臺灣博碩士論文加值系統

摘要
2003年嚴重性呼吸徵候群（SARS）在台灣爆發流行，它的病因、傳染途徑、治療及結果都受到非常的重視。「被傳染SARS的可能性」衝擊了病患到醫療服務的可近性，我們希望了解SARS對病患就醫模式的影響，能作為提供更符合病患需求的醫療服務之參考依據。
由於高雄地區當時有出現SARS病患及流行狀況，因此我們的研究問題有三項：1.SARS前、中、後病患就醫模式（包括重複就醫、輕病就醫、延誤就醫、對家庭醫師制的接受度、重視健康的程度、採取替代的方式如中藥、求神拜拜、藥局買藥等）是否有差異？2. SARS前、中、後病患對選擇就醫的層級是否有差異？3. 病患的個人特質（年齡、性別、婚姻、教育程度、職業、家庭收入、宗教信仰）與健康狀況（使用慢性病處方簽、重大傷病卡、就醫次數）是否與SARS之前、當中、之後病患就醫模式有相關？
本研究之研究對象為高雄市、縣地區各層級醫療院所門診就診病患，樣本選取以分層隨機抽樣選取樣本人數，醫院的抽樣方式以集群抽樣方式。問卷內容分為四部分：第一部分是SARS之前（指92年2月之前）的就醫模式13題及較常去就醫的地點（就醫層級選擇層級）1題、第二部分是SARS當時（指92年3月至6月）、第三部分是SARS之後（指92年7月之後）、第四部分是病患的基本資料13題，全部共55題。
共發出問卷1834份，回收有效問卷共1101份，回收率達60.03%。問卷調查期間為93年2月至5月。檢驗量表的”內部一致性信度”（Internal Consistency），Cronbach’α係數為0.861，達可靠之信度水準。SARS對病患就醫模式的影響是降低了重複就醫與輕病就醫且減少延誤就醫，對於疾病預防的重視是增加的，但是對於固定家庭醫師制度是降低的，對於替代方案則無顯著差異。SARS對病患就醫選擇的影響是降低醫學中心的選擇率。個人特性及健康狀況對對病患就醫模式及就醫層級選擇影響上，發現男性、或高中以下、或家庭收入5萬/月以下、或慢性病處方簽者、或重大傷病者、或健保卡使用E卡以上者，較多重複就醫、輕病就醫，在固定家庭醫師及重視健康上也較少。

Abstract
Since the outbreak of sever acute respiratory syndrome (SARS). The potentially serious impact of SARS on people’s accessibility to medical services should not be overlooking. Many wondered whether the fear of SARS among patient’s alike changed people’s seeking behaviors.
Kaohsiung Area remains one of the most severely affected areas of Taiwan. We aimed to identify three problems: 1. Whether the impact of SARS influenced hospital’s ambulatory patient’s seeking behaviors (including overuse, underused, health and preventive behavior, fixed medical care place, and use alternative medicine)? 2. Whether the impact of SARS influenced patient’s selection of hospitals level or clinics? 3. Whether the demographic and health status characteristics affected patient’s seeking behaviors during or after the SARS?
Questionnaires were distributed to all willing hospital’s ambulatory patients of Kaohsiung Areas during 2003 Feberry to May. The sampling methodology was stratified, and cluster random sampling. The survey included questions regarding concern about 3-SARS-periods (included pre-SARS, during-SARS, after-SARS) patient’s seeking behaviors (13 items of each period) and selection of hospitals level or clinics (1 item), personal demographic and health status characteristics (12 items).
Of the 1834 questionnaires distributed, 1101 (60.03%) were returned. The Cronbach [alpha] for internal consistency reliability was 0.861 for the Questionnaire. We used the repeated measured CATMOD procedure in SAS (Version 8.0, SAS Institute Inc., Gary, NC, 1999-2000) to test the data of 3-SARS-periods patients seeking behaviors. We compared pre-SARS with during-SARS, and compared pre-SARS with after-SARS patient’s seeking behaviors. Comparisons were considered significant at P< or =0.01 and P values were 2-tailed.
Combined data for the two comparisons showed that significantly decreased the overuse such as repeated use and go to the medical centers for command cold, decreased the underused such as delay seeking care, increased health and preventive behavior, but fixed health care place deceased, the percentage of use alternative medicine’s didn’t significantly changed. The two comparisons of selection of hospitals level and clinics showed that significantly decreased the percentage of selection of medical center level. Male, single, educational level under high school, family income below 50,000 per month, the chronic disease patient''s prescription user, the major illness/injury card user, and high use（use above E health care card）group patients were statistically significant more percentage of overuse, and less percentage of health behavior, fixed medical care place.

第一章 緒論..............p5
第二章 文獻探討..........p7
第三章 研究方法..........p18
第四章 研究結果..........p22
第五章 討論與結論........p28
圖,表,附件.................p38

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參考網站：
WHO http://www.who.int
行政院衛生署 http://www.doh.gov.tw
疾病管制局 http://www.cdc.gov.tw
行政院主計處 http://www.dgbas.gov.tw。

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