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研究生:林春梅
研究生(外文):lin chun mei
論文名稱:比較良性攝護腺肥大患者兩種治療方式之生活品質及成本效果分析
論文名稱(外文):A comparative study of the quality of life and the cost-effectiveness analysis on two different types of therapy for BPH pts
指導教授:李麗傳李麗傳引用關係
指導教授(外文):lee Li Chuan
學位類別:碩士
校院名稱:國防醫學院
系所名稱:護理研究所
學門:醫藥衛生學門
學類:護理學類
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:137
中文關鍵詞:良性攝護腺肥大成本分析生活品質
外文關鍵詞:benign prostate hyperplasiacost analysisquality of life
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本研究目的運用「成本效果分析」之經濟評估技術,採用健保局及病患之觀點,比較攝護腺肥大患者接受口服藥物治療、手術治療二種不同治療方式,在成本與生活品質上之差異及其成本效果比較。本研究採類實驗設計法的二組前後測設計,在控制了年齡、教育程度、收入及婚姻狀態等變項後,探求二種不同治療方式對依變項的成本及效果指標的影響。研究工具包括:應用決策分析模式的成本效果分析)、病患因排尿問題所花費用(六個月)之問卷表、攝護腺肥大生活品質問卷量表。研究期間自民國90年11月至91年4月,採立意取樣法,研究樣本係在臺北市某醫學中心,在門診期間被醫師診斷為中度阻塞症狀之攝護腺肥大患者,共200位,一組為未接受手術而使用同一種藥物治療之100位,另一組為願意接受手術之100位,兩組皆接受問卷調查。統計方法包括:描述性統計、卡方檢定、獨立樣本T檢定法、相依樣本T檢定法、Pearson積差相關分析、GEE Model 迴歸模式檢定。研究結果發現:接受手術治療之總成本顯著高於口服藥物治療,達統計上顯著差異;接受手術治療6個月後生活品質與口服藥物治療6個月後之生活品質無顯著不同,但接受手術治療6個月後之國際攝護腺症狀評分(IPSS)較口服藥物治療進步顯著(治療成功定義:治療後達到降低IPSS 30%),達統計上顯著差異;接受口服藥物治療之成本效果比值顯著優於手術治療,達統計上顯著差異。研究結果除了可協助醫護人員了解良性攝護腺肥大患者經口服藥物治療在生活品質、臨床效果上之差異外,期能幫助醫院管理者做決策時之參考,及幫助護理人員提供患者多方面選擇的資訊,以做為臨床指導患者之參考,進而提升醫療服務品質。
關鍵字:良性攝護腺肥大、成本分析、生活品質。
The purpose of this study is using Cost-effectiveness Analysis to compare the difference between life quality and cost-effectiveness on benign enlarged-prostate patient who has been treated by oral medicine or surgery. After controlling age, education, income and marriage, this study was a quasi-experimental design to explore the effects on life quality and cost-effectiveness between the two different treatments. The reliability and validity-tested instruments were used in this study as followings: Cost-effectiveness analysis, the patient’s questionnaire about the cost of urine movement (6 months), the patient’s questionnaire about life quality. During November of 2001 to April of 2002, a total of 200 samples that were diagnosed as mid-level clog enlarged prostate were drawn from outpatient clinic in a Taipei medical center. There were two groups in this study; 100 patients were included in oral medicine treatment (used the same medicine), and another 100 were treated by surgery. The descriptive statistics, X2 test, independence sample t test, dependence sample t test, Pearson analysis, GEE Model were used in this study. According to this study, the results stated that the total cost of surgery treatment has a significant higher than the oral medicine. There was no notable difference on life quality between the groups after six months. Surgery patients had much more progress than oral medicine treatment on the Index of Prostate IPSS.( the definition of successful treatment is to fall IPSS30%). The medication treatment had a significant better score on Cost-effectiveness Analysis than the surgery. The results of this study may assist the health providers to understand the difference of cost and quality of life between the two different treatments. It also offered an important reference to the hospital administrators and nurses who dedicated decision-making and quality care to the service.
Key Word :benign prostate hyperplasia, cost analysis, quality of life
第一章 緒論
第一節 研究動機與重要性-------------------------1
第二節 研究目的---------------------------------4
第三節 名詞界定---------------------------------5
第二章 文獻查證
第一節 良性攝護腺肥大之治療---------------------10
第二節 成本分析之相關概念-----------------------13
第三節 生活品質之相關概念-----------------------18
第四節 良性攝護腺肥大患者不同治療方式之---------20
成本分析與生活品質之相關研究
第三章 研究架構
第一節 研究架構---------------------------------38
第二節 研究問題---------------------------------40
第三節 研究假設---------------------------------41
第四章 研究方法
第一節 研究設計---------------------------------42
第二節 研究對象---------------------------------43
第三節 研究工具與信效度檢定---------------------44
第四節 資料收集的過程---------------------------52
第五節 研究倫理的考量---------------------------54
第六節 資料整理與分析---------------------------55
第五章 研究結果
第一節 研究樣本之屬性與分析---------------------57
第二節 醫療保險給付金額之計算-------------------62
第三節 自付金額之計算---------------------------68
第四節 各效果指標之評量結果---------------------72
第五節 決策分析結果與成本效果比值之推算與比較---88
第六節 敏感度分析-------------------------------97
第七節 研究工具檢測結果------------------------100
第六章 討論
第一節 醫療保險給付金額之比較------------------104
第二節 自付金額之比較--------------------------107
第三節 生活品質之比較--------------------------110
第四節 決策分析與成本效果比值之比較------------116
第七章 結論與建議
第一節 結論----------------------------------------121
第二節 研究貢獻--------------------------------123
第三節 建議------------------------------------125
第四節 研究限制--------------------------------128
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