老年人的就醫偏好及其影響因素之研究

A Study on Preferences in Care Seeking for Illnesses and Associated Factors of the Elderly in Taiwan

洪佩汝(Hung Pei JU)

指導教授 ： 劉俊昌

亞洲大學/健康學院/長期照護研究所/碩士(2010年)

摘要

老人的就醫偏好會影響其健康以及醫療支出。本研究在探討國內老年人就醫偏好及其影響因素。以國衛院2005年「國民健康訪問調查」之65歲以上樣本為分析對象。該樣本共2,725人，其中男性占49.5%，女性占50.5%。年齡介於65-102歲間，平均年齡73.58歲。以該問卷中有關就醫偏好的題項C1為本分析的主要依變項。該題之題幹敘述為當你自覺身體不適時最常選擇的處理方式為何？所提供的選目分為西醫、中醫、民俗療法、自行買藥與不理會等五個類別。由於選填民俗療法一項者人數太少，分析時將之與中醫合併為一類，以該變項成為四組的類別變項。將問卷中可能與就醫偏好有關的題項，以Andersen的就醫偏好行為模式架構，分為傾向因素、能用因素與需要因素等三群作為自變項，以進行分析。為便於分析及解釋，部分區間變項以及三個或以上選目的自變項多經過重新併組(Recode)成為二分變項(Dichotomous Variable)。本分析是以SPSS 12版為工具，使用的統計方法主要為該套裝軟體中的Frequencies, Tables, Crosstabs,以及 Multinomial Logistic Regression 等程式及其相關副指令。結果主要以N，%，卡方，Odds Ratios等統計量來呈現。變項內組間的差異以及變項間關聯考驗的顯著水準都定於P<.05。結果顯示:共有77.79％首選西藥，11.46 ％選擇自行購買藥品，6.42％傾向不理會，4.12％尋求中醫，0.21％選擇民俗療法。傾向因素中的性別，年齡和居住情形能有效預測就醫偏好。男性看中醫的可能性較女性低，女性尋求看中醫及民俗療法的可能性是男性的1.64倍。能用因素能夠瞭解老年人收入情形，家庭月收入低於3萬元者選擇自行買藥與不理會高於10萬的家庭。需要因素中其自覺健康能預測和評估老年人就醫偏好；對於看中醫與民俗療法(針對看西醫而言)：有無罹患高血壓、糖尿病、心臟病等與就醫偏好有關，當有上述疾病時，選擇看中醫的可能性比看西醫低。對於自行買藥比西醫(參照組而言):有無罹患高血壓、氣喘、心臟病等與就醫偏好有關，當有上述疾病時，選擇自行買藥的可能性比看西醫低。對於不理會比西醫(參照組而言):對於有無罹患糖尿病、慢性呼吸道疾病等與就醫偏好有關，當有上述疾病時，選擇不理會的可能性比看西醫低。性別、居住情形、健康檢查、個人罹病數及預防保健行為等皆會影響老年人就醫偏好。因此Andersen Model能有效瞭解、預測老年人的就醫偏好。值得關注的是有6.42％台灣的老人生病時選擇採取不理會的態度。期望能透過教育的有效途徑和加強醫療服務，幫助需要的老年人為他們的健康保健作出明智的決定。

關鍵字

就醫 ； 慢性疾病 ； 偏好 ； 老年人

並列摘要

Population aging has been one of the main public health issues in Taiwan. The ways of the elderly seeking for health care will affect their health and care expenditure. Preference is an indicator to evaluate behaviors. By determining a specific preference of a person will be helpful for predicting the specific behavior of the person. The purpose of this study was to examine the preferences of care seeking for illnesses and associated factors of the elderly in Taiwan by using a data set collected from a national representative sample of the elderly aged 65 and over in 2005. The data for this analysis is a part of the entire data set from the "National Health Interview Survey" conducted by the National Institutes of Health in 2005. In this analysis, a question in the questionnaire- item C1 served as dependent variable. All the variables thought to be potential covariates of the dependent were classified into 3 categories based on the Andersen’s framework of health care seeking (predisposing factors, can use factors and need factors) and were treated as predictors. For univariate descriptions, the procedure of Frequencies was used. To determine the associations between two categorical variables, the procedure of Crosstabs with Chi-square and Risk tests were adopted. For predicting the multinomial dependents (western medicine, Chinese medicine and folk therapies, self purchasing medicines form drug stores, and without doing any treatment) from the independents, the Multinomial Logistic Regression procedures were adopted. To facilitate the statistical treatments and logic interpretation of the results, many of the categorical variables with more than 2 groups were recoded dichotomously. Some interval variables were recoded into categorical also. The results indicated that majority (77.79%) of the elderly preferred western medicine for illness caring, 11.46% selected self medication through purchasing medicines from a drug store, 6.42% tended to remain the ill conditions unattended,4.12% sought unattended Chinese medicine, 0.21% preferred to be served by folk therapy. Among the predisposing factors, gender, age, and residential condition were effective predictors of care preferences. Being a female was 4.76 times as likely as a male to seek Chinese and folk medicines for caring. Among the enabling factors, education, family income, household size and marital status were effective predictors of care preferences of the elderly. Among the need factors, diseases were effective to predict care preferences of the elderly. In conclusion, the Anderson’s framework of health care seeking was a useful mechanism to predict health care preferences of the elderly. It deserves more attention, that 6.42％ of the elderly in Taiwan unattended their illnesses. Effective ways through improving education or enhancing care services may be needed for the elderly to make wise care decision for their health.

並列關鍵字

care seeking ； illness ； preference ； elderly

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