智能障礙者使用抗精神疾病用藥情形之分析

The Exploration of Psycholeptics Using in Intellectual Disability

張剛準(Gang-Zhun Zhang)

指導教授 ： 徐尚為

亞洲大學/健康學院/健康管理研究所/碩士(2011年)

摘要

目的: 精神疾病是智能障礙者最常見合併症之一，需透過藥物來穩定治療，然而國內對其相關研究卻相當缺乏。本研究針對智能障礙者使用抗精神疾病用藥之探討，針對該弱勢族群的醫療利用與資源分配之研究。
方法: 使用2004~2007年全民健康保險資料庫，擷取ICD-9編碼為317~319之智能障礙編碼者作為本研究樣本，再串聯醫令檔篩選有使用ATC編碼為N05A用藥之智能障礙者，分析影響其醫療耗用與用藥差異之情形。
結果: 2004~2007年智能障礙者使用抗精神疾病之盛行率為14.0~17.3 %，女性盛行率14.8~18.0%高於男性盛行率13.5~16.7%。就醫場所以區域醫院最高佔42.1~45.5%，醫院地區以都市地區居多佔66.6~70.4%。醫療耗用上，性別僅在藥費沒有差異，給藥天數方面，男性多於女性15.3天。障礙程度、部分負擔及投保地區之差異，均會影響藥費與給藥天數。進一步以邏輯斯迴歸分析各種抗精神疾病用藥發現，因個人特質與就醫場所差異而有所不同，且以就醫場所因素之影響大於個人特質因素。
結論: 本研究初步探討智能障礙者對抗精神疾病用藥情形，釐清個人特質與就醫場所影響抗精神疾病用藥之差異。於醫療資源配置上，建議需重視鄉村與偏遠地區之智能障礙者就醫可近性，以增進其醫療福址。此外，建議往後研究者，可以針對智能障礙者長期用藥或合併其他疾病影響醫療耗用情形作探討。

關鍵字

智能障礙 ； 抗精神疾病用藥 ； 醫療利用

並列摘要

Purpose: Mental illness is one of the most common complications among the intellectual disability that needs stabilize the treatment through medication. However, the domestic researches on this subject are quite few. This research is to explore the use of antipsychotics by the intellectual disability and conduct a further research on the health care usage and resource allocations for the disadvantaged groups.
Methodology: Using 2004 to 2007 National Health Insurance Research Database, people with ICD-9 codes 317-319 were selected as the intellectual disability. Subjects who use ATC N05A medicine were screened to analyze outpatient health care utilization.
Results: From 2004 to 2007, the prevalence rates of using antipsychotics by the intellectual disabled was 14.0~17.3 % in which the female’s 14.8~18.0% is higher than the male’s 13.5~16.7%. In term of medical treatment site, the regional hospitals account for the largest part of sites with 42.1~45.5% while urban areas account for the largest part of locations of hospital with 66.6~70.4%. On medical consumption, the gender difference only not appears in the medicine cost. As to the of days of medicine prescription, the male have 15.3 days more than the female and the differences of degree of disability, copayment and insurance areas will affect the cost of medicine and the number of days of administration. After logistic regression, we found that there were differences with the different personal characteristics and medical treatment sites and the factor of medical treatment sites had greater effects than the factor of personal characteristics.
Conclusions: In this research, we had preliminary study of medication of antipsychotics by the intellectual disabled to clarify the effects of personal
characteristics and medical treatment site on the differences of medication of antipsychotics. On the part of medical resource allocations, we recommend that the authorities pay more attention to the availability of medical treatment for the intellectual disabled in countryside and remote areas to enhance their medical welfares. In addition, we also recommend that the follow-up researchers conduct further exploration into the effects of long-term medication or association with other diseases by the intellectual disabled on medication consumption.

並列關鍵字

intellectual disability ； antipsychotics ； medical utilization

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