跳到主要內容

臺灣博碩士論文加值系統

(44.192.48.196) 您好!臺灣時間:2024/06/26 02:59
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

我願授權國圖
: 
twitterline
研究生:蘇筱婷
研究生(外文):Hsiao-Ting Su
論文名稱:臺南社區民眾衛教戒菸成本效益分析
論文名稱(外文):Cost-effectiveness Analysis of Community-based Health Education Program for Smoking Cessation in Tainan, Taiwan
指導教授:陳秀熙陳秀熙引用關係
指導教授(外文):Hsiu-Hsi Chen
口試委員:陳淑娟嚴明芳陸玓玲
口試委員(外文):Shu-Chuan ChenMing-Fang YenDih-Ling Luh
口試日期:2020-07-21
學位類別:碩士
校院名稱:國立臺灣大學
系所名稱:公共衛生碩士學位學程
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:2020
畢業學年度:108
語文別:中文
論文頁數:80
中文關鍵詞:戒菸社區戒菸衛教戒菸班戒菸衛教諮詢成本效益分析
外文關鍵詞:Smoking CessationGroup TherapyConsultation ServiceCost-Effectiveness
DOI:10.6342/NTU202002739
相關次數:
  • 被引用被引用:1
  • 點閱點閱:148
  • 評分評分:
  • 下載下載:0
  • 收藏至我的研究室書目清單書目收藏:0
研究目的:依據世界衛生組織(WHO)調查顯示,全球有63%的死亡由非傳染性疾病引起,而「菸草」是其主要風險因素。在台灣,菸草及相關危害每年造成至少2萬7,000 人死亡,另約有287萬人因吸菸及二手菸罹病,足以顯現吸菸不僅影響個人健康,更會對社會造成龐大的負擔,因此菸害防制為當前公共衛生領域中刻不容緩的課題之一。為了協助吸菸者戒菸,目前發展出許多介入方式,在社區中,則以戒菸班、護理人員衛教為最常使用之介入方法。本研究以醫療經濟觀點,探討以社區為主的戒菸班及衛教諮詢做為社區衛教介入計畫之成本效益。
方法:本研究採橫斷式調查,以2019年臺南市各區衛生所辦理戒菸班及2019年接受社區戒菸衛教諮詢服務之吸菸民眾為研究對象,利用機率性成本效用分析(Probabilistic cost-utility Analysis, CUA)評估社區戒菸衛教,即「戒菸班」及「戒菸諮詢衛教」介入後相較於台南市「行動醫院-全民健檢」社區整合式篩檢之成本效益,並計算因戒菸每增加一個生活品質校正生命年所需額外付擔的成本。
結果:在提升戒菸意願部分,經由戒菸班介入後,戒菸意願有改善者占80%,惡化者占3.6%,戒菸班介入計畫之戒菸成功率為49.5%,社區戒菸衛教諮詢介入計畫之戒菸成功率12.5%。在成本效益部分,若對照組設定為未有任何介入措施時吸菸民眾之戒菸率為0%,則戒菸班介入每增加一個生活品質調整後之生命年數所需成本為新臺幣5,363元;社區戒菸衛教諮詢,每增加一個生活品質調整後之生命年數所需成本為為新臺幣1,323.4元。若進一步以參加行動醫院整合式篩檢民眾之戒菸狀況作為基礎組(戒菸率為14.4%),在不考慮生產力損失之前,戒菸班介入計畫之增量成本效用比為新臺幣9,266元,社區戒菸衛教諮詢介入計畫之增量成本效用比為新臺幣-7,273元(成本增加、效益減少),在支付意願為新臺幣10,000元時,戒菸班達到成本效益的比率為70%,在支付意願超過新臺幣30,000元時,戒菸班達到成本效益的比率為100%。若進而考慮生產力損失後,則戒菸班之增量成本效益比屬於優勢策略(效益增加、成本減少),在任何支付意願下,戒菸班符合成本效益的比例達100%。
結論:本研究顯示戒菸班介入計畫確實能提升民眾戒菸意願,且戒菸成功率較社區戒菸衛教諮詢服務介入計畫高。在成本效益部分,在考慮生產力損失後,戒菸班更具成本效益。
Objective: According to a World Health Organization (WHO) survey, 63% of deaths are caused by non-communicable diseases in worldwide, and tobacco is the main risk factor. Smoke contains more than 7,000 chemical components, at least 250 of which are known to be harmful, and more than 69 cause cancer. In Taiwan, tobacco and related hazards cause at least 27,000 deaths each year, 2.87 million people were ill because of smoking and second-hand smoke. It shows that smoking not only affects personal health, but also causes a huge burden on society. Therefore, the tobacco control is one of the urgent issues in the current public health. In order to assist smokers to quit smoking, there are many effective interventions, including group therapy, personal consultation, telephone consultation, physician counseling, nursing health education, self‐help smoking cessation, nicotine and non-nicotine replacement therapy. However, group therapy and smoking counseling services in community are the most commonly used intervention methods in the community. In this study, the effectiveness of group therapy and smoking counseling services in community, as personalized health education intervention programs, was discussed in the view of medical economics.
