停經婦女醫療服務利用研究

Medical utilization of menopausal women

王佳蕙(Chia-Hui Wang)

指導教授 ： 張菊惠

長榮大學/健康科學學院/醫務管理學系(所)/碩士(2011年)

https://doi.org/10.6833/CJCU.2011.00123

摘要

目的：探討中老年女性因停經及停經後疾患就醫之比率、醫療服務利用型態及醫療處置內容。
材料與方法：採縱貫式相關性研究設計，資料來源為全民健康保險資料庫。研究對象為2005年初次被診斷為停經及停經後疾患之婦女(ICD_9=627)（2001-2004年無停經就醫紀錄），追蹤其四年內（2005-2008）之停經就診資料。除描述醫療服務利用率、就醫地點與科別、複向求醫、就醫規律性、就醫期間外，並描述醫師處方內容中荷爾蒙處方比率與預防保健處置率。此外，應用Anderson醫療服務利用模式，探討影響更年期就醫與處方內容之傾向因素（年齡、投保類別、預防保健行為）、能用因素（投保金額、都市化程度）、需求因素（慢性病史、婦科病史、重大傷病）與醫療因素（過去三年婦產科就醫次數、過去三年就醫次數）之相關性為何。以SPSS12.0進行資料分析，統計方法包括描述性統計、雙變項分析及二元邏輯斯迴歸。
結果：中老年女性之婦女停經就醫率從2005年9.4%降至2008年7.7%，以50-59歲最高（12.3%~17.3%）。曾就醫者中有35.8%僅就醫一次，19.2%看兩次，45.0%就醫三次以上。就醫場所以醫院婦產科（46.7%）最多，其次為婦產科診所（24.2%）與中醫院所（13.7%）。針對三次以上就醫者進行就醫規律性分析，發現規律者佔38.0%，平均就醫間隔為1.1月（標準差0.8），平均就醫次數為9.8次（標準差10.7），平均就醫期間為12.2月（標準差13.6），就醫忠誠度方面，50.0%在單一院所就醫，64.6%在單一科別就醫。農漁林牧與眷屬身份比軍公教婦女因停經就醫的機率較高，有慢性病史比無慢性病史及有婦科病史停經比無婦科病史婦女較容易因停經就醫，年齡、過去三年就醫次數及過去三年預防保健會影響婦女有無因停經就醫。三次以上就醫婦女以低收入者和過去三年就醫次數愈多者，其停經就醫次數愈多。有慢性病史比無慢性病史停經婦女就醫規律性機率較高，過去三年就醫次數及過去三年預防保健會影響婦女停經就醫是否有規律性。
43.4%就醫婦女被開立荷爾蒙處方，其中又以婦產診所荷爾蒙處方率最高（80.1%），其次為家醫院所（66.1%）和醫院婦產科（55.5%）。15.6%婦女在醫師開立荷爾蒙處方後便未再就醫，14.7%規律使用荷爾蒙，平均使用期間為15.4月（標準差14.7）。68.2%荷爾蒙處方合併開立預防保健檢查。勞工、農漁林牧、地區人口及眷屬身份比軍公教婦女使用荷爾蒙機率較高，有慢性病史、有婦科病史及有重大傷病比無慢性病史、無婦科病史及無重大傷病的婦女使用荷爾蒙機率較高，年齡與過去預防保健次數會影響婦女是否使用荷爾蒙。就醫婦女年齡越高荷爾蒙使用率越低，有慢性病史及有婦科病史的就醫婦女荷爾蒙使用率越高。
結論：更年期就醫與傾向因素、需求因素有關，規律就醫與需求因素有關，荷爾蒙使用與傾向因素、需求因素有關。

