COVID-19疫情對頻繁急診醫療利用者之影響：以北部某醫學中心為例

Abstract

研究背景與目的： 2019年底COVID-19的出現，對全球醫療體系造成巨大的影響，已有許多研究指出COVID-19大流行對各種醫療利用皆帶來不同程度的影響，醫療排擠及醫療浪費再次被提起，而COVID-19疫情對醫療體系造成的影響可視為一自然實驗，其結果亦可能是醫療資源重整的一大參考依據。 頻繁急診醫療利用已是各國廣泛討論的現象，頻繁急診醫療利用者此族群人數相對少，卻佔據了不對等之高比例急診醫療資源，國外文獻指出頻繁急診醫療利用者約佔總就診人數之2~4%，但其就診次數佔總急診就診次數中可達8~25%，顯示出少數人高醫療利用之狀況，可能造成醫療資源分配不均降低整體醫療品質，而頻繁急診醫療利用之特殊狀況更提醒著我們照護連續性之概念是否妥善進行。 我國對於相關議題之探討較少，本研究將以北部某醫學中心為例，探討頻繁急診醫療利用者之現況，並以COVID-19疫情分期視為對醫療利用之介入，進而探討COVID-19疫情對頻繁急診醫療利用者之急診醫療利用的影響。 研究方法： 本研究是以我國北部某醫學中心之2019年急診醫療利用者，排除未滿20歲及病歷不完整者，觀察樣本共34,768人(共計47,887人次)，依照其就診次數大於等於四次以上，作為頻繁急診醫療利用者之定義。並透過傾向分數加權，增加實驗組與對照組之可比性，以差異中的差異法觀察了解兩組別於2020年疫情初期及2021年我國疫情爆發期之急診醫療利用變化。 研究結果： 研究資料顯示總計34,768之樣本數，2019年平均急診就診次數1.3次，而頻繁急診醫療利用者佔總樣本人數之2.4%，該族群之平均就診次數高達5.7次，顯示頻繁急診醫療利用者對急診醫療利用次數有相關。而頻繁急診醫療利用者之特性變項，如人口學特徵、需要因素及使能因素等，與過去研究發現一致，可作為頻繁急診醫療利用者之預測變項。在多變量分析結果中顯示COVID-19疫情對整體急診醫療利用造成負向之影響，且因疫情分期不同，有影響程度之差別。而在控制相關變項後下，頻繁急診醫療利用者相對於非頻繁急診醫療利用者，其急診醫療利用下降更為明顯。 結論： 本研究發現COVID-19疫情對整體急診醫療利用有負向影響，且在控制人口學特徵、使能因素、需要因素等病歷中可取得之變項下，對頻繁急診醫療利用者之負向影響更劇，推估除病歷中可取得之變項特性外，仍有未知之影響因素，因頻繁急診醫療利用者此群族人數比例相對小，了解頻繁急診醫療利用者個體根本問題，是未來能努力前進之新策略。

Background: COVID-19 has had a huge impact on the global medical system. Many studies have pointed out that the COVID-19 pandemic has had varying degrees of impact on various healthcare utilization. Medical exclusion and health waste have been brought up again. The impact of -19 on the health system can be described as a natural experiment, and the results may also be a major reference for the reorganization of health resources. Frequent emergency department users (FEDU) have been widely discussed in various countries. The population of this group is relatively small, but they occupy an unequally high proportion of medical resources. Many studies indicate that FEDU account for about 2~4% of the total number of emergency visits. However, the number of visits accounted for 8-25% of the total emergency medical visits. Which shows the high healthcare utilization of a small number of people, which may cause uneven distribution of medical resources and reduce the overall quality. The special situation of FEDU is reminder depends on whether our continuity of care is being performed properly. There are few discussions on related issues in Taiwan. This study will take a medical center in the north as an example to discuss the status of FEDU. We want to know the impact on emergency department utilization of COVID-19 epidemic among FEDU. Methods: This study is based on the emergency department visit of a medical center in northern Taiwan. Excluding those under the age of 20 or medical records incompletely. 34,768 people and 47,887 visits of them were the data observed. The definition of FEDU is the number of visit above 4 times in one year. To increase the comparability between the experimental group and the control group through propensity score matching. Difference-in-difference method (DID) is used to observe the emergency department utilization change of the two groups in different state of COVID-19. Results: The sample size of 34,768 had an average of 1.3 visits, and FEDU had 5.7 visits. Consistent with the results of previous studies, demographic variable and medical needs of FEDU can be used as predictors variable. The reduce utilization of emergency department of the overall impact of COVID-19. And more obviously impaction on FEDU. Conclusions: We find the emergency department utilization reducing of FEDU is more obviously impaction than the others after controlling demographic and other variable in this study. There are some problems couldn’t be calculated in medical record. Understanding the typical problems of FEDU is point to help facilitate the strategic direction.