膽囊相關疾病患者重複就診與接受膽囊切除術機率之相關性研究

A study on the association between repeated visits by the patients with gallbladder disease and probability of cholecystectomy

許佳雯(Chia-Wen Hsu)

指導教授 ： 林文德

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2013年)

https://doi.org/10.6833/CJCU.2013.00100

摘要

目的：探討膽囊相關疾病患者重複就診及影像攝影檢查次數與接受膽囊切除術機率之相關性。
方法：利用全民健保2005年百萬承保歸人檔(LHID2005)，選擇2009年初次診斷為膽囊相關疾病且在90天內接受膽囊切除術者為實驗組，運用GMATCH配對法以初確診日、疾病別、年齡及性別為配對條件，以1:3的比例配對產生初確診膽囊相關疾病後90天內未接受膽囊切除術者做為對照組。在控制初確診醫院層級別、就醫次數、合併症等相關變項後，以羅吉斯迴歸分析重複就診及影像攝影檢查次數與接受膽囊切除術機率的相關性。
結果：研究對象1,454人，其中實驗組352人，對照組1,102人，膽囊相關疾病患者在初確診90天內就診醫院數每多一家，接受膽囊切除術的勝算就多2.8倍(勝算比為2.80，95%信賴區間為2.22-3.54)；接受影像攝影檢查次數雖與接受膽囊切除術機率成正相關，但每多一次檢查的膽囊切除術勝算約高1.14倍(勝算比為1.14，95%信賴區間為0.96-1.35)，未達統計顯著意義。
結論：臺灣民眾在初次診斷出膽囊疾病後跨醫院的重複就診並無法達到類似國外強制執行第二意見而降低手術率的效果，未來應了解患者重複就診的原因及動機，以防止不必要的重複就診行為。

關鍵字

膽囊切除術 ； 重複就診

並列摘要

Objective: This study was aimed to investigate the association between repeatedly visiting physician by patients with gallbladder-related disease as well as the number of imaging test, and the probability e of receiving cholecystectomy.
Methods: The experimental group was selected using the insurant files from the 2005 Longitudinal Health Insurance Database; patients were chosen from those who received cholecystectomy in 2009 and were first diagnosed with gallbladder-related diseases within 90 days. Next, the GMATCH algorithm was employed; the pairing conditions comprised the type of disease, age, sex, and the date of first diagnosis. The control group comprised patients who were first diagnosed with gallbladder-related diseases but did not receive cholecystectomy within 90 days. The ratio of patients in the experimental and control groups was set at 1:3. After controlling the relevant variables regarding the level of the hospital at which the diagnosis was made, the number of visits, and Charlson’s comorbidities index , a logistic regression analysis was used to measure the correlation between repeated visits from patients with gallbladder-related disease as well as the number of visits for imaging test, and the acceptance rate of cholecystectomy.
Results: The study comprised 1,454 participants; the experimental group comprised 352 participants, and the control group comprised 1102. Regarding the number of hospitals visited within 90 days following the first diagnosis of a gallbladder-related disease, an increase of one hospital increased the odds of cholecystectomy by 2.8 times (odds ratio: 2.8; 95% confidence interval from 2.22 to 3.54). Concerning the number of visits for imaging test, an increase of one visit increased the odds of cholecystectomy by 1.14 times (odds ratio: 1.14; 95% confidence interval from 0.96 to 1.35), although the association was not statistically significant.
Conclusion: C Patients’ repeatedly visiting physicians in different hospitals in Taiwan after gallbladder-related diagnoses been first made did not decrease the probability of cholecystectomy. In the future, the reason and motivation behind repeated visits must be studied to prevent unnecessary consumption of healthcare resources.

並列關鍵字

cholecystectomy ； repeated visits

參考文獻

2. 李靜玟, 吳肖琪. 市場競爭及其他因素對精神科急性住院病患醫療利用之影響. 臺灣公共衛生雜誌. 2005;24(4):296-305.

3. 王敏容, 王如萱, 王佳惠, 郭乃文. 市場競爭程度對醫院開發自費醫療服務之影響. 北市醫學雜誌. 2005;2(10):895-906.

4. 蔡文正, 龔佩珍, 楊志良, 江怡如. CT及MRI醫療利用與影響費用因素. 臺灣公共衛生雜誌. 2005;24(6):529-538.

5. 文羽苹, 黃旭明, 江東亮. 台灣醫療保健支出成長率的分析：醫療通膨，質量與公平性. 臺灣公共衛生雜誌. 2012;31(1):1-10.

6. 行政院衛生署. 民眾就醫指引手冊. 臺北: 行政院衛生署; 2006.