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http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/7787
標題: | 區域醫療資源與非緊急急診利用之相關性探討 The Association between Regional Medical Resources and Non-urgent Emergency Department Use |
作者: | Pei-Hsuan Lin 林佩萱 |
指導教授: | 楊銘欽 |
關鍵字: | 急診,非緊急急診,基層醫療資源,二部模型,全民健保研究資料庫, emergency department,non-urgent emergency department use,primary care access,two-part model,National Health Insurance Research Database, |
出版年 : | 2017 |
學位: | 碩士 |
摘要: | 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. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/7787 |
DOI: | 10.6342/NTU201701203 |
全文授權: | 同意授權(全球公開) |
顯示於系所單位: | 健康政策與管理研究所 |
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檔案 | 大小 | 格式 | |
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ntu-106-1.pdf | 2.26 MB | Adobe PDF | 檢視/開啟 |
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