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研究生:洪雯菊
研究生(外文):Hung Wen-Jiu
論文名稱:智能障礙者罹患精神疾病之住院及其醫療資源耗用相關因素分析
論文名稱(外文):Hospital Admission Care Utilization and Correlated Factors among Patients with an Intellectual Disability Co-occurring with Psychiatric Disorders
指導教授:林金定林金定引用關係
指導教授(外文):Lin Jin-Ding
口試委員:羅慶徽徐尚為林金定
口試委員(外文):Loh Ching-HuiHsu Shang-WeiLin Jin-Ding
口試日期:2011-05-12
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:2011
畢業學年度:99
語文別:中文
論文頁數:94
中文關鍵詞:健保資料庫醫療資源耗用精神疾病智能障礙
外文關鍵詞:National health insurancePsychiatric disorderMedical utilizationIntellectual disability
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摘要
因為受限於智能不足與社會適應之限制,智能障礙者是身心障礙健康較弱勢的一群,他們面臨多就醫的溝通問題,醫療利用也較一般人來得高;許多研究顯示出精神疾病是智能障礙者罹患最多的合併症之一,而國內精神疾病患者也是高醫療資源耗用的族群,但目前國內的醫療保健政策,少有針對罹患精神疾病的智障者分析其醫療使用相關因素之研究。故本研究目的乃在於探討,智能障礙者合併精神疾病利用住院醫療照護情形,以及造成其高醫療耗用的相關因素。研究方法藉由2005年的身心障礙全民健保資料庫,採橫斷性的研究設計,分析其住院醫療費用清單明細檔,探討1,268位合併精神疾病的智障者之住院次數、天數,及其相關醫療耗用。研究結果,合併精神疾病的男性佔58.9%較多;年齡20至39歲合併精神疾病的智障者共佔62.5%;經羅卲斯迴歸校正後發現,合併精神疾病的智障者有較高的住院費用耗用(OR=4.099, 95% CI=3.261-5.153);發現人口特性影響高醫療耗用因素中以有低收入戶身份耗用較高醫療費用(OR=2.484, 95% CI=1.252-4.929);而合併兒童期精神疾病的男性智障者有較高的醫療費用耗用(OR=11.558, 95% CI=1.830-73.012)。從研究發現智障者合併精神疾病確實耗用較高的醫療資源,而本研究發現的醫療資源耗用因素,可作為往後醫療衛生單位在照護有雙重診斷的智障者之參考。
Abstract
Aims: This study described and examined the hospital admission care use and medical expenditure among patient with intellectual disability (ID) co-occurring with psychiatric disorders in Taiwan. Methods: A cross-sectional retrospective study was conducted in the study, based on the data of inpatient use and medical expenditures of 2005 national health insurance claims in Taiwan. Results: The main findings of the study revealed that there were 2,565 individuals with ID using hospital inpatient care, and the factors of male (58.9%), 20-39 years old (62.5%) person with ID were more likely to use the psychiatric inpatient care. The logistic regression model analyses found that those ID patient co-occurring with psychiatric disorders (OR=4.099, 95% CI=3.261-5.153), come from low income family (OR=2.484, 95% CI=1.252-4.929), and the male ID patient co-occurring psychoses with origin specific to childhood (OR=11.558, 95% CI=1.830-73.012) consumed more medical expenditure than their counterparts. Conclusions: The study confirmed with previous studies that those people with ID accompanied with dual-diagnosis had used more medical cost than their counterparts. Therefore, the health authorities should pay much attention to the mental health issues of people with ID, to improve their quality of health in psychiatric admissions.
目錄
摘要 VIII
第一章 緒論 1
第一節 問題背景 1
第二節 研究動機與重要性 2
第三節 研究目的 3
第二章 文獻探討 4
第一節 智障者的基本人口特質 4
第二節 罹患精神疾病的健康問題 5
第三節 精神疾病的醫療耗用問題 8
第三章 研究方法與步驟 12
第一節 研究架構 12
第二節 研究假設 13
第三節 名詞解釋 13
第三節 研究工具 14
第四節 研究方法 15
第五節 研究對象 15
第六節 資料處理與分析 16
第四章 研究結果 19
第一節 智能障礙者罹患精神疾病情形 19
第二節 智能障礙者罹患精神分裂 24
第三節 智能障礙者罹患其他器質性精神病態(慢性) 26
第四節 智能障礙者罹患慢性情感性精神病 27
第五節 智能障礙罹患源於兒童期之精神病 29
第五章 討論 31
第一節 智能障礙者罹患精神疾病情形 31
第二節 智障者罹患精神病的住院服務之醫療利用情形 32
第三節 智障者罹患不同精神病的醫療耗用分析 33
第四節 影響智障者罹患精神疾病的醫療耗用之相關因素 36
第五節 研究限制 39
第六章 結論與建議 40
參考文獻 43


