臺灣特殊需求者牙科門診資源耗用分析研究

The Resources Utilization Analysis of Outpatient Dental Services among People with Special Needs in Taiwan

林昱璇(Yu-Shiuan Lin)

指導教授 ： 葉德豐

中臺科技大學/管理學院/健康產業管理研究所/碩士(2012年)

摘要

研究背景：隨著國民的生活水準提高，對健康需求也由被動式的治療疾病，轉換為主動的預防疾病發生，口腔健康的重要也逐漸受到重視，特殊需求者口腔健康普遍比一般人差，對牙醫需求比一般人高，目前尚無針對此族群為研究對象的全國性研究，探討其口腔健康的相關因素。
研究目的：透過了解特殊需求者接受牙科醫療服務情形，提供作為其追蹤及治療的依據，建立其服務網絡，落實世界衛生組織(WHO)所提出的全民健康的理念。
研究方法：本研究為橫斷式研究，藉由國家衛生研究院健康保險資料庫2005年承保抽樣百萬人歸戶檔之2009年醫療利用資料，門診處方及治療明細檔(CD)與門診處方醫令明細檔(OO)中的特定治療項目代號，分析國內特殊需求者牙科門診就醫狀況，利用SPSS 19統計軟體，以卡方檢定、獨立t檢定、變異數分析與羅吉斯迴歸分析，探討其特殊需求牙科醫療耗用情形使用狀況。
結果：研究結果顯示，符合身障牙科治療條件者共966人，其中男性569人(57.1%)、女性為427人(42.9%)；年齡0-17歲為228人(22.9%)、18-64歲為637人(64.1%)佔多數、65歲以上為131人(13.2%)；身障類別以身心障礙者892人(89.6%)佔多數，精神障礙僅佔104人(10.4%)；身障等級以重度佔多數597人 (59.9%)，中度399人(40.1%)；就醫次數最少為1次，最多為26次，就醫次數為4次以內佔67.1%。4266人次牙科門診中，使用身障牙科身份的為3030人次，佔全部就診次數的71.2%。根據羅吉斯迴歸分析的結果，在控制其他變項的影響後，女性使用身障的機率顯著低於男性(OR=0.847, p=0.024)；中度使用身障牙科機率顯著低於重度(OR=2.347, p=0.000)；「年齡」與「身障類別」在使用身障牙科機率則無顯著差異；使用身障牙科施行根管治療顯著低於於未使用身障牙科進行根管治療(OR=0.349, p=0.000)；地區醫院使用身障牙科治療機率顯著高於醫學中心(OR=0.448 p=0.004)，基層院所使用身障牙科治療機率顯著低於醫學中心(OR=-0.199, p=0.045)，區域醫院則無顯著差異；在「就醫區域」方面，除高屏與東區使用身障牙科機率與台北區無顯著差異外，其他三區均顯著高於台北區，勝算比(OR)介於1.518至2.212。在控制其他變項的影響後，表示使用身障牙科的平均每件醫療費用比未使用的多79.7%；男性的平均每件醫療費用比女性少4.7%；成人（18-64歲）的平均每件醫療費用比兒童（0-17歲）多19%，老人（65歲以上）的平均每件醫療費用比兒童少8%；身心障礙的平均每件醫療費用比精神障礙多18.5%；「就醫院所」與牙科門診醫療費用的關係中，地區醫院平均每件醫療費用比醫學中心高17.1%；基層院所使用身障牙科平均每件醫療費用比醫學中心少16%，區域醫院平均每件醫療費用比醫學中心少5.7%。符合身障牙科麻醉治療條件者共187人次，未使用身障牙科為13人次佔7.0%、使用身障牙科為174人次佔97.0%，「麻醉方式」以全身麻醉為最多(43.3%)，其次依序為靜脈麻醉(33.7%)、麻醉照護(23.0%)；全身麻醉之「麻醉時間」以2小時以內為最多(66.7%)，其次依序為2-4小時(23.4%)、4小時以上(9.9%)。
結論：研究結果得知特殊需求者中以男性比女性多，年齡分布以成人 為最多(64.1%)，在身障等級中重度佔多數、在身障類別中身心障礙佔比率最高；主要牙科治療項目以牙結石清除為主，樹酯充填(18.6%)次之；就醫區域以中區最高，台北次之；就醫院所以基層院所為最多，提供麻醉服務以醫學中心最高，全身麻醉為主，對象年齡層以成人為主，兒童次之。本研究建議應加強宣導，建立特殊需求者之醫療網絡，應多數特殊需求者尋求治療以基層院所為最多，卻無麻醉之服務，麻醉醫師跨院支援，協助特殊需求者接受治療，提高特殊需求者就診率。

