- 學位論文
高屏地區65歲以上慢性肺部疾病患者接種流感疫苗成效評估
Program Evaluation of Influenza Vaccination on Patients over 65 years old with Chronic Pulmonary Disease in KAO-PING Areas
摘要
本研究旨在評估高屏地區慢性肺部疾病患者流行性感冒疫苗接種情形，及其有無接種流行性感冒疫苗其上呼吸道感染、肺炎及慢性肺部疾病醫療利用、醫療費用有無差異，次之瞭解流行性感冒疫苗接種之成效。 本研究對象為高屏地區民國九十一年度年齡滿65歲（民國二十六年以前出生含二十六年次），因慢性肺部疾病主診斷為ICD-CM 9 code 490-496，經資料處理後有效樣本數為49,907人，資料來源為向中央健康保險局高屏分局九十一年、九十二年度醫療費用；研究方法以SPSS 10.0 For Windows套裝軟體進行描述性及推論性統計分析；醫療服務利用包括九十一年十月至九十二年九月之急診次數、門診次數及住院天數，醫療費用包括同期之急診費用、門診費用及住院費用。 研究結果發現：（一）接種率：91年度慢性肺部疾病患者流感疫苗接種率59.09%。（二）醫療利用：整體住院天數已接種者平均住院天數17.03日低於未接種者25.55日，降低8.52日；肺炎門診次數已接種者平均次數2.83次低於未接種者3.17次、肺炎住院天數已接種者平均天數15.80日次低於未接種者23.43日，降低7.63日；慢性肺部疾病住院天數已接種者平均15.35日次低於未接種者22.51日，降低7日（三）醫療費用：整體急診費用已接種者平均9,505元低於未接種者20,381元，降低10,876元；住院醫療費用已接種者平均64,310元低於未接種者119,489元，降低55,179元，肺炎急診費用已接種者平均19,204元低於未接種者44,157元，降低24,952元；門診費用已接種者平均928元低於未接種者1,215元，未接種者多286.88元；住院費用已接種者平均74,135元低於未接種者134,293元，降低60,158元；慢性肺部疾病急診費用已接種者平均4,694元低於未接種者5,381元，降低687元；住院費用已接種者平均51,195元低於未接種者90,293元，降低39,098元。 本研究比較有無接種流感疫苗之結果已接種流感疫苗整體樣本住院利用與費用均有明顯降低，其中肺炎及慢性肺部疾病住院利用與費用尤其顯著，顯示慢性肺部疾病患者接種流感疫苗可使疾病嚴重度減輕，且以住院情況改善最為明顯，已接種者僅需持續門診照護，病情即可控制在穩定情況下，得使病患生活得以改善，健保支出得以降低，本研究支持流感疫苗接種政策應持續推展；惟本研究僅評估一年度之效益，外推或擴大解釋有所限制，未來建議以3~5年長期觀察研究，評估本國流感疫苗效益評估，建立更明確因果關係。
並列摘要
This research is to evaluate the inoculation of influenza bacterin of the patients in Kaohsiung and Pingtung in Taiwan, R.O.C. suffering from chronic pulmonary disease, and whether it results in differences in medical treatment and medical expenses in respiratory track infection, pneumonia, and chronic pulmonary disease. Secondly, this research studies the effectiveness of inoculation of influenza bacterin. The objects of the study are the patients aging 65 years old (born before 1937) who have suffered from the chronic pulmonary disease diagnosed as ICD-CM 9 code 490-496. 49,907 effective samples are used after data, the record of the medical expenses of 2002, 2003 from Health Insurance of Kaohsiung and Pingtung, analyzed. The software of SPSS 10.0 For Windows has processed the study methodology and analysis. Medical services have included times of emergency and outpatient services, days of hospitalization, and medical expenses of emergency, outpatient services, and hospitalization from October 2002 to September 2003. Study results: (I) medical treatment: the patients inoculated with bacterin have had less days of hospitalization (17.03 days) than that of those not inoculated (22.55 days) for 8.52 days. The former also have had less outpatient services (2.83 times) than the latter (3.17 times.) The average days of hospitalization of the former caused by pneumonia are 15.80 days, which are less than 23.43 days of the latter for 7.63 days. The average days of hospitalization caused by chronic pulmonary disease of the former are 15.35 days, which are less than 22.51 days of the latter for 7 days. (II) Medical expenses: The emergency expenses of the former are 9,505 NT dollars, which are lower than 20,381 NT$ of the latter for 10,876. The expenses of hospitalization treatment of the former are 64,310 NT$, which are lower than 119,489 of the latter for 55,179 NT$. The expenses of the treatment of pneumonia of the former are 19,204 NT$, which are lower than 44,157 NT$ of the latter for 24,952 NT$; the outpatient services expenses of the former are 928 NT$, which are lower than 1,215 NT$ of the latter for 286.88 NT$, and the hospitalization expense of the former are 74,135 NT$, which are lower than 134,293 NT$ of the latter for 60,158 NT$. The emergency expenses of chronic pulmonary disease of the former are 4,694 NT$, which are lower than 5,381 NT$ of the latter for 687 NT$, and the hospitalization expenses of the former are 51,195 NT$, which are lower than 90,293 NT $ for 39,098 NT$. (III) Inoculation rate: In 2002, 59.09% of the patients suffering from chronic pulmonary disease had been inoculated with the influenza bacterin. This study compares the differences between being inoculated with influenza and the opposite. It appeals that influenza bacterin has helped to decrease the medical expenses and times of hospitalization, especially to the patients suffering from chronic pulmonary disease. Along this line, the study shows that the cases infected with chronic pulmonary disease and inoculated with influenza bacterin can be improved, especially in hospitalization. The cases inoculated will be under control with simply regular outpatient services. Meanwhile, their life quality is improved as well as the expenditure of Health Insurance. Along this line, this study supports the policy of influenza bacterin. Nevertheless, this study has only researched on the one-year data. There is also restriction in the area researched. Three to five-year long observation is therefore suggested for further research as well as an overall country study in order to have a more specific casual relationship.