關鍵字

更年期婦女 ； 醫療服務利用型態 ； Anderson醫療服務利用模式 ； 荷爾蒙治療

並列摘要

Objectives:
To explore Middle-aged women go to a doctor ratio and medical utilization and medical prescription content because of menopausal and postmenopausal disorders.
Methods:
This essay is using the longitudinal correlational design and data is from national health insurance data. The subjects were diagnosed with menopausal and postmenopausal disorders of women in early 2005(ICD_9=627) (2001-2004 without menopause of medical records), tracking their menopause of medical records for four years. In addition to describing the medical utilization ratio, medical treatment sites, pluralistic medical utilization, medical treatment
regularly, medical treatment period. And describing physicians prescribe content of hormone prescriptions rate and preventive health care rate. Furthermore use Anderson medical services utilization patterns, to explore the impact of menopause medical and prescribing the content, contain of predisposing component (age, insurance type, preventive health behavior), enabling component(the insured amount, the degree of urbanization),need component(history of chronic diseases, gynecological history, major injury, obstetrics and gynecology the number of medical treatment and over the past three years the number of medical)
Results: The middle-aged women go to a doctor ratio dropped from 9.4% to 7.7% from 2005 to 2008. Those who had went to a doctor 35.8% only once, looked twice 19.2% and 45.0% three or more. Most of medical treatment sites were hospital’s obstetrics and gynecology（46.7%）, followed by obstetrics and gynecology’s clinics（24.2%）and Chinese medical（13.7%）. Three or more go to a doctor of menopause women who regularity analysis for medical treatment, who accounted for 38.0% of medical treatment regularly, the average medical treatment interval of 1.1 months (standard deviation 0.8), the average number of medical treatment 9.8 times (standard deviation 10.7), average during his treatment was 12.2 months (standard deviation 13.6), medical treatment loyalty, 50.0% medical treatment in single institution, 64.6% medical treatment in single division. Agriculture, fisheries and forestry, animal husbandry and dependents medical treatment due to menopause the probability were the higher than military and government of women, a history of chronic diseases than without a history of chronic diseases, gynecological history than without gynecological history of women may be susceptible to medical treatment due to menopause. Age, in the past three years the number of medical and preventive health care over the past three years, will affect whether women medical treatment due to menopause. Three or more go to a doctor of menopause women who low-income women and the doctor more times over the past three years medical treatment due to menopause more times. A history of chronic diseases than those without history of chronic diseases of menopause women have a higher risk of medical treatment regularity, over the past three years the number of medical treatment and preventive health care over the past three years will affect whether women have regular medical treatment.
43.4% of women are prescribed hormones, among which the highest rate of prescription hormones in obstetrics and gynecology’s clinics（80.1%）, followed by the family Medicine（66.1%） and hospital’s obstetrics and gynecology（55.5%）. 15.6% women are prescribed hormones after no further medical treatment, 14.7% of the regular use of hormones, average period of 15.4 months (standard deviation 14.7). 68.2% combined hormone prescriptions with preventive health check. Labor, agriculture, fisheries and forestry, animal husbandry, population and dependents status to use hormones than the military and government are higher probability of women, A history of chronic diseases, gynecological history and a major injury have a higher probability to use hormones, age and the past the number of preventive health care will affect whether using hormone of women. Go to a doctor of menopause women who the higher age and lower hormone usage. A history of chronic diseases and gynecological history of diseases are the higher hormone rate.
Conclusion: Medical treatment due to menopause is relates to predisposing component, enabling component and need component. Medical treatment regularity is relates to need component. Hormones usage is relate to predisposing component and need component.

並列關鍵字

menopausal women ； medical utilization ； Anderson medical services utilization patterns ； hormone therapy

參考文獻

黃惠美:某醫學中心婦產科門診45-60歲婦女更年期症狀與生活品質之關係,臺北醫學大學護理學研究所碩士論文，2007。

林恭儀：癌症患者的中醫就醫行為，國立臺灣大學公共衛生學院，預防醫學研究所，2008。

王育群:更年期婦女對荷爾蒙療法及保健食品之風險知覺與使用,國立台灣大學衛生政策與管理研究所碩士論文，2006。

陳雅苓:更年期問題解決因應方式與自覺健康,國立台灣大學公共衛生學院碩士論文，2005。

成令方:更年期不是病-向醫療化Say No。醫療品質雜誌2010;4(2):71-74。