整合式照護模式對65歲以上慢性病患醫療利用之可能影響

Potential Effect of Integrated Care Program on Medical Utilization of Patients Above 65 Years Old with Chronic Conditions

張芝綺(Chih-Chi Chang)

指導教授 ： 楊銘欽

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2010年)

https://doi.org/10.6342/NTU.2010.00241

摘要

研究背景與目的：國內外研究皆顯示，慢性病盛行率逐年上升，多重慢性病患乃是我國醫療照護系統中最重要的資源使用者，且隨著我國人口結構的逐年老化，多重慢性病的盛行率將逐年升高，其醫療照護課題也將愈趨重要，本研究目的主要是在了解65歲以上慢性病患基本特質與其重複醫療利用情形，並探討整合式照護模式對其可能產生之影響。
研究方法：研究資料採用國家衛生研究院所提供的全民健康保險學術研究資料庫2006-2007年百萬承保抽樣歸人檔，研究樣本最後選取之所有慢性病患共73,027人，其中忠誠病患共41,957人，。以t檢定、變異數分析(ANOVA)及卡方檢定作檢定，並採用對數複迴歸及逐步複迴歸統計方法探討慢性病患者之醫療資源利用情形與其影響因素。
研究結果：根據本研究之定義，忠誠病患同院多科就診者占60.5%，有重複用藥者占67.2%。醫療費用上，忠誠病患平均每人每年重複診查費為1,037.90點；所有慢性病患平均每人每年重複診查費為2,102.50點，平均每人每年重複藥費為16068.06點，平均每人重複用藥日數為28.42日。女性慢性病患在對同一家機構的忠誠度上比男性要高，在總藥品項數上以女性較高，總重複用藥費用上以男性較高。除85歲以上者可避免多次就醫診察費隨著年齡的增加而上升，總用藥項數也隨年齡之增加而上升。隨慢性病數、看診醫師數、就醫科數之增加，越容易重複醫療利用，也越容易忠誠於一家機構，可避免多次就醫之診察費、總藥品項數、總重複用藥費用以及總重複用藥日數皆隨著慢性病數之增加而上升，但在所有慢性病患中，隨著機構數的增加，越不容易重複用藥，且總重複用藥費用及總重複用藥日數是越低的。
研究結論：研究發現隨年齡、慢性病數、就醫科數及看診醫師數之增加，重複醫療利用之情形會越來越高。

關鍵字

慢性病 ； 多重慢性病 ； 全民健康保險 ； 醫療利用 ； 重複醫療 ； 成本效益分析

並列摘要

Background and objectives: Studies have shown that the prevalence of chronic diseases increased year by year, and patients with multiple chronic diseases are the most important users of our health care system. As the population aging, the prevalence of multiple chronic diseases will increase and the issue of their medical care will be more important. The purpose of this study was to understand the basic characteristics of patients 65 years old and over with chronic conditions and the potential effects of integrated care program on their medical utilization.
Methods: The source of data came from claims data of the first to twenty-fifth sets of samples registry of beneficiaries of National Health Insurance of 2006 and 2007. Study sample of patients were 73,027 people of all chronic patients and, among them, 41,957 people who were loyal to a medical institution . Data were analyzed by using student’s t test, analysis of variance (ANOVA) and chi-square test. Multiple logistic regression and stepwise multiple regression were used to explore utilization and factors of patients with chronic conditions.
Results: According to the definition of this research, among all the study samples, 60.5% were loyal patients who had multiple specialty visits in a medical institution, and 79.5% had overlapped drug use. On the medical expenses, the loyal patients’ average annual overlapped diagnosis fees were 1,037.90 points; and all chronic patients’ average annual overlapped diagnosis fees were 2,102.50 points, their overlapped drug cost were 13713.26 points and the overlapped drug use days per person was 35.77 days. Women had a higher percentage of loyalty to a medical institution and they also had higher total number of drug items, but the total cost of overlapped drug use was higher in male. In addition to the patients who were older than 85 years old, the avoided multiple medical diagnosis fees increased with age, and the total drugs increased with age,too. Patients with higher number of chronic conditions, the number of physician visits, and the number of medical specialists, were more likely to have multiple specialty medical treatment and overlapped drug use, and the probability of the loyalty to a medical institution was higher. The avoided diagnosis fees, the total number of drug items, the total overlapped drug costs and the total number of overlapped drug use days all increased with the increase of chronic conditions. But in all chronic patients, with the number of medical institutions increase, the probability of the overlapped drug use decreased, and the total cost of overlapped drug use and total number of overlapped drug use days were also decreased.
Conclusions: The study found that, the overlapped medical utilization increased as age, number of chronic conditions and number of the physicians visit increased.

並列關鍵字

chronic conditions ； multiple chronic conditions ； National Health Insurance ； health services utilization ； overlapped medical utilization ； cost-benefit analysis

參考文獻

劉雅文.(2008). 以2005年承保抽樣歸人檔分析高血壓病人之重複醫療資源利用情形.國立台灣大學醫療機構管理研究所碩士論文.

林惜燕. (2005). 慢性病老年病人門診潛在性不適當用藥與不良結果之關係. 國立台灣大學醫療機構管理研究所碩士論文.

紀姵嘉. (2009). 糖尿病患使用中、西醫門診之模式對醫療資源利用的影響. 國立台灣大學醫療機構管理研究所碩士論文.

行政院衛生署. (2001). 中華民國八十九年衛生統計.

陳惠姿. (2007). 整合性照顧系統. 護理雜誌, 54(5), 5-10.