基層醫療診所的酒癮盛行率

Prevalence of Alcoholism in a Primary Care Setting

郭千哲(Chian-Jue Kuo)

《台灣精神醫學》 19卷2期 (2005/06) Pp. 137-147

https://doi.org/10.29478/TJP.200506.0007

摘要

目的：本研究在一基層醫療求診者中，探討酒癮盛行率和相關特質。方法：樣本為1993年11月至1994年4月台北縣金山鄉群醫中心的求診者。在1432位求診者，以系統取樣選取198個案進行二階段研究。其中73位曾飲酒，有70位完成實驗性酒癮篩檢問卷及精神科醫師半結構化臨床會談確定診斷。由回顧近一年的病歷是否有記載酒精相關問題，探討基層醫師對酒癮者的偵測率。結果：研究樣本與社區人口比較，前者顯示年齡分佈老化且女性較多。依ICD-10-DCR診斷準則，酒癮一年及終生盛行率分別為6.7及11.1%，若依DSM-Ⅲ-R，則為7.7%及13.8%。在13位一年內具酒癮的個案中，2位具酒精心理性依賴；但有10位(76.9%)具重覆身體傷害，包括酒精導致的肝病、高血壓、消化性潰瘍及痛風等。基層醫師可偵測8.3%酒癮個案，而依文化差異發展的一篩檢工具(C-CAGE)可偵測84.6%的酒癮個案。結論：基層醫療求診之酒癮個案，少數達依賴程度，大多有酒精相關身體傷害，係屬酒癮病程較前期，具防治價值。基層醫師之低偵測率，建議可用酒癮篩檢工具輔助。

關鍵字

盛行率 ； 酒精傷害性使用 ； 酒精依賴 ； 基層醫療診所

並列摘要

Objective: This study investigated the prevalence of alcoholism and its associated factors in a primary care setting. Methods: From November 1993 to April 1994, 198 subjects were enrolled randomly and systematically from 1432 individuals visiting a primary care setting in Taipei County. Among them, 73 subjects reported having used alcoholic beverages in theft lifetime. An experimental self-administered alcoholism screening instrument (E-CAGE) was completed by 70 of these subjects, and each of them also received a clinical interview by a psychiatrist for the diagnosis of alcoholism. The physician diagnosis of alcoholism was made based on alcohol-related problems recorded in the medical charts in the recent one year. Results: Compared with the community population, this study sample had a higher proportion of older ages and female gender. Using the ICD-10-Diagnostic Criteria for Research (ICD-10-DCR) and DSM-Ⅲ-R, the one-year/lifetime prevalence of alcoholism was 6.7%/l1.1% and 7.7%/13.8%, respectively. Among the thirteen subjects with alcoholism by one-year prevalence, only two fulfilled the criteria for alcohol dependence; however ten subjects (76.9%) had repeated physical harm associated with alcohol use, which included liver disease, hypertension, peptic ulcer and gouty arthritis, etc. Primary care physicians detected only 8.3% of alcoholism cases. However the Chinese CAGE (C-CAGE), an instrument developed by E-CAGE with consideration of cross-cultural differences, could detect 84.6% cases with alcoholism. Conclusion: Most of the subjects with alcoholism who had alcohol-related physical harm were in the early course of alcoholism. Use of the C-CAGE can assist physicians in detecting the alcoholism.

並列關鍵字

prevalence ； harmful use of alcohol ； alcohol dependence ； primary care settings

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