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研究生:李志偉
研究生(外文):Chih -Wei Lee
論文名稱:智能障礙者醫療照護需求評估-以台閩地區智能障礙者的醫療利用情形為例
論文名稱(外文):Health care needs assessment of the persons with intellectual disabilities-A case study of the health care utilization of persons with intellectual disabilities in the Taiwan Area
指導教授:林金定林金定引用關係
指導教授(外文):Jin - Ding Lin
學位類別:碩士
校院名稱:國防醫學院
系所名稱:公共衛生學研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2002
畢業學年度:90
語文別:中文
論文頁數:158
中文關鍵詞:智能障礙者醫療照護需求醫療利用台閩地區
外文關鍵詞:intellectual disabilityhealth care needshealth care utilizationTaiwan Area
相關次數:
  • 被引用被引用:37
  • 點閱點閱:1939
  • 評分評分:
  • 下載下載:537
  • 收藏至我的研究室書目清單書目收藏:8
摘 要
人口群中,智能障礙者較一般人口群有較高的罹病率與造成二次殘障的機率,這隱含著他們有較高的醫療需求及醫療花費。過去台灣地區缺乏社區性智障者的醫療照護利用之調查研究,因此他們的醫療需求常常被忽略,甚至未曾出現在醫療政策中。本研究藉由全國性調查,探討我國目前智障者的健康狀況、醫療利用情形及其影響因素、以及身心障礙醫療福利的認知及就醫期望,藉以評估智障者實際的醫療需求,以作為未來政府相關醫療福利政策制定之參考。本研究以內政部民國89年12月底台閩地區領有身心障礙手冊的智能障礙者之人口資料為研究母群,經抽樣選取5,094位智障者為研究樣本,透過郵寄問卷由其主要照護者依據實際情況填答。回收有效問卷為1,071份。主要研究結果發現:一、智障者主要健康問題為神經性疾病(含癲癇)、精神疾病及消化系統相關疾病;二、在智障者醫療利用情形部分,其健保卡使用量、平均住院天數、急診次數皆比參加全民健康保險的國人還要高,而門診的主要就診科別為內科、精神科及牙科,住院與急診原因分別為手術開刀及發燒。另外定期健康檢查及復健治療的利用率普遍偏低;三、影響智障者醫療服務利用因素可分為傾向因素、能力因素及需要因素。其中影響住院的因素為:領有重大傷病卡、定期服藥、自覺健康情形;影響急診的主要因素為:罹患疾病、定期服藥、自覺健康情形;健保卡使用情形則受智障者年齡、教育程度、定期服藥及自覺健康情形所影響;而影響其定期健康檢查的因素為領有重大傷病卡;影響復健治療的因素為:主要照護者性別、年齡、領有重大傷病卡、合併其他障礙;四、智障者對身心障礙醫療福利認知普遍不足且利用率偏低;五、在智障者就醫期望部分,主要照護者希望醫師能耐心的作診斷、減免醫療費用或優待、醫師能詳細的解釋病情及病因;六、政府應優先辦理的醫療照護項目中,依序為「智障者定期免費健康檢查」、「提供醫療補助費用」、「提供醫療資源資訊」。綜合上述結果,本研究建議,應定期為智障者做全身健康檢查,促進主要照護者對身心障礙醫療福利的認知,導正醫療專業人員對智障者的態度,能詳細的為智障者說明病情病因,以減少其在就醫時的疑慮與不安。本研究是以智障者的醫療利用情形來評估其醫療需求,對於其醫療需求不足的部分應以計劃性的政策來解決,因此對於未來的研究上,建議能對主要照護者做進一步的深入訪談或質性研究,以發掘目前未被注意到的影響醫療服務利用之因素,進而研擬適當、可行的醫療照護政策與服務,以增進智障者的健康。
Abstract
Persons with intellectual disabilities(ID) face enormous obstacles in seeking the kinds of basic health care that many of us take for granted. Historically, the health care of ID has often been overlooked in general discussion on health care issue. Diminish the barriers of their health care and satisfied their health needs is our duty. The purpose of this study is to identify the health needs and determinants of persons with ID. A structured questionnaire involving 1071 informants of main carers of persons