精神疾病對於糖尿病患者醫療資源利用影響評估

Evaluation of Mental Illness Effects on Medical Utilization of Diabetic Patients

黃俊仁(Chun-Jen Huang)

指導教授 ： 毛莉雯

高雄醫學大學/健康科學院/公共衛生學研究所碩士在職專班/碩士(2005年)

摘要

本研究的目的在探討糖尿病患好發精神疾病者之危險因子，並比較糖尿病患精神疾病高危險群及低危險群之醫療資源利用情形，及探討糖尿病患中精神疾病好發危險與否對於醫療資源利用之影響。
本研究採立意取樣橫斷性研究，對某醫院之糖尿病患236人進行問卷訪測，以前瞻性方法進行一級資料蒐集，包括糖尿病患之基本資料、健康狀態及中國人健康問卷評估其精神狀態，並以中國人健康問卷將研究對象分為1.精神疾病高危險群及2.精神疾病低危險群等兩組。並輔以次級資料之分析，將兩組糖尿病患相關資料與其民國92年健保費用資料檔做一串連，健保資料庫包括患者之門急診及住院之醫療費用、就診次數、主診斷碼..等，比較兩組糖尿病患精神狀態與醫療資源利用是否有所差異，並探討糖尿病患之基本特質、健康狀態..等相關因素。
本研究發現在糖尿病患者人口學特質中，只有年齡及婚姻狀況達統計學上顯著差異，其餘皆未達統計學上顯著差異；在健康狀況的部份，兩組患者在是否有其它身體疾病、合併症數、平均病程達統計上顯著差異，其餘皆未達顯著差異。在醫療使用部份，除平均門診次數達統計學上顯著差異外，其餘皆未達顯著差異。
在糖尿病患者醫療費用之影響因子部份，顯著影響門診費用的因子包括血糖控制值(HbA1c)及病程，調整後整體迴歸模式的解釋力達18.9%。顯著影響糖尿病患者住院費用的因子包括居住狀況、是否罹患高血壓、心臟病、肝病、腎臟病、巴金森氏症及其它疾病，調整後整體迴歸模式的解釋力達15.0%。顯著影響總醫療費用的因子包括居住狀況、是否高血壓、心臟病、肝病、腎臟病及其它疾病，調整後整體迴歸模式的解釋力達16.9%。
本研究中，精神疾病高危險群患者之平均年齡顯著較低危險群高，喪偶者在高危險群中的所佔比例亦顯著較低危險群高；精神疾病高危險群患者相較於低危險群患者，有較多的身體合併症，且高危險群患者其病程亦顯著較低危險群患者長。
精神疾高危險群患者有顯著較多的門急診就醫次數。除門急診次數達顯著外,門急診及住院總額、住院次數天數及總醫療費用，皆未達到統計學上顯著差異，但就平均值而言，精神疾病高危險群患者之門急診及住院總額、住院次數天數及總醫療費用，皆較精神疾病低危險群患者的平均值高。
而在門急診、住院及總醫療費用之影響因子部份，精神疾病高低危險，並無法明顯去預測該群糖尿病患者醫療資源利用情形；顯著影響門急診費用的因子為血糖控制值及病程；患者之居住狀況與身體健康狀況中是否罹患其它身體疾病，對於住院費用及總費用有較大程度的影響。

關鍵字

糖尿病 ； 醫療資源利用 ； 精神疾病

並列摘要

The objective of this study is to probe into the risk factors for mental illness in diabetes patients, compare medical utilization in diabetes patients in high- and low-risk groups for developing mental illness, and find out whether the risk of development of mental illness in diabetes patients has any effect on medical utilization.

This study used purposive sampling and cross-sectional design. 236 Diabetes patients at a certain hospital were interviewed by means of questionnaire, and a prospective method was used to collect data, including patients’ demographic data and health status. A Chinese health questionnaire was used to assess patients’ mental status and divide subjects into two groups, namely 1. high-risk group for developing mental illness and 2. low-risk group for developing mental illness. Following, the data were analyzed and matched with health insurance files of 2003. These health insurance files included data regarding costs of outpatient/emergency treatment and of hospitalization, the number of consultations, main diagnostic code, etc. A comparison was made to see whether there was a difference between the two groups in terms of mental status and medical utilization, and related factors were studied, such as patients’ basic characteristics, health status, etc.

With regard to diabetes patients’ demographic data, this study found a statistically significant difference for age and marital status, while no statistically significant difference was found for the other variables. With regard to health status, a statistically significant difference was found between the two groups for whether patients had any other disease, for the number of complications, and for mean disease course, while for the other variables no statistically significant difference was found. With regard to medical utilization, a statistically significant difference was only found for the mean number of outpatient consultations.

With regard to factors influencing medical costs in diabetes patients, factors that significantly influenced the costs of outpatient/emergency treatment included HbA1c level (indicator of blood glucose level) and disease course. After adjustment the full regression model explained 18.9% of the variance in costs of outpatient/emergency treatment. Factors that significantly influenced the costs of hospitalization included living conditions and whether or not the patient had hypertension or heart, liver, kidney, Parkinson’s or any other disease. After adjustment the full regression model explained 15.0% of the variance in costs of hospitalization. Factors that significantly influenced total medical costs included living conditions and whether or not patients had hypertension or heart, liver, kidney or any other disease. After adjustment the full regression model explained 16.9% of the variance in total medical costs

In this study, the mean age of patients in the high-risk group for developing mental illness was significantly higher than in the low-risk group. The high-risk group had a significantly higher ratio of widows than the low-risk group. Compared to patients in the low-risk group, patients in the high-risk group had more physical complications, while their disease course was significantly longer.

The patients in the high-risk group required more outpatient/emergency consultation than low-risk group significantly. No statistically significant difference was found for the costs of outpatient/emergency treatment and the total costs of hospitalization, the number of times and days of hospitalization, and total medical costs. The mean values for total costs of outpatient/emergency treatment and hospitalization, number of times and days of hospitalization, and total medical costs, however, were higher in the high-risk group than in the low-risk group.

Factors influencing costs of outpatient/emergency treatment and hospitalization and total medical costs cannot clearly predict medical utilization in diabetes patients in high- and low-risk groups for developing mental illness. Factors that significantly influence costs of outpatient/emergency treatment are HbA1c level and disease course.
With certain living conditions and health status, the fact whether a patient also has any other disease has a relatively great effect on the costs of hospitalization and total medical costs.

並列關鍵字

Medical Utilization ； Diabetes Mellitus ； Mental Illness

參考文獻

1. ADA(1998): Economic Consequences of Diabetes Mellitus in the U.S. in 1997, Diabetes Care, 21(2), 296-309.

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