臺灣博碩士論文加值系統

研究目的：瞭解彰化縣民眾於社區整合性篩檢中初次發現血糖異常後之求醫行為與結果，及其相關因素。

研究方法：民國105年的社區整合性篩檢前，沒有糖尿病史之民眾中，發現409位民眾之空腹血糖異常(高於126mg/dl)，在民國106年7月至11月之間，以電話追蹤其求醫行為及結果(包括：糖尿病確診狀況及糖尿病品質支付服務(P4P)納入狀況)，追蹤率82.3%。相關因素包含：105年篩檢問卷中之性別、年齡、教育程度、職業、篩檢時空腹血糖、個人慢性病史、家族糖尿病史、吸菸、喝酒、嚼檳榔及早餐、水果、飲料、點心使用情形，以及106年電話追蹤調查之就診地點及轉診訊息來源。採用多卡方檢定、變異數及多元邏輯式迴歸分析。

研究結果：(1)民眾於社區篩檢中發現空腹血糖異常後，僅60.90%自述會去尋求進一步之確診；前往確診之中，篩檢血糖異常者有77.89%自述被確診為糖尿病；自述被確診為糖尿病之患者，有47.97% 被納入糖尿病品質支付的服務中。(2)多變項分析中發現與血糖異常者之確診行為相關之因素包括：年齡及個人慢性病史，年齡介於50-64歲以及65歲(含)以上者比上小於50歲者自述有確診行為的可能性分別多2.79倍及3.32倍，即年紀大者自述去確診的可能性較高；沒有個人慢性病史者自述去確診的可能性比有個人慢性病史者多2.5倍，即沒有慢性病者自述有確診行為的可能性較高。(3)106年追蹤調查中發現，血糖異常者之確診行為與其篩檢服務提供機構有關：有收案者自述去衛生所確診的可能性較高，無收案者則是自述去醫院的可能性較高。 (4)與自述被醫師診斷為糖尿病之相關因素為：篩檢時空腹血糖。(5)針對自述確診為糖尿病之民眾，分析與糖尿病品質支付服務納入狀況之相關因素，發現經多元邏輯式回歸調整其他干擾因子之後發現，社會人口學、疾病史、篩檢時空腹血糖、健康生活型態以及飲食生活型態與篩檢異常民眾是否被納入糖尿品質支付服務無關。

結論與建議：本研究發現年齡越小及篩檢時血糖越低者，自述去確診的比例越低。提高民眾之確診率及提高糖尿病品質支付收案率必須提供一個完善的服務計畫，可以針對篩檢異常者提供衛教以及完善的通知與提醒系統，最後未來研究可以對於醫師的治療措施和民眾的知識上再多加探討。

Objectives
The purposes of this study was to investigate the medical seeking behavior and related factors after screening for abnormal blood glucose in the CIS in 2016

Methods
Based on the screening records of CIS in 2016, 409 abnormal blood glucose persons were included those who had no DM history. Using telephone to follow-up their medical seeking behavior after screening in 2017. The follow-up rate was 82.3%. The outcomes included (1) to go to a physician after screening; (2) the DM diagnosis by physician; and (3) to be included in the pay-for-performance (P4P) program for DM. The correlated factors included gender, age, education, job, smoking, alcohol drinking, betel-nut chewing, personal disease history, and family disease history which reported at the screening questionnaire. Logistic regression were adopted to analysis the multi-variate models.

Results
(1) Among 312 abnormal blood glucose persons who were followed in 2017, 190 persons went to a physician (60.9%). Those who elder, higher blood glucose and person with personal disease history were more likely to go to a physician.
(2) Among 190 persons who were went to a physician after screening, 148 persons were diagnosed as DM (77.9%). Only higher blood glucose in the screening were statistical significant related with confirmed DM after adjusted other related factors.
(3) Among 148 persons who were diagnosed as DM, 71 persons were included in the DM-P4P program (47.9%). No any factors were statistical significant related with included in the DM-P4P program.
(4) After follow up in 2017, providers with screening service was the relate facor with the medical seeking behavior of abnormal blood glucose persons.

Conclusion
To provide health education and complete communication system for the younger and lower abnormal blood glucose persons to go to a physician to confirm the DM is needed.

內容目錄 i
圖目錄 ii
表目錄 iii
誌謝 iv
中文摘要 v
英文摘要 vi
第一章 緒論 1
第一節 前言 1
第二節 研究目的 2
第二章 文獻探討 3
第一節 台灣糖尿病政策背景 3
第二節 篩檢異常民眾之求醫行為 7
第三節 糖尿病患者之求醫行為相關因素 7
第四節 台灣糖尿病共同照護成效 12
第五節 台灣地區及彰化縣整合性篩檢介紹 15
第三章 材料與方法 18
第一節 研究概念架構 18
第二節 研究對象 19
第三節 資料來源 23
第四節 主要測量變項之操作型定義 24
第五節 統計分析 30
第六節 研究倫理道德考量 31
第四章 研究結果 32
第一節 研究對象受訪狀況之相關因素 32
第二節 篩檢血糖異常民眾自述之確診行為相關因素 37
第四節 篩檢血糖異常民眾納入糖尿病品質支付服務之相關因素 49
第五節 糖尿病篩檢陽性民眾之求醫行為及結果 55
第六節 受訪者自述之篩檢後續過程依糖尿病品質支付服務 61
第七節 受訪者自述之篩檢後續過程依糖尿病篩檢陽性者之分布 74
第五章 討論 84
第一節 篩檢血糖異常民眾之求醫行為及結果之分布 84
第二節 研究對象受訪及自述醫師診斷結果之相關因素 85
第三節 篩檢血糖異常民眾自述之確診行為相關因素 85
第四節 篩檢異常民眾納入糖尿品質支付服務之相關因素 86
第五節 篩檢異常民眾之求醫行為相關因素 87
第六節 篩檢異常民眾納入糖尿病品質支付服務依受訪者自述之民國105篩檢後續過程 89
第七節 糖尿病篩檢陽性民眾依受訪者自述民國105年篩檢後續過程 91
第六章 結論與建議 93
第一節 結論 93
第二節 建議 94
第三節 研究限制 95
參考文獻 96
附錄一 民國105年篩檢後續追蹤問卷 100
附錄二 彰化整合式篩檢問卷 104

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