Research design and method: This study uses a cross-sectional survey, taking group therapy conducted by public health centers in Tainan City in 2019 and smoking counseling services in community in 2019 as the research object. Using probabilistic cost-utility analysis method to evaluate the cost-effectiveness of the personalized health education, as group therapy and smoking counseling services in community. The cost-effectiveness of the intervention program is compared with Tainan community-based integrated screening (called mobile hospital). The benefits of the intervention program are expressed in terms of the increased quality-adjusted life year after smoking cessation.
Results: In the part of cessation intention, after intervened by group therapy, 80% of the participants are improved, and 3.6% worsened. In the cost-effectiveness part,
we assumed that without any intervention, the smoking cessation rate of smokers is 0%. The quit rate of group therapy is expected to achieve 49.5%. The cost for each additional quality-adjusted life year is NT$ 5,362.57. The quit rate of quitting smoking in the smoking counseling services in community is 12.5 %, the cost of each additional quality-adjusted life year is NT$ 1,323.4. If the smoking cessation status of people participating in mobile hospital is further used as the basic group (the smoking cessation rate is 14.4%). Considering the cost of being unable to work due to reduced QALY, the estimated incremental cost-benefit ratio of the group therapy is NT$9,266, and the smoking counseling services in community is NT$-7,273 (increased cost and reduced benefit). The cost-effective proportion of group therapy is almost 100%. Regardless of the cost of being unable to work after reduced QALY, if the willingness-to-pay is NT$10,000, the rate of cost-effectiveness of group therapy is about 70% and if the willingness-to-pay is over NT$30,000, the rate of cost-effectiveness of group therapy is achieved 100%.If we consider the cost of being unable to work after reduced QALY, the incremental cost-benefit ratio of the group therapy falls in the fourth quadrant. Under any willingness to pay, the cost-effective ratio of the smoking cessation class reaches 100 %.
Conclusion: This study shows that the group therapy intervention can indeed increase people's cessation intense, and the quit rate in higher than community health education and consultation service intervention plan. Taking into account the cost of being unable to work due to reduced QALY, group therapy are more cost-effectiveness and can be widely used in the community.
第一章 導論 1
第一節 研究背景及起源 1
第二節 實習單位特色與簡介 2
第三節 文獻回顧 3
第四節 研究架構與假設 19
第五節 研究目的與研究問題 21
第二章 方法 22
第一節 研究對象 22
第二節 資料收集 23
第三節 成本與效用之測量 26
第四節 成本效用分析 33
第五節 統計方法 40
第三章 結果 41
第一節 戒菸班介入計畫之成本效益分析 41
第二節 社區戒菸諮詢衛教服務計畫之成本效益分析 43
第三節 戒菸班及社區衛教諮詢服務之成本效益分析 45
第四節 結果小結 47
第四章 討論 66
第一節 社區戒菸衛教介入計畫之戒菸率 66
第二節 社區戒菸衛教介入計畫之成本效益 68
第三節 社區戒菸衛教提升民眾戒菸意願 70
第四節 建議 76
一、中文部分
1.衛生福利部國民健康署:107年成人吸菸行為調查。衛生福利部國民健康署,2019。
2.衛生福利部國民健康署:108年臺灣菸害防制年報。衛生福利部國民健康署,2019。
3.行政院衛生署國民健康局(現為衛生福利部國民健康署):門診戒菸治療醫師訓練計畫教育課程基本教材(第六版)。行政院衛生署國民健康局,2011。
4.李蘭、潘怜燕、晏涵文、李隆安:臺灣地區成年人之吸菸現況:盛行率及危險因子。中華公共衛生雜誌, 13(5), 1994。

二、英文部分
1. Straif AJSMBSK. Tobacco smoking and cancer a brief review of recent epidemiological evidence. Lung Cancer. 2004;45: S3–S9.
2. Beaglehole R, Bonita R, Horton R, et al. Priority actions for the non-communicable disease crisis. The Lancet. 2011;377: 1438-1447.
3. Control CfD, Prevention. How tobacco smoke causes disease: The biology and behavioral basis for smoking-attributable disease: A report of the surgeon general2010.
4. Thun MJ, Henley SJ, Calle EE. Tobacco use and cancer: an epidemiologic perspective for geneticists. Oncogene. 2002;21: 7307-7325.
5. Health UDo, Services H. The health consequences of smoking—50 years of progress: a report of the Surgeon General: Atlanta, GA: US Department of Health and Human Services, Centers for Disease …, 2014.
6. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004;328: 1519.
7. Pirie K, Peto R, Reeves GK, Green J, Beral V. The 21st century hazards of smoking and benefits of stopping: a prospective study of one million women in the UK. The Lancet. 2013;381: 133-141.
8. Ockene IS, Miller NH. Cigarette smoking, cardiovascular disease, and stroke: a statement for healthcare professionals from the American Heart Association. Circulation. 1997;96: 3243-3247.
9. Csordas A, Bernhard D. The biology behind the atherothrombotic effects of cigarette smoke. Nat Rev Cardiol. 2013;10: 219-230.
