探討護理人員罹患癌症後續醫療資源耗用與醫療療效之長期縱貫性研究

To Evaluate Medical Resource Utilization and Medical Outcome among Nurse with Cancers: A Long-term Longitudinal Study

陳小芬(Hsiao-Fen Chen)

指導教授 ： 許弘毅

高雄醫學大學/健康科學院/醫務管理暨醫療資訊學系碩士在職專班/碩士(2018年)

摘要

研究目的
目前國內對於護理人員健康議題的研究，大多以護理工作壓力、輪班、職業環境與癌症風險為研究主題，但探討護理人員罹癌相關特性的研究較缺乏，也沒有罹患癌症後續醫療資源耗用與醫療療效之相關研究。因此本研究目的希望藉由大型健康保險資料庫的長期資料分析，探討護理人員罹患癌症相關特性之長期趨勢、醫療資源耗用與醫療療效之差異及其重要影響因子。
研究方法
本研究採回溯性縱貫性研究設計，研究對象為罹患癌症之護理人員，利用1997年至2013年全民健康保險資料庫百萬人承保抽樣歸人檔與門、住診醫療費用進行串檔研究。為降低對照樣本之選擇性誤差，將人口學特型、臨床特性及機構特性作為基準，對罹癌之護理人員與一般族群進行傾向分數(PSM) 1:8配對。並運用卡方趨勢分析評估罹癌護理人員個人特性、臨床特性以及機構特性之長期趨勢，線性複迴歸分析以及Cox存活分析，探討罹癌護理人員在研究期間醫療資源耗用與醫療療效之趨勢變化及其重要相關影響因素。
研究結果
研究發現罹癌之護理人員434位，一般族群3,472位。研究期間罹癌護理人員年齡有增加趨勢以及罹癌時的年資幅度改變增加最大(ES=1.02)。護理人員癌症發生率為一般族群的0.29倍(95% CI= 0.27~0.32)，罹癌風險顯著較低。在醫療資源耗用方面，罹癌之護理人員與一般族群雖無顯著差異(p=0.641)，但是在死亡前一年罹癌之護理人員醫療總費用明顯高出一般族群305,024元。在醫療療效方面，兩組在癌症復發率及死亡率並無顯著差異(p=0.615)。
討論與建議
研究結果顯示護理人員比一般族群罹癌風險顯著較低，罹癌後在醫療資源耗用以及醫療療效皆無顯著差異。表示護理人員對於一般族群有較佳的預防保健概念，且不會因為個人醫療知識專業化程度較高，進而影響其高度使用醫療資源，也不會提早接受癌症醫療。建議護理人員因身為醫療知情者，工作忙碌之餘，應更加照護自己的身心健康，除早期發現更應積極投入治療或介入照護措施，以提高生活品質。

關鍵字

護理人員 ； 癌症 ； 醫療資源耗用 ； 發生率 ； 死亡率

並列摘要

Research purposes
Currently, most researches on the health issues of nursing staff focuses on their work pressure, working shifts, work environment and cancer risk. However, there is a lack of researches on the relevant characteristics of nursing staff with cancers, and there is also a lack of researches on the medical resource consumption and medical efficacy of nursing staff with cancer. Therefore, the purpose of this study, conducted with the analysis of long-term data from large health insurance databases, is to explore the long-term characteristics of nursing staff with cancers, the differences in the medical resource consumption and medical efficacy, and other important factors.
Research method
This study aimed at nursing staff with cancers as research objects, adopting retrospective longitudinal research design. The data were obtained from the Longitudinal Health Insurance Database (LHID 1997 to 2013) of Taiwan National Health Insurance Research Database, linked with the medical expenses of the outpatients and the inpatients. In order to reduce the selection bias of the control samples, the demographic characteristics, clinical characteristics and institutional characteristics were used as benchmarks while Propensity Score Matching (PSM) of 1:8 between nurses with cancers and ordinary people was conducted. Chi-Square Trend Analysis was adopted to assess the long-term trend of personal characteristics of nursing staff with cancers, clinical characteristics, and institutional characteristics while Linear Regression Analysis and Cox survival analysis were adopted to explore the trend and change between the nursing staff's medical resource consumption and medical efficacy during the study period, as well as other important factors.

Research result
434 nursing staff with cancers and 3,472 ordinary people were analyzed in this study. During the study period, the age of the nursing staff with cancers was increasing, and the change in the age range of developing cancers increased the most (ES=1.02). The cancer incidence rate among nurses was 0.29 times as high as that of the ordinary people (95% CI = 0.27 to 0.32), indicating that cancer risk was significantly lower. In terms of the medical resource consumption, there was no significant difference between the nursing staff with cancers and the ordinary people (p=0.641), but the total medical expenses of the nursing staff with cancers was significantly higher than that of the general population by NTD$ 305,024 one year before the death. In terms of medical efficacy, there was no significant difference in cancer recurrence rate and mortality rate between the two groups (p=0.615).
Conclusion and suggestion
This study concluded that the nurses have a significantly lower cancer risk than the ordinary people, and there was no significant difference in the medical resource consumption or the medical efficacy after developing cancers. In other words, the nursing staff is more aware of health care than the ordinary people. However, the nursing staff, even with high degree of medical knowledge, may not overuse the medical resources or receive medical treatments for cancers earlier. It is recommended that the nursing staff with medical expertise should pay more attention to physical and mental health of their own. When diagnosed with cancers in early stage, the nursing staff should actively receive medical treatment or medical preventions to improve life quality.

並列關鍵字

nursing staff ； cancers ； medical resource utilization ； incidence rate ； mortality rate

參考文獻

英文文獻

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