附錄一、表格目錄
表1. 智能障礙者合併相關精神疾病之住院人口 53
表2. 智能障礙者合併精神疾病的就醫醫院權屬別分布情形(人次) 54
表3. 智能障礙者住院之基本人口學特性分析 55
表4. 智能障礙者的相關住院醫療耗用 56
表5. 智能障礙者有無合併精神疾病之住院基本人口學特性比較 57
表6. 智能障礙者有無合併精神疾病之住院醫療相關費用比較 58
表7. 智能障礙者住院費用高低與住院基本人口學特性之羅吉斯迴歸 59
表8. 智能障礙者住院天數高低與住院基本人口學特性之羅吉斯迴歸 60
表9. 智能障礙者合併精神疾病之住院基本人口學特性分析 61
表10. 智能障礙者合併精神疾病的相關住院醫療耗用 62
表11. 智能障礙者合併精神疾病的住院醫療費用高低與基本人口學特性之比較 63
表12. 智能障礙者合併精神疾病的住院醫療費用與基本人口學特性之比較 64
表13. 智能障礙者合併精神疾病之住院醫療費用影響因素複迴歸分析 65
表14. 智障者合併精神疾病的住院醫療費用高低與基本人口學特性之羅吉斯迴歸 66
表15. 智能障礙者合併精神分裂之住院基本人口學特性分析 67
表16. 智能障礙者合併精神分裂的相關住院醫療耗用 68
表17. 智能障礙者合併精神分裂的住院醫療費用高低與基本人口學特性之比較 69
表18. 智能障礙者合併精神分裂的住院醫療費用與基本人口學特性之比較 70
表19. 智能障礙者合併精神分裂之住院醫療費用影響因素複迴歸分析 71
表20. 智能障礙者合併精神分裂的住院醫療費用高低與基本人口學特性之羅吉斯迴歸 72
表21. 智能障礙者合併其他器質性精神病態之住院基本人口學特性分析 73
表22. 智能障礙者合併其他器質性精神病態的相關住院醫療耗用 74
表23. 智能障礙者合併其他器質性精神病態的住院醫療費用高低與基本人口學特性之比較 75
表24. 智能障礙者合併其他器質性精神病態的住院醫療費用與基本人口學特性之比較 76
表25. 智能障礙者合併其他器質性精神病態的住院醫療費用影響因素複迴歸分析 77
表26. 智能障礙者合併其他器質性精神病態的住院醫療費用高低與基本人口學變項之羅吉斯迴歸 78
表27. 智能障礙者合併情感性精神病之住院基本人口學特性分析 79
表28. 智能障礙者合併情感性精神病的相關住院醫療耗用 80
表29. 智能障礙者合併情感性精神病的住院醫療費用高低與基本人口學特性之比較 81
表30. 智能障礙者合併情感性精神病的住院醫療費用與基本人口學特性之比較 82
表31. 智能障礙者合併情感性精神病的住院醫療費用影響因素複迴歸分析 83
表32. 智能障礙者合併情感性精神病的住院醫療費用高低與基本人口學特性之羅吉斯迴歸 84
表33. 智能障礙者合併源於兒童期精神病之住院基本人口學特性分析 85
表34. 智能障礙者合併源於兒童期精神病的相關住院醫療耗用 86
表35. 智障者合併源於兒童期精神病的住院醫療費用高低與基本人口學特性之比較 87
表36. 智能障礙者合併源於兒童期精神病的住院醫療費用與基本人口學特性之比較 88
表37. 智能障礙者合併源於兒童期精神病的住院醫療費用影響因素複迴歸分析 89
表38. 智障者合併源於兒童期精神病的住院醫療費用高低與基本人口學變項之羅吉斯迴歸 90


附錄二、圖目錄
圖1. 智能障礙者合併精神分裂症之病別細項 91
圖2. 智能障礙者合併其他器質性精神病態(慢性)之病別細項 92
圖3. 智能障礙者合併情感性精神病之病別細項 93
圖4. 智能障礙者合併源於兒童期精神病之病別細項 94


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1. 嚴嘉楓、羅慶徽、林金定、陳美花、吳佳玲、李宗楠、馮世祥(2004)。健康需求評估應用於身心障礙福利機構健康促進計畫初探。身心障礙研究,2,214-228。
2. 嚴嘉楓、林金定(2009)。智能障礙青少年健康情形與醫療利用及其相關因素之研究。身心障礙研究,7,94-120。
3. 蕭淑貞、李依玲、康云瑄、鄭進興、張凱雁(2008)。社區與醫院間聯盟以提供精神病患持續性護理之初探。精神衛生護理雜誌,3,1-8。
4. 蔡艷清、嚴嘉楓、林金定(2004)。精神疾病與智能障礙:流行病學與醫療照護需求分析。身心障礙研究,2,95-108。
5. 葉玲玲、藍忠孚、鄭若瑟(2003)。台灣精神分裂症患者精神醫療利用與費用之分析探討。台灣公共衛生雜誌,22,194-203。
6. 陸雪芬、洪成志、汪文聖、許樹珍(2010)。精神分裂症病患與家庭成員面臨疾病遺傳不確定情境之生活經驗探討。護理雜誌,57,55-63。
7. 林維娟、張鴻仁、王本仁、周穎政、李丞華(2004)。影響住院病患跨區利用之因素。台灣公共衛生雜誌,23,453-461。
8. 林金定、嚴嘉楓、李志偉、吳佳玲(2003)。智能障礙者醫療需求評估與就醫障礙之分析。台灣公共衛生雜誌,22,108-117。
9. 李靜玟、吳肖琪(2005)。市場競爭及其他因素對精神科急性住院病患醫療利用之影響。台灣公共衛生雜誌,24,296-305。
10. 林金定(2004)。智能障礙科學研究與發展─趨勢與展望。身心障礙研究,2,126-133。