with ID in Taiwan was used to measure their health care needs. Health care needs in this study were measured by the utilization of inpatient, outpatient, and emergency care, regular health exam, rehabilitation services. The research findings show that the average age of persons with ID was 25.5 years old, 47.7﹪of persons with ID had diseases currently, and 67.7﹪of persons with ID had additional disabilities as well. The average inpatient days was 16.9, the average emergency frequency was 2.29 times, and the average consumption of National Health Insurance cards was 9.5 during the previous 7 months. Their illness prevalence and health care utilization were higher than the general population but their health care needs were not being properly met. The most health problems linked to ID were epilepsy, psychiatric disorders and dental cavities. The perception of main carers of persons with ID to the health welfare and related policies was poor. Regarding to the expectation, the main carers hope the doctors could be more patient and explain the cause of illness which persons with ID suffered. In the meanwhile, they also wish the government could provide regular health exam, subsidy the medical cost and provide information of the health care for persons with ID. This study was one of the first attempted to promote a community-based health care needs approach to the field of ID in Taiwan. These data strongly suggest that access to a quality health care, regular health exam and sufficient health care information are important factors in the control of health care for ID in the community.
目錄
研究結果附表目錄 III
摘 要 V
英文摘要 VI
第一章 緒論 1
第一節 研究源起與研究動機 1
第二節 研究目的 1
第二章 文獻探討 2
第一節 智障者的界定 2
第二節 智障者的健康特質 7
一、智能障礙的盛行率分析 7
二、智障者的健康問題 8
第三節 需求的概念 12
第四節 智障者的健康需求評估 13
一、智障者健康需求評估的特徵 14
二、智障者的醫療利用模式 14
第三章 研究材料與方法 17
第一節 研究問題及研究架構 17
一、研究問題 17
二、研究架構 17
第二節 研究對象及研究工具 20
一、研究對象 20
二、研究工具 22
第三節 資料處理與分析 23
第四章 研究結果 24
第一節 智障者及主要照護者人口學特徵 24
第二節 智能障礙者的醫療服務利用情形 27
第三節 主要照護者對身心障礙醫療福利之認知與利用 29
第四節 就醫期望 32
第五節 影響智障者醫療服務利用相關因素之分析 33
第五章 討論 40
第一節 智障者的特質與健康情形 40
一、智障者主要照護者之基本特質 40
二、智障者基本特質 40
第二節 智障者的醫療服務利用分析 43
第三節 主要照護者對身心障礙醫療福利認知及就醫期望之探討 44
一、主要照護者對身心障礙醫療福利認知之分析 44
二、主要照護者對智障者醫療照護優先辦理事項之選擇 45
