臺灣博碩士論文加值系統

C 型肝炎病毒(HCV)感染是肝病的重要成因之一，全國約近100萬人口感染C型肝炎病毒。C型肝炎抗病毒治療可減少肝硬化及肝細胞癌發生的危險性及延長病人的存活率。因此適當的防治策略之ㄧ是找出該治療的病人，施行抗病毒治療，避免肝硬化肝癌的發生。
本研究目的旨探討：(一)社區肝炎篩檢後續醫療照顧追蹤情形(篩檢結果的認知、篩檢後就醫狀況)；(二)實驗性介入措施照護活動的效益；(三)影響參與『照護活動及主動轉介』之相關因素。
研究使用結構式問卷以面訪及電訪方式，調查於2004~2007年間，台南縣衛生局於全民健保成人健檢之整合性篩檢資料檔中，符合研究條件：年齡≦65歲、anti-HCV陽性、ALT≧80IU/L之個案，於社區肝炎篩檢後其接受醫療照顧的情形，符合研究條件並實際收案人數共907人。
研究結果發現：社區肝炎篩檢後，經寄發報告及衛教說明，仍僅86.8%的個案知道自己有慢性C型肝炎，其中僅接近半數是因此次篩檢得知；有48.7%在未參加篩檢前即知道本身已有C型肝炎；有74.3%的C型肝炎陽性帶原個案因此而就醫。社區篩檢C型肝炎陽性個案，有在定期就醫追蹤的比例(59.4%)及被醫師建議進行干擾素合併抗病毒藥物治療者，接受該治療的比例(42.1%)偏低。
在個案接受篩檢是否符合干擾素合併抗病毒藥物治療狀況時，我們發現就醫行為與是否接受本次篩檢有關(P＜0.05)。就醫行為以未就醫者接受篩檢比例較有就醫者高3.1倍(95%CI＝2.30- 4.29)，未定期追蹤者其接受率為有定期追蹤者的4.0倍(95%CI＝3.02- 4.29)，就醫追蹤間隔大於6個月者，接受率為小於6個月者的2.7倍(95%CI＝2.30- 4.29)，顯示較少使用醫療資源及未適當就醫之族群其接受篩檢檢查活動的意願較高。
在篩檢後符合干擾素合併抗病毒藥物治療的137人，於多變項分析之結果，其接受轉介治療的相關因素與：有無就醫及就醫層級之變項有關(P＜0.05)。未就醫者，接受轉介比例較有就醫者低，僅為0.5倍(95%CI＝0.22-v1.14)。於基層醫療追蹤者，接受轉介的比例較地區級以上醫院追蹤者低，僅0.4倍(95%CI＝0.17- 0.89)。結果顯示：未適當就醫之族群於轉介治療活動時，其接受的意願反而較低。有96人接受轉介就醫治療評估，轉介後共33人接受治療，而完成治療者其SVR為76.9%。
由研究結果顯示目前大規模的整合篩檢對於後續的照護仍有所不足，而研究所執行的轉介照護可以提高部份民眾其就醫情況；然而在接受抽血篩檢時原本較無就醫的人接受較高但是再進一步轉介至教學醫院治療時反而意願偏低，顯示在篩檢與接受治療之間仍然有差異，而使篩檢達到早期發現早期治療的預防效益上有所限制，未來如何克服之間的差異是值得進一步探討的議題。

Hepatitis C virus (HCV) infection is one of the major causes of liver disease, and nearly a million people of Taiwan are HCV carriers. Antiviral therapy of hepatitis C could reduce the risk of developing liver cirrhosis and hepatocellular carcinoma (HCC), and improve the survival of chronic hepatitis C patients. Hence, early detection of the HCV patients for antiviral treatment to avoid their development of liver cirrhosis and hepatoma is a appropriate preventive strategy.
This study examined three issues: (1) the treatment of HCV carriers in the community after current screening, (2) the effectiveness of the caring activities of experimental intervention, (3) the influential factors on “participation of follow-up examinations for antiviral treatment and acceptance of active referral program ”.From participants of a comprehensive health examination from 2004 to 2007, conducted by the Public Health Bureau of Tainan County, those participants of age less than or equal to 65 years old, anti-HCV positive and ALT larger than or equal to 80IU/L were recruited in this study. A total of 907 eligible cases were involved in the study.
Our findings indicate that after the screening examination and the mailing of the report and health instruction materials, only 86.6% of the individuals were aware that they were infected with hepatitis C virus, and only half of them became aware of the situation because of this screening program. 48.7% of the patients knew they were infected of HCV before participating in this screen. 74.3% of those who are tested positive reported that they had clinic visits due to HCV infection. A low rate was found in the treatment of the individuals who were found infected with hepatitis C. The rate of the routine follow-up clinic visit cases was 59.4%, and the rate of those who received interferon and combination antivirus therapy among eligible patients was 42.1%.
We found in the screening that hepatitis treatment behavior is associated with the implementation of the influential caring activities (P<.005). Those who have never received medical care are 3.1 times more than those who have received in participating in the activities of medical treatment. The response rate of non-regular medical tracers is 4 times higher than the regular tracers. The cases of medical follow-up with an interval longer than six months are 2.7 times higher in
vii response rate than their counterparts who are of medical follow-up with an interval shorter than six months. It tends to indicate that those who less frequently utilize medical resources and those who inappropriately receive treatment appear a relatively higher willingness in accepting care activities.
The result of multivariate analysis indicates that the factors leading to accepting referral treatment of those 137 individuals who received interferon and combination antivirus therapy are associated with the level of the hospitals attended. Those who have never received treatment are .5 time less than those who have in accepting treatment referral. Those who perform follow-up treatment at basic level hospitals are .4 time less than their counterparts who do the same at area level hospitals. Findings indicate that those who have never received appropriate treatment are less willing in accepting referral treatment activities. A total of 96 individuals accepted referral treatment evaluation. Thirty-three of them received treatment, and the SVR of those who completed the treatment is 76.9%.
The results of the research indicate that large-scale integrating screening remains insufficient in promoting follow-up medical care, while the referral care performed as a result of the research advances the reception of treatment of a significant proportion of the patients. Those who have never received treatment are more acceptable of the screening. They are less willing in accepting the referral to receive treatment at teaching hospitals. It indicates that there remains a gap in screening and acceptance of treatment, which interrupts the preventive effectiveness of the early detection of the disease that the screening aims to achieve. How to overcome the problem seems to be the subject that is worthwhile for further study.

中文摘要…………………………………………………………………v
英文摘要………………………………………………………………vi
誌謝…………………………………………………………………vii
目錄.................................................viii
表目錄................................................ xi
圖目錄..................................................x
第一章
緒 論…………………………………………………………………1
第一節 前 言………………………………………………………1
第二節 研究目的…………………………………………………3
第二章
文獻探討…………………………………………………………5
第一節 C型肝炎的流行病學(流行趨勢及分佈情形)………………5
第二節 肝炎篩檢主動轉介就醫之情形……………………………9
第三節 疾病主動轉介就醫之成效………………………………14
第四節 慢性C型肝炎抗病毒治療成效之相關研究………………19
第三章 研究方法……………………………………………………26
第一節 研究設計……………………………………………………26
第二節 研究樣本及資料蒐集………………………………………26
第三節 研究工具……………………………………………………30
第四節 倫理考量……………………………………………………31
第五節 資料分析方法………………………………………………31
第四章 研究結果……………………………………………………33
第一節 研究樣本特性資料…………………………………………33
第二節 肝炎篩檢後續醫療照顧追蹤之結果………………………34
一、肝炎篩檢個案對其篩檢結果的認知情形……………………34

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