關鍵字

牙科治療 ； 醫療資源耗用 ； 麻醉 ； 特殊需求

並列摘要

Background: With the increasing living standards, the needs of health were transformed from disease treatment into preventive medicine. Oral health becomes an important issue. The oral health demands of people with special needs are higher than the generals. There seemed to be a lack of countrywide study in the oral health-related factors.
Objective: This study aimed to investigate the dental healthcare utilization of people with special needs in order to provide the guides for follow-up and treatment, build up the service network, and fulfill the idea of universal health that WHO has always advocated.
Methods: This study used the cross-sectional study from the National Institutes of Health 2009 Health Insurance database, the out-patient prescription and treatment of the detail file (CD) and outpatient prescription physician order detail file (OO) in the specific treatment program code to analyzed dental outpatient utilization of people with special needs The utilization of dental services and anesthesia services were explored by SPSS 19 statistical software,.
Results: The results showed that a total of 966 was enrolled our study. There were 569 male(57.1%) and 427 female (42.9%); 17 years old and less, 18-64 years old, and more than 65 years old were 228 (22.9%), 637 (64.1%) and 131 (13.2%) respectively ; the physical disabilities and mental disorders accounted for 892 (89.6%) and 104(10.4%) respectively; severe disabled level accounted for 597 (59.9%) and others accounted for moderate; number of visits ranged from 1 to 26, and 67.1% visited 4 times or less. A total of 4266 dental outpatient were enrolled in our study. 3030(71.2%) visits were treated as the special needs. According to the results of the logistic regression analysis, after controlling the other variables, the use of the special needs in female were significantly lower than male (OR = 0.847, p = 0.024), severe disabled level were significantly higher than moderate (OR = 2.347, p = 0.000); "age" and "disabled category" showed no significant difference; treatment for root canal treatment was significantly lower than not-treatment (OR = 0.349, p = 0.000); medical center was significantly lower than district hospitals (OR = 0.448 p = 0.004) but higher than primary clinics(OR=-0.199, p=0.045); except Kaohsiung-Pingtung and Eastern, the three other areas were significantly higher than Tiepei area(OR=1.518~2.212). After controlling the other variables, the health expenditure of using special needs was 79.7% higher than non-using cases (exp (B) = 1.797, p = 0.000); the male was 4.7 % higher than female (exp (B) = 0.953, p = 0.009); adults (18-64 years old) was 19% higher than children (0-17 years old)(exp (B) = 1.019, p = 0.412), the elderly (over 65 years) was 8% less than children(0-17 years old) (exp(B)=0.920, p=0.008); the physical disabilities 18.5% higher than mental disorders(exp(B)=1.185, p=0.000); district hospitals were 17.1% higher than medical center, but primary clinics and regional hospitals were 16%and 5.7% lower than medical center. A total of 187 were accepted the anesthesia treatment for special needs, only 13(7.0%) visits did not claim their special identity. There were 43.3% general anesthesia, 33.7% intravenous anesthesia, and 23.0% anesthesia car. In general anesthesia time, most (66.7%) were less than two hours, 23.4% were 2-4 hour , and only 9.9 % were more than four hours.
Conclusion: The results indicates that among the special needs, male is more than female. As for the age distribution, the adults (18-64 years) account for 64.1% of the total. The severely disabled accounts for the majority. Among the disabled category, people with physical disabilities is the highest. In the dental treatment projects, the item to clear the main tartar accounts for 18.6% of the total, followed by the resin filling. The central area is the highest , followed by Taipei area. The medical center is the highest in the anesthesia services; the general anesthesia is the main item; the main patients are adults, followed by children. This research suggested that advocacy should be strengthened to improve the attendance rates of the patients of special needs.

並列關鍵字

special needs ； dental treatment ； medical resource utilization ； anesthesia

參考文獻

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