and 60.08% in 2013. The average age of 31.37±8.94 years (p = .019), the number of medical visits of 22.65 ± 24.02(p<.001), the total cost of 88,689±163,127 new taiwan dollar(p=.005), duration of hospitalization of 19.03±25.65 days(p=.041), the total cost of hospitalization of 448,497±375,838 new taiwan dollar (p=.002), survival time of 101.99±1.22 Month(p<.001) were significant differences between two group. Our study showed that the intervention of case management could improved medical management, prolonged life and reducted medical consumption in patients with AIDS. Conclusion Our study suggested not only the medicine treatment, but case management could integrated medical care and reduce mortality in patients with AIDS. We suggested the govement and health-care provider should promote the case management which could be beneficial in medical resource and consumption, and in quality of lift in patients with AIDS.

並列關鍵字

AIDS ； case management ； medical resource consumption

參考文獻

中文文獻

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