臺灣博碩士論文加值系統

產婦選擇診所或醫院生產之相關因素探討
－以澎湖地區為例
摘 要

目的
依照行政院衛生署統計，自從全民健康保險推行之後，民眾就醫選擇加大，妊娠婦女選擇在醫院中生產的比率逐年上升，接受診所提供的產檢及接生服務的比例日漸下降，主要的原因是因為在全民健保的庇蔭下，民眾就醫的可近性上升，由於醫院的醫療設備通常比一般婦產科診所完善，因此產婦傾向前往醫院接受產檢及生產，導致婦產科診所及醫院婦產科間服務數量比率有改變的情形。根據九十三年在澎湖地區的醫院及診所生產人數統計比例為48:52，顯示澎湖地區產科生態有別於台灣，澎湖地區產婦選擇生產場所的影響因素有哪些？本研究之研究目的如下：
• 瞭解澎湖地區妊娠婦女就醫型態、人口學特徵及個人能力因素情形。
• 瞭解澎湖地區妊娠婦女就醫相關之環境影響與需求。
• 建立妊娠婦女選擇醫療機構之迴歸分析模式。

方法
• 利用Andersen 醫療利用行為模式研擬結構式調查問卷，分析產婦會選擇在診所或醫院生產的行為模式。
• 採SPSS for Windows 10.0 統計套裝軟體進行複對數迴歸分析，找出會選擇在醫院或診所生產的影響因素。
• 研究對象來源為澎湖地區懷孕28週以後（妊娠第三期）的產婦。
• 取樣方式為分別於有接生服務之診所及醫院，對符合上述條件之門診或住院之產婦實施問卷，取樣期間從94年1月15日至94年3月15日共計兩個月。

結果
• 產婦的年齡、教育程度、職業、宗教、每月家庭總收入、有無私人人壽保險、自費項目多寡、候診時間的長短，有無產科合併症，先前不好的生產經驗，有沒有固定醫師接生，和認同生產為一個自然過程的觀念等十二項，都與產婦選擇生產場所行為顯著相關。
• 把所有可能顯著影響產婦選擇生產場所的變項投入複對數迴歸分析模式中，則發現僅有五個變項達到顯著性，即教育程度，是否有私人人壽保險，認同生產為一個自然過程的觀念，先前不好的生產經驗及有固定醫師接生。
• 在綜合考量因素統計中，發現澎湖地區產婦在選擇生產場所時最重要的考量因素依序為醫師的因素，其次為醫療設備，及病房設施。最不會考慮的因素依序為交通的因素，經濟的因素及候診時間的長短。

結論與建議
• 研究發現會選擇在醫院生產的產婦，普遍年齡愈大，社經地位較高，而且不認同生產是一個自然的過程，必需有良好的急救醫療設備才會安心。因此醫院必須對於年紀較輕，教育程度較低的產婦，加強宣導「生產雖然是一個自然的過程，但是並非每個人都很順利，有完善的醫療急救設備，才是安全的保障」。
• 研究發現會在診所生產的產婦是希望有固定的醫師接生，而醫院的醫師因為來自台灣，假日經常返台，以致造成產婦心�堛漱ㄕw，建議澎湖地區的醫院必須培養自己在地的年輕婦產科醫師，願意留在醫院為澎湖當地產婦服務。
• 候診時間過長也是產婦選擇到診所生產的原因，因此醫院必須簡化作業流程，或加開門診看診次數，以縮短候診時間。
• 自費項目太多或先前不愉快的生產經驗，容易讓診所的產婦改變生產場所，因此診所要吸引產婦到院生產，必須盡量減少或降低自費品項，並提高服務品質。

關鍵詞：澎湖地區、妊娠婦女、生產場所、複對數迴歸分析

Factors Associated with Pregnant Women for Choosing Deliver at Clinics
or Hospital ------ Penghu Area as Example

Abstract

Objectives：
According to the statistics of Health Department of Executive Yuan,after health care insurance carry out,that pregnant women choose hospital to deliver more often than clinics in recent years. The main reason is that people choose medical organizations more convenient than before under health care insurance. Pregnant women are more likely to receive prenatal exam and deliver at hospital due to good medical equipments. This condition changes the delivery rate at clinics and hospitals in Taiwan,but this situation is not same as Penghu.The Penghu County Health Bureau reported that Penghu birth rate at hospital and clinics was forty eight over fifty two last year. What’s the factors associated with pregnant women for choosing delivery place in Penghu.The purposes of this study including：
To know pregnant women’s medical behavior and demographic, enabling factors in Penghu area.
To know pregnant women’s medical need and environmental factors in Penghu area.
Set up a logistic regression model for explaining pregnant women’s delivery place.

