本研究之目的為比較及探討在台灣地區接受血液透析及腹膜透析的末期腎臟病患分別所使用的住院醫療服務及費用,並且以深度訪談方式探討醫師對推行腹膜透析治療其推廣所面臨之問題。利用財團法人國家衛生研究院之2004 年全民健康保險研究資料庫之中「住院醫療費用清單明細檔」、「住院醫療費用醫令清單明細檔」與「承保檔」、「醫事機構基本資料檔」進行串檔後,篩選出連續接受透析超過三個月的14,851 位血液透析及221 位腹膜透析病患,比較及探討兩者住院費用、因併發症住院之天數及總醫療費用。並對10名有照護腹膜透析病患經驗之腎臟專科醫師進行了半結構式的個人深度訪談,以進一步了解臨床醫師對於推廣「連續性可攜帶式腹膜透析治療模式推廣計畫」的看法及是否有執行上的困難。 我們發現:血液透析及腹膜病患在2004 年平均住院利用次數分別為1.78 次及1.14 次,住院天數分別為28.3 天及26.4 天。在醫療利用情形,血液透析住院病患高於腹膜透析住院病患。透析病患住院總藥費分別為24,076 元及45,317 元,總醫療費用分別為210,480 元及234,786 元;在醫療費用方面,腹膜透析住院病患高於血液透析住院 病患。 受訪的腎臟專科醫師皆願意配合政策推行腹膜透析治療,但最主要困難為病患及家屬的配合意願低。受訪的醫師建議衛生單位應加強教育宣導病患及家屬、甚至一般民眾對腹膜透析治療的認知,以提高腹膜透析接受率。
The aims of this study were to compare the hospitalization utilization and expenses in patients with end-stage renal disease receiving hemodialysis (HD) and peritoneal dialysis (PD), and utilize in-depth interview to explore the problems that nephrologists may encounter in promoting PD. By linking the hospitalization expenses inventory files, hospitalization medical orders inventory files, patient files, and institution files in the 2004 National Health Insurance Research Database owned by the National Health Research Institutes, we identified 14,851 patients and 221 patients that received HD and PD, respectively, continuously for more than 3 months. To compare their hospitalization costs, lengths of stay (LOS) due to complications, and total expenses for medical care. A total of 10 nephrologists with experiences in caring for patients on PD attended our interview. By using semiconstructive in-depth interview, we explored their thoughts of the “Continuous Ambulatory Peritoneal Dialysis Promoting Program” and whether difficulties exist in executing the program. The mean hospitalization frequency in patients on HD and PD was 1.78 and 1.14, while the mean LOS due to complications was 28.3 days and 26.4 days in the year 2004, respectively. The utilization of medical care was more frequent in patients on HD than those on PD. However, the mean expenses for medicine in hospitalization of patients on HD and PD were NTD 24,076 and NTD 45,317, and the mean medical care expenses were NTD 210,480 and NTD 234,786, respectively. The expenses consumed by patients on PD were more than those on HD. All the interviewed nephrologists were willing to comply with the policy and promote PD, but the primary obstacle was the low willingness of the patients and their family. They suggested that in order to encourage the utilization rate of PD, the healthcare authorities should educate patients, their family and even the public, and enhance their acknowledgement of PD.
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