慢性阻塞性肺病門診照護連續性之相關因素探討

The determinants of continuity of care for patients with chronic obstructive pulmonary disease

目標：測量慢性阻塞性肺病(chronic obstructive pulmonary disease, COPD)病人的COPD相關門診照護連續性，並探討影響其門診照護連續性的相關因素。方法：採用國家衛生研究院全民健保「2005年承保抽樣歸人檔」為主要資料來源，並自其中選取2,611位2006年COPD新個案為研究對象。本研究以照護連續性指標(continuity of care index, COCI)，測量研究個案自確診日後3年內之COPD門診照護連續性，且以多項式邏輯斯迴歸(multinomial logistic regression)分析病人特質對照護連續性的影響。結果：本研究對象COCI整體平均值為0.64(SD=0.32)，其中有33.6%的個案在研究期間，COPD相關門診皆由同一位醫師診療。多項式邏輯斯迴歸結果顯示，於控制其他變項後，以照護連續性高組為參考組，男性、年長者、低月投保金額且COPD相關急診次數多的研究對象發生低照護連續性的風險較高。結論：個人特質顯著的影響COPD病人照護連續性，在面臨高齡化社會多重慢性病人增加的環境之下，無論處於何種支付制度或整合式照護體系，皆應深入探討影響照護連續性的原因，並積極尋求提升病人照護連續性的方法。

Objectives: To examine the determinants of continuity of care (COC) for patients with chronic obstructive pulmonary disease (COPD) in Taiwan. Methods: The data source was the 2005 Longitudinal Health Insurance Database which included data about one million beneficiaries randomly sampled from all National Health Insurance (NHI) enrollees in Taiwan in 2005. The study population included 2,611 subjects who were newly diagnosed as COPD patients in 2006. Every subject was traced for 3 years after the date of confirmed diagnosis. We used the continuity of care index (COCI) as the dependent variable to measure COC for patients with COPD and multinomial logistic regression to analyze the determinants of COC. Results: The mean value of the COCI for the entire study sample was 0.64 (SD = 0.32). There were 878 subjects (33.6%) with a COCI value of 1, indicating that these patients visited the same physician for all COPDrelated visits. The logistic regression model showed that, after controlling for covariates and using the high COCI group as a reference, subjects who were male, elderly, in the low NHI monthly insured amount group, and with a high number of COPD-related ED visits were more likely to be in the low COCI group. Conclusions: There were significant associations between COC and the personal characteristics of COPD patients. In an aging society with an increasing number of patients with multiple chronic conditions, we suggest that any health authority should investigate the factors influencing COC and seek innovative approaches to improve patients’ COC, whatever the health care system may be.