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研究生:洪湘雯
研究生(外文):Hung, Hsaing Wen
論文名稱:台灣地區阿茲海默氏症患者之醫療利用
論文名稱(外文):The Utilization of Alzheimer’s Disease Patients in Taiwan
指導教授:蔡維河蔡維河引用關係
指導教授(外文):Tsai, Wei Her
學位類別:碩士
校院名稱:國立台北護理學院
系所名稱:醫護管理研究所
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
語文別:中文
論文頁數:100
中文關鍵詞:阿茲海默氏症醫療利用Andersen醫療利用模式
外文關鍵詞:Alzheimer’s diseaseutilizationAndersen model
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背景:隨著人口老化結構,盛行於老年人的失智症人數也隨之增加。許多研究顯示阿茲海默氏症會引起重大的社會和經濟成本。然而,台灣針對阿茲海默氏症醫療利用研究仍屬罕見。

目的:探討阿茲海默氏症患者三年醫療利用情形並與對照組比較。

方法:使用國家衛生研究院發行之2005年承保抽樣歸人檔,擷取1998年1月1日至2004年12月31日期間首次使用阿茲海默氏症治療藥物者,參考Andersen醫療利用模式,採病例對照研究設計,匹配年齡及性別,依1:5比例隨機抽取非阿茲海默氏症及非失智症之患者,並排除觀察期間曾中斷ㄧ年以上無任何門診就醫紀錄者或觀察時間未滿三年者,得病例組為462人,對照組為2,310人。

結果:控制其他影響因素後,病例組在第一、二、三年門診次數,分別比對照組多8、5、5次;急診次數,分別比對照組各年間多0.1、0.2、0.1次;住院次數,分別比對照組各年間多0.1、0.1、0.1次;住院日數,分別比對照組多2、3、5天,門診醫療費用,分別比對照組多41,722、27,523、22,274元;急診費用,分別比對照組多307、404、250元;住院費用上,則分別比對照組多7,398、13,486、17,985元。

結論:阿茲海默氏症患者醫療利用三年期間皆顯著高於對照組,建議相關單位在阿茲海默氏症患者照護上,應及早進行長期之規劃,鼓勵阿茲海默氏症防治及照護之研究發展。
Background: As the population ages, the senile dementia population also increases. Many studies show that Alzheimer’s disease will take a significant social and economic toll. Despite this finding, studies on health service utilization in the treatment of Alzheimer’s disease in Taiwan are still few and far between.

Objectives: Exploration on health service utilization over a period of three years among patients with Alzheimer’s disease and comparison with the control group.

Method: From the 2005 Registry for Beneficiaries' Claims Data Files of the National Health Research Institutes, we selected patients who used treatment drugs for Alzheimer’s disease between January 1st 1998 and December 31st 2004 for the first time with reference to the health service utilization model of Andersen’s. The study was designed with a control group. Patients without Alzheimer’s disease or dementia were randomly selected at the ratio of 1:5 based on their age and sex and those without any outpatient visit records for one year or longer during the observation period or having not completed the three-year observation were excluded. 462 patients were enrolled in the case group while 2,310 were enrolled in the control group.

Result: After other influential factors were controlled, patients in the case group had 8, 5, and 5 more outpatient visits; 0.1, 0.2, and 0.1 more emergency room visits; 0.1, 0.1, and 0.1 more hospitalization times; 2, 3, and 5 more hospitalization days and paid NT$41,722, NT$27,523, and NT$22,274 more outpatient expenses; NT$307, NT$404, and NT$250 more emergency treatment expenses, and NT$7,398, NT$13,486, and NT$17,985 more hospitalization expenses in Years 1, 2, and 3, respectively, compared to patients in the control group.

Conclusion: During the three-year period, the health service utilization among patients with Alzheimer’s disease was obviously higher than that among patients in the control group. It is hence suggested that authorities concerned should plan long-term care for patients with Alzheimer’s disease before it is too late and encourage studies on the prevention and control of the disease and care for patients with Alzheimer’s disease.
目錄
中文摘要 ….………………………………………………………………………………I
英文摘要 ….………………………………………………………………………… II
目錄 ……………………………………………………………………………………… III
表目錄 ..…………………………………………..……………………………………… IV
圖目錄 ………………………………………………………………………………………V
第一章 緒論 ……………………………………………………………………………….1
第一節 研究背景、動機與研究之重要性 ………………………………………….1
第二節 研究目的與研究問題 ………………………………………………………..4
第二章 文獻探討 …………………………………………………………………………..5
第一節 阿茲海默氏症 ………………………………………………………………..5
第二節 全民健康保險阿茲海默氏症治療藥物 …………………………………….11
第三節 回顧醫療利用相關概念 …………………………………………………….14
第四節 彙整阿茲海默氏症醫療利用相關實證研究分析成果…………………...…19
第三章 研究方法 ………………………………………………………………………….24
第一節 研究設計及研究架構 .…………………………………………………...….24
第二節 研究材料、研究對象及變項名稱和操作性定義 …………………….…....27
第三節 資料處理與統計分析 …………………………………………………...…..38
第四章 研究結果 ………………………………………………………………………….44
第一節 病例組與對照組之人口學特性、門診就醫科別、醫療利用之情形 ….....44
第二節 病例組與對照組之醫療利用與人口學變項之相關分析 ………………….51
第三節 阿茲海默氏症患者醫療利用相關因素之複回歸分析結果 ……………….69
第五章 討論 ……………………………………………………………………………….84
第一節 研究結論與探討 ………………………………………………………….…84
第二節 研究限制 …………………………………………………….………………87
第三節 研究建議 ……………………………………………………………….……89
參考文獻 …………………………………………………………………….……………..91
附件一 全民健康保險給付之阿茲海默氏症治療藥物………………………………....100
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