Abstract: | 隨著我國人口逐漸老化,多重慢性病問題日益嚴重,多重慢性病人乃成為醫療照護系統中最重要的資源使用者,雖各國普遍有醫療費用持續上漲之情形,但我國門診醫療之高利用率卻是世界各國少見之情形。本研究主要瞭解多重慢性病人醫療利用的情形,並探討整合照護模式實施後對其醫療利用成效之差異比較及影響醫療成效的因素。本研究對象選取中部某醫學中心門診整合照護2013年1月至2015年3月收案病人810人,最後篩選出770人。以Wilcoxon sign rank test分析整合前後一年其總醫療費用、藥費、診察費、就診次數及藥物品項數的變化,並採用對應分析方式推論醫療利用成效之影響因素。研究結果發現參與整合照護之樣本多為男性高齡長者、榮民身分且能自行步行之特性。於每人每年總醫療費用部分,整合前為23,906(±25,149)元,整合後增加為25,810(±23,090)元;每人每年藥費,整合前為12,296(±18,213)元,整合後增加為14,966(±18,518)元;每人每年就診科別數方面,整合前4.1(±2.1)科,整合後降低為3.5(±2.2)科;每人每年藥物品項數,整合前3.7(±1.3)科,整合後增加為5.1(±2.0)科;每人每年門診就診次數部分,整合前13.5(±8.4)次,整合後降低為12.5(±8.0)次。運用對應分析方法探討整合成效之相關性,推論出未使用輔具、無手術且無住院者其醫療總費成效較好,有手術者則醫療總費則有增加的情形;醫療利用結果發現榮民身分在總醫療費用、就診次數及就診科別數均大於健保身分,且高齡者其就診科別及診次較非高齡者多。而男女性別與醫療總費沒有明顯差異,藥費越高、藥物品項越多、就診次數多及看診科別數多則其醫療總費越高。 With the trends of population aging in Taiwan, and multiple chronic diseases problems getting increasingly worse, patients with chronic diseases became the most important resources users in healthcare system. Medical expenses were continually rising all over the world, but the high medical resources consumption in Taiwan was rare compared with other countries around the world. The purpose of this study was to investigate medical utilization of multiple chronic diseases patients, and find out the effect of healthcare utilization and impact factor after implementing integrated outpatient care. The participants in this study were 770 patients selecting out of 810 patients from one medical center of integrated outpatient care in central Taiwan from January 2013 to March 2015. The method to carry out this study was using Wilcoxon sign rank test, analyzing annual medical expenses, medicine fees, diagnosis fees, outpatient visits, and amounts of drug items, and surmised the impact factor based on correspondence analysis.The results of the study were that the samples of attending integrated outpatient care were mostly elderly male veterans, who were able to walk on foot. The total medical expenses was NT$23,906(±25,149) per person annually before integration and increase to 25,810(±23,090) after integration; the total medicine fees was NT$12,296(±18,213) per person annually and increased to NT$14,966(±18,518) after integration; the amount of drug items were 3.7(±1.3) and increase to 5.1(±2.0) after integration; the outpatient visits were 13.5(±8.4) times and reduced to 12.5(±8.0) times after integration. The results, according to meta-analysis, revealed that it had great effect on those without using assistive devices, surgery, and hospitalization. The total medical expenses of those patients who had surgery increased. The finding of medical utilization showed that the total medical expenses, outpatient visits, and treatment divisions of veterans were more than those patients taking out National Health insurance. Furthermore, treatment divisions and outpatient visits of the elderly were much more than non-elderly. The total medical expenses didn't show great difference between male and female. The more the medicine fees, medicine items, outpatient visits, treatment divisions, and the more total medical costs. |