高雄地區長期照護機構65歲以上住民牙科就醫行為及牙科服務滿意度之調查

本研究目的乃針對高雄地區65歲以上長期照護機構住民本身，因多數長照住民有行動障礙、存留牙顆數、口腔清潔方式、醫療資源的分佈問題等，故調查其過去三年內牙科服務的滿意度、就醫行為及就醫相關經驗，並探討彼此間的相關性。本研究為橫斷性研究（Cross-sectional study），採分層立意取樣調查(Stratified-purposive sampling survey)。資料收集於民國98年8月至民國98年12月期間，高雄縣市長期照護機構住民的資料，包括：性別、年齡、留置機構期間、慢性疾病、殘障類別與嚴重度、牙科就醫行為及牙科服務滿意度等情形。共計19間長照機構，包含養護中心和護理之家，以及335位65歲以上住民參與牙科就醫行為調查，其中95位有牙科就醫行為之住民再進行牙科服務滿意度調查。資料以JMP6.0及SPSS10.0統計軟體進行資料整理和分析，並以χ2 test for trend、ANOVA和事後檢定來解釋各變項之間的相關性，複迴歸及邏輯斯迴歸為分析影響牙科就醫行為或牙科服務滿意度之重要因子。 335位住民中，其中男性153位，女性182位，平均年齡77.3歲，以75歲至84歲之年齡層病患最多。社會人文變項中，輕度以上失能者佔65.1%、持有身心障礙手冊者佔32.8%。平均每人罹患慢性病2.4種，疾病診斷以高血壓居多(53.4%)、其次為糖尿病(35.5%)、第三則是中風者(28.7%)。在口腔方面，存留牙顆數為20顆以上的住民佔12.8%，存留牙顆數為1~19顆的住民佔59.7%，全口無牙者佔27.5%。機構住民的留置期間，以小於1年者(38.2%)最多。3年內有牙科就醫行為的比率為28.4％。1年內有定期回診率4.2%。牙科就醫的原因大都是牙痛(75.8%)，不規律牙科就醫的大部份原因是老人覺得不需要(57.7%)，其次有活動障礙者佔53.3%。三年內牙科服務之整體滿意度(總分):滿意佔50.5％，不滿意佔49.5%。最滿意的項目是牙醫師的態度(83.2%)，其次是牙科接待人員的態度(78.9%)。不過，『在治療後，牙科人員會提供衛教口腔清潔和預防資訊』是不滿意項目中比率最高者。本研究結果顯示由於台灣老年人口日益增多且因受限於身體功能障礙和慢性疾病較多，使口腔健康狀況亦不佳。其相關影響因素為：住民年齡、日常生活自理能力(ADL)、慢性疾病，和口腔清潔方式等。另外，牙科服務之滿意度雖無直接影響老年住民之牙科就醫行為，但老年住民『再追蹤的意願度』與牙科服務滿意度是有顯著關係的。因此，為了提升長期照護機構住民之口腔健康，建議應請牙醫師每半年至機構做例行性口腔檢查，並在機構設置專業專職的口衛人員，以進一步改善老年住民的口腔衛生環境、規劃良好的繼續教育課程，以加強醫師和牙科輔助員的相關專業知識技能，提供衛教口腔清潔和預防資訊及提昇服務態度。並應就如何解決老年住民的活動障礙來做進一步的思考。

關鍵字

長期照護機構；口腔照護；滿意度；就醫態度；口腔狀況

並列摘要

The main purpose of this study was to investigate the dentist visiting experience of residents above 65 years old, their satisfaction of dental service in the past three years and explored their correlation.Method: This study was a cross-sectional study and a stratified-purposive sampling survey. The data was collected from 335 residents above 65 years old in 19 long-term care institutions in Kaohsiung City and County from August to December 2009, questionnaires including: sex, age, and education level, duration of living in long-term care institutions, related systemic diseases, type and level of disability, the dentist visiting experience and the satisfaction of dental service. The collected data was processed and analyzed with statistical software JMP6.0 and SPSS10.0, and the correlation of each variable was analyzed by Chi-Square Test for Trend, ANOVA, and Logistic regression.Results: There were a total of 335 residents interviewed, 153 male and 182 female residents. The average age of the residents was 78.85 years old. The highest distribution of age range was between 75 and 84 years old. For social demographic variables, 32.8% of residents were certified as disabled, and 53.3% with motion barrier. The residents were diagnosed with 2.4 chronic diseases in average, among that, hypertension was the most often seen chronic disease 53.4%, DM was 35.5%, and “stroke” was 21.2% respectively. In oral condition, the number of existed and with functional teeth more than 20, ranged between 1-19 and the edentulous was 12.8%, 59.7% and 27.5% respectively. Most of the residents (38.2%) stayed in the institutions less than one year. The utilization of dental services of residents in the past three years was 28.4% and the follow-up rate of every single year in the past three years was 4.6%. The main reason of dental visit was toothache (75.8%). The majority of reasons for irregular dental check-up was “no need” (57.7%), and “motion barrier” (53.3%). Furthermore, the satisfaction of residents to the overall dental service in the past 3 years showed that the “satisfied” was almost the even with “dissatisfied” (50.5%, 49.5%). The highest satisfied item was “the attitude of the dentist” (83.1%), and then “the attitude of the dental receptionist” (78.9%). Nevertheless,”oral education of dental professionals” was the lowest satisfied item.Conclusions: The study shows that the oral health condition of the elderly is becoming worse due to the number of elderly population and their physical function impairment and chronic diseases is gradually increasing in Taiwan. The main factors affecting dental visit are as follows: age of residents, ADL, chronic diseases and tooth-brushing behavior. Although satisfaction of dental services doesn’t affect the utility rate of dental visit for the elderly residents, “willingness of dental check-up” is an important factor to affect the dental service satisfaction.In order to improve the oral health of elderly residents in the long-term care institutions, the activities of oral hygiene instruction for the elderly residents should be arranged in the institutions by the professionals, a biannual oral examination for long-term care residents is highly recommended. Furthermore, the continuous education curriculum concerning oral health education to enhance the knowledge and skill of dentists, dental hygienists, assistants and caregivers should be conducted. provide oral education and prevention information, and promote the service attitude of dental professionals. We need to make ponder to solve the elderly resident's motion barrier further.

並列關鍵字

Long-term care institutions ； oral care ； patient satisfaction ； the experience of dental visits ； the attitude of dental visits ； oral health survey ； oral hygiene