區域醫療資源與非緊急急診利用之相關性探討

Abstract

目的：本研究旨在了解國內非緊急急診利用情形，並探討病患個人特質及區域醫療資源與非緊急急診利用的相關性。 方法：使用全民健保研究資料庫2010年承保抽樣歸人檔，以2013年非外傷急診就醫紀錄110,338人次，歸戶後共67,224位成年人為研究對象。本研究將臺灣急診檢傷與急迫度分級量表第四級、第五級之個案定義為非緊急急診，分別以廣義估計方程式(GEE)和二部模型(two-part model)進行分析。 結果：非緊急急診比率為18.3%，居住地基層醫師占率較高者，有非緊急急診利用的機率顯著較低(OR=0.70)；年齡、收入、共病症、門診照護連續性及是否為假日就醫是非緊急急診利用的相關因素。 結論：研究結果顯示，區域醫療資源與非緊急急診利用相關。建議衛生主管機關未來在制定相關政策時，應考量基層醫療資源配置，同時提供充分就醫場所資訊供民眾參考，以提高醫療資源使用效率。

Objectives: Policymakers have increasingly focused on emergency department (ED) utilization for non-urgent conditions. This study aims to explore non-urgent emergency department use in Taiwan and to determine the association between healthcare resources and presentation to ED with non-urgent conditions. Method: This study included 110,338 ED visits in 2013 made by 67,224 adult ED patients selected from National Health Insurance Research Database. ED visits triaged as level 4 or level 5 based on Taiwan Triage and Acuity Scale (TTAS) were defined as non-urgent ED use. Generalized estimating equation (GEE) and two-part model were performed to identify the factors associated with non-urgent ED use. Result: 18.3% of total ED visits were non-urgent in 2013. People from areas with higher proportion of primary care physicians are less likely to present to EDs for non-urgent conditions (OR=0.70). Characteristics such as age, income, comorbidities, continuity of ambulatory care and seeking care on holidays are associated with non-urgent ED use. Conclusion: The results indicated that access to primary care providers was associated with non-urgent ED use. To improve the efficiency of healthcare resource utilization, primary care resource allocation should be considered.