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台灣地區智能障礙者的醫療利用特性與影響因素:以2001年門診利用分析

Medical Care and Affected Factors among People with Intellectual Disabilities in Taiwan: Outpatient Utilization in 2001

摘要


智能障礙者(以下簡稱智障者)有較高的罹病率與造成二次障礙的機率,這個群體有較高的醫療需求及醫療花費,過去在台灣地區較缺乏社區性智障者的醫療照護利用相關調查研究。本研究欲藉由全國性調查,以Andersen's醫療利用行為模式的理論為基礎,分析台灣地區智障者在2001年門診醫療利用情形及探討影響其利用之相關因素,作為研擬適當、可行的醫療照護政策與服務之參考,以增進智障者的健康。本研究以內政部民國89年12月底台閩地區領有身心障礙手冊的智能障礙類之人口資料為研究母群,經多步驟隨機抽樣選取5,094位智障者為研究樣本,透過郵寄問卷方式,由其主要照護者依據智障者之實際情況填答。回收有效問卷為1,071份。其研究結果發現:2001年智障者門診醫療利用,健保卡使用量推估年平均就醫次數為16.3次,高於2000年參加全民健康保險的國人(年平均14.2次);門診的主要就診科別為內科、精神科及牙科;主要疾病類別為神經疾病、精神疾病及消化系統疾病。影響其門診醫療利用之相關因素,以逐步迴歸模式,得出醫療利用最佳預測模式:隨著智障者年齡增加,智障者之健保卡平均使用格數就會減少,而若智障者有定期服用藥物及進行復健的情形,其健保卡使用的格數會增加;此外自覺愈不健康者以及其主要照護者為女性時,智障者的健保卡使用量也會增加。本研究期望未來能夠以智障者實際醫療利用情形及其相關影響因素,界定其醫療需求,進而針於其醫療需求不足之處,制定符合需求、前瞻性的醫療照護政策。

並列摘要


In Taiwan, the medical care provision often neglects the medical care needs of people with intellectual disability (ID), moreover, their medical care needs have received limited attention in the medical care system. This study was conducted to examine the medical care utilization and its determinants among the people with ID living in the communities. The samples were recruited from the Taiwan National Disability Registration Database; subjects were stratified by the administrative geographical areas and selected by the multi-stage random sampling for the study. We analyzed 1,071 respondents to determine their medical care utilization and the related determinants for the utilization. The findings showed that people with ID utilized more outpatient care than the general population. The determinants of the outpatient utilization of people with ID were age, medicine taking regularly, rehabilitation necessity, ill health status and the gender of the caregiver in the stepwise logistic regression model. Based on the results of the medical care utilization among people with ID in the study, the health authority should reorient the medical care system toward the medical care needs of people with ID efficiently and effectively to maintain and improve the quality of medical care for this group of people.

參考文獻


林金定、嚴嘉楓、李志偉、吳佳玲、陳美花(2003)。以醫療社福專家觀點初探智能障礙者理想醫療照護模式。身心障礙研究。2,32-41。
林金定、嚴嘉楓、李志偉、吳佳玲(2003)。智能障礙者醫療需求評估與就醫障礙之分析。台灣衛誌。22,108-117。
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張梅瑛(2009)。台灣地區老人身心健康狀況對醫療服務利用之研究〔碩士論文,亞洲大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0118-1511201215465776
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