10. Jha P. Avoidable global cancer deaths and total deaths from smoking. Nat Rev Cancer. 2009;9: 655-664.
11. Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: combination of national statistics with two case-control studies. BMJ. 2000;321: 323-329.
12. Salonen JT. Stopping smoking and long-term mortality after acute myocardial infarction. Heart. 1980;43: 463-469.
13. West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol Health. 2017;32: 1018-1036.
14. Stead LF, Carroll AJ, Lancaster T. Group behaviour therapy programmes for smoking cessation. Cochrane database of systematic reviews. 2017.
15. Lancaster T, Stead LF. Individual behavioural counselling for smoking cessation. Cochrane database of systematic reviews. 2017.
16. Stead LF, Hartmann‐Boyce J, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane database of systematic reviews. 2013.
17. Stead LF, Buitrago D, Preciado N, Sanchez G, Hartmann‐Boyce J, Lancaster T. Physician advice for smoking cessation. Cochrane database of systematic reviews. 2013.
18. Rice VH. Nursing intervention and smoking cessation: meta-analysis update. Heart & lung. 2006;35: 147-163.
19. Lancaster T, Stead LF. Self‐help interventions for smoking cessation. Cochrane database of systematic reviews. 2005.
20. Stead LF, Perera R, Bullen C, et al. Nicotine replacement therapy for smoking cessation. Cochrane database of systematic reviews. 2012.
21. Jorenby DE, Leischow SJ, Nides MA, et al. A controlled trial of sustained-release bupropion, a nicotine patch, or both for smoking cessation. New England Journal of Medicine. 1999;340: 685-691.
22. Tsai S-T, Cho H-J, Cheng H-S, et al. A randomized, placebo-controlled trial of varenicline, a selective α4β2 nicotinic acetylcholine receptor partial agonist, as a new therapy for smoking cessation in Asian smokers. Clinical therapeutics. 2007;29: 1027-1039.
23. Ebbert JO, Wyatt KD, Hays JT, Klee EW, Hurt RD. Varenicline for smoking cessation: efficacy, safety, and treatment recommendations. Patient preference and adherence. 2010;4: 355.
24. Buczkowski K, Marcinowicz L, Czachowski S, Piszczek E. Motivations toward smoking cessation, reasons for relapse, and modes of quitting: results from a qualitative study among former and current smokers. Patient Prefer Adherence. 2014;8: 1353-1363.
25. McCaul KD, Hockemeyer JR, Johnson RJ, Zetocha K, Quinlan K, Glasgow RE. Motivation to quit using cigarettes: a review. Addict Behav. 2006;31: 42-56.
26. Gallus S, Muttarak R, Franchi M, et al. Why do smokers quit? Eur J Cancer Prev. 2013;22: 96-101.
27. Hyland A, Borland R, Li Q, et al. Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15 Suppl 3: iii83-94.
28. Prochaska JO, DiClemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice. 1982;19: 276-288.
29. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology. 1983;51: 390.
30. Carlo C. DiClemente SKF, Mary M. Velasquez, James Q Prochaska, Wayne F. Velicer, Joseph S. Rossi. The Process of Smoking Cessation: An Analysis of Precontemplation,
Contemplation, and Preparation Stages of Change. Journal of Consulting and Clinical Psychology. 1991;59.
31. Rice DP, Hodgson TA, Kopstein AN. The economic costs of illness: a replication and update. Health care financing review. 1985;7: 61.
32. Cooper BS, Rice DP. The economic cost of illness revisited. Soc. Sec. Bull. 1976;39: 21.
33. Cromwell J, Bartosch WJ, Fiore MC, Hasselblad V, Baker T. Cost-effectiveness of the clinical practice recommendations in the AHCPR guideline for smoking cessation. Jama. 1997;278: 1759-1766.
34. Smith MY, Cromwell J, DePue J, Spring B, Redd W, Unrod M. Determining the cost-effectiveness of a computer-based smoking cessation intervention in primary care. Manag Care. 2007;16: 48-55.
35. Berndt N, Bolman C, Lechner L, et al. Economic evaluation of a telephone-and face-to-face-delivered counseling intervention for smoking cessation in patients with coronary heart disease. The European Journal of Health Economics. 2016;17: 269-285.
36. Stapleton J, Lowin A, Russell M. Prescription of transdermal nicotine patches for smoking cessation in general practice: evaluation of cost-effectiveness. The Lancet. 1999;354: 210-215.
37. Hymowitz N, Sexton M, Ockene J, Grandits G, Group MR. Baseline factors associated with smoking cessation and relapse. Preventive medicine. 1991;20: 590-601.
38. Luh D-L, Chen SL-S, Yen AM-F, Chiu SY-H, Fann C-Y, Chen H-H. Effectiveness of advice from physician and nurse on smoking cessation stage in Taiwanese male smokers attending a community-based integrated screening program. Tobacco induced diseases. 2016;14: 15.
連結至畢業學校之論文網頁點我開啟連結
註: 此連結為研究生畢業學校所提供,不一定有電子全文可供下載,若連結有誤,請點選上方之〝勘誤回報〞功能,我們會盡快修正,謝謝!
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top