居家慢性精神障礙者的醫療利用及影響因素

Determinants of Medical Utilization by Chronic Psychotic Patients Who Reside at Home

傅千芬(Chien-Fen Fu) ； 謝佳容(Chia-Jung Hsieh) ； 張國榮(Kuo-Jung Chang)

《醫務管理期刊》 14卷2期 (2013/06) Pp. 87-106

https://doi.org/10.6174/JHM2013.14(2).87

摘要

目的：探討居家慢性精神障礙者的健保卡張數、住院和復健醫療利用情形，及其重要影響因素。方法：利用2000年「身心障礙者生活需求調查」的二手資料，篩選出402名居家慢性精神障礙者為研究對象，用描述性統計分析各變項的分布情形，並以卜瓦松迴歸與羅吉斯迴歸進行資料分析，並再針對住院率和住院次數，以二部模型分析。結果：本研究結果發現，高醫療利用者（使用健保卡張數5張以上）佔39.80%，看診科別以精神科（佔69.15%）和內科（佔16.67%）較多，牙科利用率（佔0.75%）則明顯偏低；住院率為29.60%。復健醫療利用率為23.13%。研究對象中，健保卡使用張數受到「傾向」、「使能」和「需要」因素的影響較大；復健醫療利用則受到「傾向」和「使能」因素影響較大；居家慢性精神障礙者的住院醫療利用明顯受到「需要因素」（自評健康狀況）的影響，但住院次數則「傾向因素」和「使能因素」的影響。結論：居家慢性精神障礙者的醫療利用，因個人的傾向、使能和需要因素而有明顯差異，建議未來研究和政策應加強因應居家慢性精神障礙者醫療利用的公平性和適切性的問題。

關鍵字

居家 ； 慢性精神障礙者 ； 醫療利用

並列摘要

Objective: This study investigated medical utilization including the number of National Health Insurance Certificates, inpatient care, and rehabilitation services by chronic psychotic patients who resided at home in Taiwan.Methods: Records of 402 Home Care Chronic Psychotics were retrieved from the 2000 National Survey on the Welfare Status of the Registered Mentally and Physically Disabled. We determined the volume of medical utilization and its determinants by using the statistical methods of Frequency tables, Poisson Regression and Logistic Regression. We also used a two-part model and Negative Binominal Regression to analyze the determinants of the rates and volume of inpatient admissions.Results: Of these patients, 39.8% were defined as high NHI medical users who used over 5 certifi cate cards; 69.15% and 16.67% visited psychiatric outpatient services and internal medicine outpatient services, respectively. Dental care utilization was quite low (0.75%); 29.6% used inpatient care and 23.13% used rehabilitation services. The utilization of NHI Certifi cates was determined by predisposing factors, enabling factors, and need. Utilization of rehabilitation services was determined by predisposing factors and enabling factors. Inpatient admission was determined by need (self-assessed health status); however, the volume of inpatient care for those admissions was determined by predisposing and enabling factors.Conclusions: Medical utilization by chronic psychotic patients was varied and determined by predisposing, enabling, and need factors. The study results suggest that the fairness and appropriateness of medical utilization by chronic psychotics in home care need to be taken into account as part of policy making to improve the quality of their health care.

並列關鍵字

Home care ； chronic psychosis ； medical utilization

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