台灣高齡人口健康促進對自覺健康及醫療服務利用之影響

The Impact of Health Promotion on Perceived Health Status and Health Services Utilization Among the Elderly in Taiwan

謝麗卿(Li-Ching Hsieh)

指導教授 ： 張明正

亞洲大學/健康學院/健康管理研究所/碩士(2008年)

摘要

本研究主要目的在瞭解台灣高齡人口健康促進生活型態現況，並探討其社會人口學變項、及自覺健康狀態與醫療服務利用的關係，綜合相關文獻的論述及配合其醫療服務利用資料，以Andersen的醫療利用行為模式為基礎，並提出建議供衛生主管機關未來研訂高齡者健康促進計畫參考依據。
研究方法 ：
研究資料取自行政院衛生署國民健康局於2003年辦理之台灣地區老人保健與生活狀況長期追蹤調查系列研究調查中之第五次追蹤調查資料。分析對象包括1989年原抽受訪樣本及1996年補充樣本，但在2003年仍存活之60歲以上追蹤受訪樣本共3084位個案。本研究中在控制基本社會人口學背景特徵變項後，分別以邏輯斯迴歸探討健康促進生活方式、自覺健康狀態對醫療服務利用情形等之影響。
研究結果如下：
1.結果顯示：年齡與身體健康狀態呈負相關，年齡愈大的老人，在身體健康狀態愈差。台灣地區65歲以上老人有11.4%的老人認為自己的健康狀況很好，24%的老人認為自己的健康狀況還算好，31.4%認為普通，26.1%認為自己的健康狀況不太好，6.9%是覺得自己很不好。
2.影響高齡人口健康促進生活型態之相關因素在人口社會特性方面：年齡與教育程度與整體健康促進生活型態具有顯著性，而健康促進生活型態與自覺健康狀態對醫療服務利用情形亦呈現顯著正相關.
3.影響醫療服務利用的有效預測因子為自覺健康狀況和健康促進生活型態兩個變項；「自覺目前健康狀況」及「健康責任」為老人醫療服務利用最強的預測因子.
4.結果顯示：老人整體自覺健康狀況越差、身體健康越不佳及健康促進生活型態不佳者，較常利用西醫醫療服務，而健康促進生活型態變好、自評健康變好的老人西醫門診服務利用的次數顯著較少。
5.營養狀況會影響醫療服務的利用，特別在門診、急診及住院次數，自覺健康狀況及營養狀況越差者其醫療服務的利用越多。因此本研究建議應對老人傳達正確的飲食觀念及營養行為之衛教.
6.健康促進生活方式及自覺健康狀態的加入，確實有助於提升醫療利用模型之解釋能力；且不同健康促進生活方式對於自覺健康狀態的影響不同。
因此本研究建議未來要探討健康促進對醫療服務利用影響的研究宜採用長期追蹤的研究方法，並且增加健康促進變項，以便能看出其與自覺健康狀態及醫療服務利用之間影響關係，讓醫療資源得以獲得更妥善的運用。

關鍵字

健康促進 ； 自覺健康 ； 醫療服務利用

並列摘要

The purpose of this research is to understand the current health promotion life styles of the elderly population. This research is based on Andersen’s Medical Service Utilization Behavior Model. This model reveals the relationship between the demographic variables, self- perceived health status and medical service utilizations, and to combine the related literature and the data of medical service utilization to propose suggestions for sanitary control within health organizations in order to establish the elderly population health promotion program in the future.
Research methods：
The research data is from the 2003 fifth research of the senior citizen health and living status long term care follow-up by Bureau of Health Promotion, Department of Health. The analyzed objects include the original samples from 1989 and the supplementary samples from 1996. However, as of 2003, only 3084 samples above 60 years old still survive. After the basic demographic variables had been controlled, the researcher utilized logistic regression to discover the influence of health promotion life style, self-perceived health status and medical service utilization.
The research results are as below：
1.The results show that age and physical health conditions have negative correlations. The older the senior citizens are, the worse their health status. 11.4％ senior citizens who are above 65 of age think they are in good health condition, while only 24％ think their health conditions isn’t bad, and 31.4％ think their health condition is average and 26.1％ think they don’t have good health condition and 6.9％ senior citizens think their health condition is not good at all.
2.The significant factors that seem to affect the elder population health promotion life style among demographic characteristics are age, educational background and health promotion life style. Health promotion life style and self-perceived health status have positive correlation toward medical service utilization.
3. The effective predictive factors that seem to affect medical service utilization are self-perceived health status and health promotion life style. Self-perceived current health status and health responsibility are the strongest predictive factors when making the most of senior citizens medical services.
4. The results of this study show that senior citizens who have lower self-perceived health status, unhealthy physical conditions and negative health promotion life style use modern medicine medical services more often. In contrast, if they have better health promotion life style, better self-perceived health status, they make less use of modern medicine medical services.
5. The nutritious status affects the utilization of medical service. Senior citizens who have worse self-perceived health sand nutrition status, make use of medical service more often, especially, in frequency of use of outpatient services, emergency treatments and hospitalizations. Thus, this research suggests conveying proper education to senior citizens concerning correct eating habit and nutritious behavior.
6. Health promotion lifestyle and self-perceived health status are useful in explaining medical promotion utilization models.
This research suggests that utilizing long term follow-up studies
will reveal how health promotion affects use of medical services, and adding health promotion variables to see how they influence the relationship between self-perceived health status and medical service utilization. A better understand of this phenomenon will make for better allocation of medical resources.

並列關鍵字

health promotion ； self-perceived health ； medical service utilization

參考文獻

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