Title

1997-2004年臺灣精神疾病患者之長期就醫趨勢及其未持續或中斷就醫之風險因素探討

Translated Titles

Trend in mental health services utilization and dropout treatment predictors for patient with psychiatric disorder in Taiwan - from 1997 to 2004

DOI

10.6837/NCNU.2012.00118

Authors

張作貞

Key Words

精神疾病患者 ; 未持續或中斷就醫 ; 多重復發事件之存活分析 ; 健保資料庫 ; the patient with psychiatric disorder ; dropout treatment ; repeated recurrent event survival analysis ; claim data

PublicationName

國立暨南國際大學社會政策與社會工作學系學位論文

Volume or Term/Year and Month of Publication

2012年

Academic Degree Category

博士

Advisor

宋麗玉

Content Language

繁體中文

Chinese Abstract

本研究主要是探討1997至2004年台灣精神疾病患者之長期就醫趨勢及其未持續或中斷就醫的風險因素。研究對象為診斷為精神分裂症患者及情感性精神病患。本研究共分兩個部分,第一部分為精神疾病患者長期就醫趨勢,係利用國家衛生研究院全民健康保險研究資料庫20萬人承保抽樣歸人檔(LHID2000),予以串連重大傷病檔及門、住診費用檔之所有就醫資料,分析自1997至2004年之精神疾病患者就醫資料,進行長期趨勢分析。第二部分,則以2000年診斷為精神分裂症及情感性精神病之精神疾病患者,取其1997至2004年所有就醫資料進行多重復發事件存活分析,以發現未持續或中斷就醫之風險預測因子。 研究結果,彙整如下: 一、1997-2004年精神疾病患者之長期就醫趨勢及其精神醫療服務使用 1.1997-2004年之精神疾病罹患人數逐年上升,平均年成長率為17%;精神疾病患者有、未就醫的比例差距呈現逐年相反方向,有就醫比例由1997年的96.7%逐年減少到2004年的52.8%;未就醫比例,由3.3%逐年增加到47.2%,平均年成長率高達428%;領有重大傷病證明卡的比例偏低,只占15.6-21.2%;每年新增的精神疾病患者,44.4-59.8%在隔年會離開醫療系統中斷治療。 2.1997-2004年之各年精神醫療費用支出逐年增加,平均年成長率為19.0%;藥費占精神醫療費用近四成比例;以醫院為主體的日間病房使用率高於社區復健服務的使用。 3.1997-2004年之急性病房平均住院日數,精神分裂症35.7天(SD=44.3),由1997年的41.8天降至2004年的28.2天;情感性精神病為20.8天(SD=32.1),由1997年的17.6天降至2004年的16.1天。 4.精神分裂症之急性治療平均住院日數(<=180天),由1997年54.3天降至2004年36.0天;非急性治療平均住院日數(>180天),由322.9天降至314.5天。;情感性精神病之急性治療平均住院日數,穩定維持在26.1天;非急性治療平均住院日數,由291.0天降至265.7天。 二、影響精神疾病患者之未持續或中斷就醫的風險因素 影響精神疾病患者之未持續或中斷就醫風險因素包括:女性風險明顯高於男性的1.185倍、17歲以下的風險高於其他年齡層、未在保的風險高於其他加保類別、每月健保費繳交金額超過605元的風險高於低於524元的1.058倍、每次就醫部分負擔金額高低影響並不顯著、未跨區就醫的風險高於跨區、精神分裂症的風險高於情感性精神病。CCI權重得分愈高者的風險是得分低者的1.258倍、有使用日間病房及社區復健的風險高於未使用者、未領取重大傷病證明卡的風險要高於有領重大傷病證明卡。 歸納研究結果,建議如下: 一、政策面 (一)、強化精神醫療照護服務的深度及廣度 (二)、精神疾病患者之就醫模式的建構及定義 二、實務面 (一)以精神醫療實證實務為本,建構跨機關的個案通報平台。 (二)加強精神醫療社會工作介入手法連結於醫院、社區及家庭間。

English Abstract

The study is a longitudinal examination of mental health services utilization and treatment dropout risk factors for patients with schizophrenia and manic-depression psychosis from 1997 to 2004. The claim data of this study comes from the LHID2000 of Bureau of National Health Insurance. Repeated recurrent event survival analyses were used to identify predictors of treatment dropout. Main findings of this study were as follows: (1).Number of patients with serious mental illness had an increased tendency that the average year-growth rate was 17% from 1997 to 2004. The proportion of using mental health services decreased from 96.7% in 1997 to 52.8% in 2004. However, unused proportion of mental illness persons was increased year by year. The newly cases of serious mental illness leaved off treatment in the following year ranged form 44.4% to 59.8%. (2).The average expenditure of mental health services and medicine rose year after year. Using community rehabilitation services was lower than using daycare wards of hospitals. (3).The average length of stay for acute care had a decreased direction from 41.8 days in 1997 to 28.2 days in 2004 in patients with Schizophrenia, and form 17.6 days to 16.1 days in those with manic-depression psychosis. (4).The average admission day of Schizophrenia had a drop course from 54.3 days in 1997 to 36.0 days in 2004 for acute treatment (<=180 days), and from 322.9 days to 314.5 days for non-acute treatment (>180 days). The average admission day of manic-depression psychosis was steadily kept on 26.1 days during 1997-2004 for acute treatment. Otherwise, non-acute treatment had a downside from 291.0 days in 1997 to 265.7 days in 2004. The risk factors of treatment dropout are: (1).the female sex, young age, underinsured status, and schizophrenia were associated with high dropout risk. (2).psychiatric comorbidity was related with a trend toward dropout. (3).patients who used daycare services and psychiatric community rehabilitation services had a higher dropout rate than who did not use these services. (4).patients who had catastrophic illness cards were at higher dropout risk than those without the cards. The results also support the planning process and improvement of mental treatment system.

Topic Category 人文學院 > 社會政策與社會工作學系
社會科學 > 社會學
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