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  • 學位論文

牙醫初診照護頻率與拔牙風險之相關研究

The study on the relationship between frequency of routine dental check-up and risk of tooth extraction.

指導教授 : 林文德

摘要


目的 以受過牙體復形或根管治療處置之民眾為研究對象,分析接受初診照護次數多寡與拔牙風險的相關性,以評估初診計畫成效。 研究方法 本研究為回溯性縱貫式次級資料分析,研究觀測時間為2004年7月1日自2008年12月31日,共計四年半。以第一次初診(無初診之對象則隨機選取一次牙醫門診日期作為指標門診日期)前一年接受過牙體復形、根管治療處置之牙齒為觀察樣本,再依觀測日期內接受初診照護次數分為初診照護次數高、低與無初診三組。以逐步邏輯斯迴歸分析影響初診次數多寡之因素,並以傾向分數法配對樣本,最後以寇克司迴歸分析牙齒拔除之相關風險。 結果 研究對象共216,722人,其中接受初診照護次數較高者有956人,接受次數低者9,685人,無接受初診照護者206,081人。高初診者拔牙率為2.72%,低初診者拔牙率為3.75%,無初診者拔牙率為4.07%。配對後初診低者平均為48.92個月,無初診者牙齒保留時間為47.50個月,初診次數高者為47.41個月。無初診者拔牙風險為高初診者的0.995倍(CI=0.697~1.420, P=0.977),低初診者拔牙風險為高初診者的0.949倍(CI=0.668~1.349, P=0.771),初診照護頻率高、低與無初診者彼此牙齒存活情形無明顯差異。病患年紀輕、都市化程度高、牙醫師數較多、月產量別較高,接受較高初診照護的機率較大。年紀較大、鄉村、東區診療場所之民眾拔牙機率較大。 結論 牙齒存活情形以在初診次數高者最佳,無初診者次之,初診次數低者最差,然三者間無顯著差異,顯示初診照護對牙齒存活狀況之影響不大。

並列摘要


Purpose The Bureau of National Health Insurance (NHI) started the Routine Dental Check-Up Program in July 2004. In this program, Taiwanese can visit dentist for a check-up every year. The purpose of this study is to examine the effect of frequency of routine dental check-up on the risk of tooth extration. Method This study adopted a three-group retrospective design and used a secondary data provided by National Health Insurance Research Database, during July 2004 to December 2008. The first routine check-up was indexed, while for those people whom never had routine check-up, the index visit was randomly chose from their dental visits. Subject whose teeth were treatedtion restoration or endodontics withing one year before index visit, then classify three group according to frequency of routine dental check-up. Stepwise logistic regression were used to examine the determinants of routine dental check-up the program and the frequency of receiving. With propensity score matching to reduse the selection bias. Cox regression were to study the relationship between frequency of routine dental check-up and risk of tooth extraction by controlling covariates such as patient’s demographs characteristies prior, dental care utilization, as well as provider’s characteritics. Result There were 216,722 people in this study, amount the 956 had high frequency group, 9,685 in low frequency group, 216,722 in no check-up group. The younger people, high urbanization, and large dentists place were the factors for high frequency of routine dental check-up. The extraction rate was 2.72%, 3.75%, amd 4.07% respectively in these three groups. And the duration of tooth retention was 47.41, 48.92, 47.50 months. Compared with high frequency group, the risk of tooth extraction in low frequency group is 0.995(CI=0.697~1.420, P=0.977), the risk of tooth extraction in no check-up group is 0.949(CI=0.668~1.349, P=0.771). Conclusion There were no association between frequency of routine dental check-up and risk of tooth extraction.

參考文獻


劉介宇、洪永泰、莊義利、陳怡如、翁文舜、劉季鑫、梁賡義:台灣地區鄉鎮市區發展類型應用於大型健康調查抽樣設計之研究。健康管理學刊 2006;4(1):1-22。
楊哲銘、林文君、鍾季樺、周佳穎。牙科總額支付制度對台北市牙醫師醫療行為之影響探討。醫護科技期刊 2001;3(3):255-266。
張育嘉、黎伊帆、汪芳國、鄭守夏。全民健保實施總額預算制度之初步影響評估:以牙醫與西醫基層為例。台灣衛誌 2006;25(2):152-162。
陳慈怡、李嬿如、游山林、陳建仁、謝長堯、陳素秋。全民健保實施前後影響子宮頸抹片篩檢之因素及成果。台灣衛誌 2005;24(5):440-451。
謝慧貞。總額預算支付制度對牙醫師醫療行為影響之研究。未出版碩士學位論文,國立成功大學企管系碩士班 2003。

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