三、主要照護者對智障者健康議題之意見及照護之態度 46
四、主要照護者對就醫期望之分析 46
第四節 影響智障者醫療服務利用之相關分析 47
第五節 研究限制 49
第六章 結論與建議 50
參考文獻 53
附錄一:「智能障礙者之醫療照護需求研究」問卷 119
附錄二:身心障礙者保護法 127
附錄三:身心障礙者鑑定作業辦法 142
附錄四:身心障礙手冊核發辦法 146
附錄五:身心障礙者參加社會保險保險費補助辦法 148
研究結果附表目錄
表1:智能障礙的各種定義分析 6
表2:台閩地區身心障礙及智能障礙人數分析 8
表3:智障者主要的醫療照護障礙 11
表4:智能障礙者的健康照護需求 14
表5:智能障礙者各縣市樣本人數分配 21
表6:最適樣本數決定 22
表7:影響智障者醫療服務利用相關因素表 47
表8:各縣市問卷回收情形 60
表9:主要照顧者社會人口學基本資料 61
表9.1:主要照顧者社會人口學基本資料(續) 62
表10:職業別性別分類表 63
表11:智障者社會人口學基本資料 64
表11.1:智障者社會人口學基本資料(續) 65
表11.2:智障者社會人口學基本資料(續) 66
表11.3:智障者社會人口學基本資料(續) 67
表12:智障者醫療服務利用情形 68
表12.1:智障者醫療服務利用情形(續) 69
表12.2:智障者醫療服務利用情形(續) 70
表12.3:智障者醫療服務利用情形(續) 71
表13:智障者就醫困難 72
表13.1:智障者就醫方便性 72
表14:主要照顧者對身心障礙醫療福利之認知與利用情形 73
表15:全民健保滿意狀況 74
表16:主要照顧者對智障者健康議題之意見分布 75
表17:主要照顧者對智障者醫療照護之態度分布 76
表18:就醫期望 77
表19:政府應第一優先辦理之事項 78
表19.1:政府應第二優先辦理之事項 79
表19.2:政府應第三優先辦理之事項 80
表20:認為政府應對智障者醫療照護優先辦理事項-依重要度分 81
表21:智障者之住院情形與各自變項關係(傾向因素) 82
表21.1、智障者之住院情形與各自變項關係(傾向因素)續 83
表21.2:智障者之住院情形與各自變項關係(能力因素) 84
表21.3:智障者之住院情形與各自變項關係(能力、需要因素) 85
表21.4:智障者之住院次數與各自變項關係(傾向因素) 86
表21.5:智障者之住院次數與各自變項關係(傾向因素)續 87
表21.6:智障者之住院次數與各自變項關係(能力因素) 88
表21.7:智障者之住院次數與各自變項關係(能力、需要因素) 89
表21.8:智障者之住院日數與各自變項關係(傾向因素) 90
表21.9:智障者之住院日數與各自變項關係(傾向因素)續 91
表21.10:智障者之住院日數與各自變項關係(能力因素) 92
表21.11:智障者之住院日數與各自變項關係(能力、需要因素) 93
表22:智障者之急診情形與各自變項關係(傾向因素) 94
表22.1:智障者之急診情形與各自變項關係(傾向因素)續 95
表22.2:智障者之急診情形與各自變項關係(能力因素) 96
表22.3:智障者之急診情形與各自變項關係(能力、需要因素) 97
表22.4:智障者之急診次數與各自變項關係(傾向因素) 98
表22.5:智障者之急診次數與各自變項關係(傾向因素)續 99
表22.6:智障者之急診次數與各自變項關係(能力因素) 100
表22.7:智障者之急診次數與各自變項關係(能力、需要因素) 101
表23、智障者之健保卡使用情形與各自變項關係(傾向因素) 102
表23.1、智障者之健保卡使用情形與各自變項關係(傾向因素)續 103
表23.2:智障者之健保卡使用情形與各自變項關係(能力因素) 104
表23.3:智障者之健保卡使用情形與各自變項關係(能力、需要因素) 105
表24:智障者之健康檢查與各自變項關係(傾向因素) 106
表24.1:智障者之健康檢查與各自變項關係(傾向因素)續 107
表24.2:智障者之健康檢查與各自變項關係(能力因素) 108
表24.3:智障者之健康檢查與各自變項關係(能力、需要因素) 109
表25:智障者之復健治療與各自變項關係(傾向因素) 110
表25.1:智障者之復健治療與各自變項關係(傾向因素)續 111
表25.2:智障者之復健治療與各自變項關係(能力因素) 112
表25.3:智障者之復健治療與各自變項關係(能力、需要因素) 113
表26:影響住院與否之因素逐步對數迴歸(Stepwise Logistic Regression) 114
表27:影響急診與否之因素逐步對數迴歸(Stepwise Logistic Regression) 115
表28:影響健保卡使用狀況因素之多變項逐步迴歸(Stepwise Multiple Regression) 116
表29:影響健康檢查之因素逐步對數迴歸(Stepwise Logistic Regression) 117
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