單複向求診行為的相關因素之探討

The Factors Related to the Patient's Choice of Medical Service-Single Ordual Approach

本研究是利用Andersen的求醫行為糢式，分析中西醫門診病人單向（僅中醫或西醫一種）或複向（中醫、西醫均有）求診的相關因素。於1989年8月至10月之間，以全省有開辦中西醫勞保的全部13家教學醫院的門診病人為對象，進行系統性抽樣與結構式問卷調查訪問。扣除拒訪與資料不全者，共得有效樣本1128位，其中579位是單向求診，549位複向求診。在單變項分析中發現與單、複向求診型式有顯著相關的因素有：性別、教育程度、婚姻狀況、有無保險、初複診別、受訪時求診中醫或西醫門診、自覺健康狀況、病患自覺疾病嚴重度、罹患肌肉骨骼神經系統、呼吸系統等疾病。單向求診比複向求診多的病人包括：男性，受大專以上教育者，未婚者，無醫療保險者，初診者，求診於西醫者，自覺健康狀況較佳者，自覺疾病嚴重度較輕者，罹患神經肌肉骨骼系統以外之疾病者，罹患呼吸系統疾病者。在多變項對數迴歸分析，控制其他變項後，發現過去一年曾經因病臥床休息或此次患病超過半個月以上者，其複向求診的比例較高。受訪時求診西醫門診或第一次發病者，其單向求診的比例較高。

The purpose of this paper was to investigate the related factors between two patterns of health service utilization: one, the single-method treatment (seeking help from either Western medicine or Chinese medicine only); the other, a dual-method treatment (seeking help from both Western medicine and Chinese medicine). Applying Andersen's health-service utilization model, an analysis was made by the basic demographic, enabling and need factors relating to differences between the two treatment patterns. During the period August to October, 1989, systematic sampling was done and a structured questionnaire survey was carried out among patients from the Outpatient Departments of 13 teaching hospitals which accept reimbursement by Labor Medical Insurance in Taiwan. The total number of valid respondents was 1128. Five hundred and seventy-nine patients received single-method treatment and 549 received dual-method treatment. Under univariate analysis, the significant variables (p＜0.05) related to the proneness to the single-method treatment were: males, people with college or higher education, unmarried people, people without medical insurance, people on their first visit, people seeking Western medical care, people considering themselves to he relatively healthy, or suffering from only minor illness, people suffering disorders of respiratory and other organs excluding neuro-musculoskeletal system. By logistic regression analysis, the significant variables related to the proneness to the dual-method treatment were visiting Chinese medicine clinics, having had bed rest during the past year, an illness with duration of longer than half a month, and the significant variables related to the proneness to the single-method treatment were visiting Western medicine clinics and illness with the first onset.