不同醫師專科別間糖尿病門診照護品質之差異

Exploring Variation in Quality of Diabetic Care among Different Medical Specialties

林文德(Wender Lin) ； 張睿詒(Ray-E Chang) ； 楊志良(Chih-Liang Yaung)

《Journal of Medical Education》 7卷3期 (2003/09) Pp. 271-281

https://doi.org/10.6145/jme.200309_7(3).0007

摘要

本研究旨在瞭解不同科別醫師提供之糖尿病門診照護品質差異，以為改善科別照護品質的參考。研究對象由2000年全民健保抽樣歸戶檔200,000位保險對象申報資料中，篩選門診主診斷為糖尿病或使用抗糖尿病藥物，且主要就診之醫師科別為一般科、內科及內分泌科之個案共4,584位所構成。照護品質以研究對象是否接受「糖尿病醫療服務改善方案試辦計畫」七項年度必要檢查檢驗項目為指標。專科別的照護品質差異除以單變項分析呈現外，並以對數迴歸分析呈現不同科別主診醫師之病患接受各項檢查檢驗之勝算比。結果發現內分泌科醫師主診的糖尿病患者接受各項檢查檢驗的比例均明顯高於其他兩科，此差異在控制不同科別醫師之病例組合及醫師本身之特性後，仍明顯存在於多數檢查檢驗中。故未來應在教育及訓練上加強不同專科醫師對糖尿病患者照護的一致性，以提升糖尿病之照護品質。

關鍵字

糖尿病 ； 專科別 ； 醫療照護品質

並列摘要

To examine the variation in quality of ambulatory care for diabetic patients among specialties in Taiwan, claim data from a nationally representative sample of National Health Insurance (NHI) enrollees in 2000 was analyzed. A cohort of 4,584 diabetic patients was selected, each with at least two ambulatory visits with either a generalist, internist, or endocrinologist who were their usual providers for diabetic care. Quality measures included the proportion of diabetic patients receiving from any provider the following tests or examinations that are recommended by the NHI as optimal, if provided annually: hemoglobin Ale, blood glucose, lipid profile, and SGPT (serum glutamic-pyruvic-transaminase) testing, as well as an eye examination. The results showed that unadjusted differences among generalists, internists, and endocrinologists were statistically significant for most quality measures. Inclusion of patient case-mix variables in a logistic regression model did not reduce the significance among the three specialties. After further adjusting for variations in individual provider characteristics, the specialty difference between generalists and internists was no longer significant. Nevertheless, the differences between generalists and endocrinologists as well as between internists and endocrinologists were still at a significant level for the majority of quality measures after adjusting for all variables pertaining case-mix and providers’ characteristics. These findings highlight the variation in quality of diabetic care among specialties and point to the need for better and consistent education and training programs for diabetic care among specialties as a way to improve quality of care.

並列關鍵字

diabetes mellitus ； specialties ； quality of care

參考文獻

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