Methods：
This study use Andersen model to design structured questionnaires for analyzing the pregnant women’s medical behavior model that choose delivery place .
This study uses multiple logistic regression analysis with SPSS for Windows 10.0,trying to find out the factors associated with pregnant women for choosing delivery place.
This target population are pregnant over 28 weeks (third trimester) women in Penghu area.
Pregnant women in Penghu conform the above requirement receive questionnaires at hospital or clinics that have delivery service. Survey period was between Jan. 15 and March 15,2005.

Results:
Pregnant women’s age, education, occupation, religion, family income per month, private insurance, payment items by patient, waiting time, obstetric complication, previous bad delivery experience, fix doctor deliver, delivery is nature procedure concept and so on are significant relation in pregnant women choose delivery place.
Put these 12 factors into multiple logistic regression analysis model. We find that education, private insurance, delivery is nature procedure concept, previous bad delivery experience, fix doctor deliver and so on have significant differences at clinics and hospital.
Synthesize statistic find that the first three thinking factors in penghu are doctor, medical equipments, and ward installation. The last three thinking factors are traffic, economic, and waiting time.

Discussion:
This research reveal that pregnant women choose hospital to deliver have old age, high socioeconomic level and not consider delivery is nature procedure. Hospital must propagate to young age and low socioeconomic pregnant women with that “thought delivery is nature procedure, but not everyone is so smooth. Good emergency equipments is the only method to ensure delivery safe”.
Pregnant women choose clinics to deliver hope fix doctor. Hospital’s obstetric doctor come from Taiwan and usual leave penghu at day off make patient not feel safty. This study suggest that penghu’s hospital have to train locality young obstetric doctor and voluntary to stay in hospital for service.
Long waiting time is the cause of pregnant women choose clinics to deliver. Hospital must simpling work procedure or increase frequency of outpatient service for shorten waiting time.
Too much payment by patient and previous bad delivery experience usual change delivery place in clinics patient. If clinics want to attract pregnant women to deliver must decrease payment items and elevate service quality.

Key words: Penghu area, pregnant women, delivery place, multiple logistic regression analysis

目錄
摘要…………………………………………………………………Ⅰ
Abstract……………………………………………………………Ⅲ
目錄…………………………………………………………………Ⅴ
圖表目錄……………………………………………………………Ⅶ
第一章 前言………………………………………………………1
第一節 研究緣起…………………………………………1
第二節 研究目的與假設…………………………………4
第三節 名詞解釋…………………………………………6
第二章 文獻探討…………………………………………………7
第一節 澎湖地區人口分佈及婦產科醫療資源現況… 7
第二節 就醫行為模式探討……………………………15
第三節 妊娠婦女就診之醫療院所選擇及考量………24
第三章 材料與方法…………………………………………… 31
第一節 研究概念架構…………………………………31
第二節 研究對象與資料來源…………………………32
第三節 變項之定義……………………………………33
第四節 資料處理與統計分析…………………………36

第四章 結果………………………………………………………38
第一節 描述性統計－交叉分析…………………………38
第二節 推論性統計－複對數迴歸分析模式……………55
第三節 綜合考量因素統計………………………………57
第五章 討論………………………………………………………59
第一節 產婦選擇生產場所行為之相關因素探討………59
第二節 產婦選擇生產場所綜合考量因素探討…………62
第六章 結論與建議………………………………………………64
第一節 結論………………………………………………64
第二節 建議………………………………………………66
第三節 研究限制…………………………………………68
參考文獻……………………………………………………………70
附錄: 產婦選擇生產場所行為調查問卷

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