台灣糖尿病與高血壓病人之經常醫療照護來源與連續性

目的:本研究目的探討糖尿病、高血壓病患特性與經常照護來源以及照護連續性之相關。方法：本研究資料來源為國家衛生研究院所提供健保被保險人的隨機樣本，該樣本由1998年截至2010年承保資料檔中抽出約8%的樣本(兩百萬人)，此研究樣本為2000年至2010年間門診申報資料患有糖尿病或高血壓病患。主要衡量經常照護來源以及照護連續性指標包括，門診患者就醫時為主要醫療服務提供者的百分比、Continuity of care Index(COCI)和Sequential Continuity(SECON)。透過廣義估計方程式(GEE)模型，從人口學變項、環境變項以及醫師特質來看糖尿病、高血壓病患特性與經常照護來源以及照護連續性之相關。結果：照護連續性以醫師為衡量單位2003年至2010年高血壓病患照護連續性介於0.65~0.8、糖尿病0.62~0.77、同時罹患兩疾病患者0.54~0.72。僅有高血壓或糖尿病患者，有主要照護醫師的勝算比是同時有糖尿病高血壓患者的1.68倍、1.45倍；照護連續性以醫院為衡量單位2003年至2010年高血壓病患照護連續性介於0.85~0.91、糖尿病0.83~0.9、同時罹患兩疾病患者0.77~0.87；僅有高血壓、糖尿病患者，有主要照護醫師的勝算比是同時有糖尿病高血壓患者的1.94倍、1.54倍。在GEE模型中，病患特性疾病嚴重度越低、都市化程度越高、社經地位越高，其照護連續性越高。結論:糖尿病、高血壓病患特性中年齡層、社經地位較低、都市化程度較低、疾病類型均會影響照護連續性的高低，對於居住在偏遠地區、社經地位較低的族群，應提供更充足的醫療資源，另外大多數病患有主要照護醫師以及主要照護院所，其型態為醫院醫師及醫院。

關鍵字

糖尿病；高血壓；經常照護來源；照護連續性。

並列摘要

Objective : To examine the usual source and continuity of care among different types of diabetic and hypertensive patients in Taiwan. Methods : Main data source comes from a random sample of National Health Insurance (NHI) beneficiaries. That sample consists of 8% of all the insured population from 1998 to 2010 based on registry for beneficiaries provided by National Health Research Institutes (NHRI). The study will identify patients with diabetes and/or hypertension from outpatient claim data between 2000 and 2010. Main variables measuring usual source and continuity of care per person per year will include indices such as the percentage of outpatients visits provided by the key provider, Continuity of care Index(COCI) and Sequential Continuity(SECON). Types of diabetic and hypertensive patients will be classified by their socio-demographic variables, environmental variables and main providers’ characteristics. Generalized estimating equation(GEE) models will be used for the analysis.Results: Base on physicians 2003-2010 hypertension Continuity of care between 0.65 to 0.8, diabetes continuity of care between 0.62 to 0.77 , while patients suffering from both diseases from 0.54 to 0.72.Hypertension, diabetes, there are key provider higher than suffering from both diseases 1.68 times, 1.45 times.Base on hospital 2003-2010 hypertension Continuity of care between 0.85 to 0.91, diabetes continuity of care between 0.83 to 0.9 , while patients suffering from both diseases from 0.77 to 0.87.Hypertension, diabetes, there are key provider higher than suffering from both diseases 1.94 times, 1.54 times. In GEE models, in patients with characteristic inclouding low comorbidity index and high degree of urbanization and socioeconomic status of higher the continuity of care. Conclusion: Diabetes, hypertension patients characteristics of age ,low socioeconomic status, low level of urbanization, the type of disease will affect the level of continuity of care. For populations living in remote areas, low socioeconomic status, we should provide more adequate medical resources. And most of the patients had key provider, which type of hospital physicians and hospitals. Keyword: Diabetic, Hypertensive, Usual Source Of Care, Continuity of Care