高雄地區長期照護機構住民醫療服務使用情形及其相關因素探討

Factors Associated with the Utilization of Medical Service among Residents in Long-Term Care Facilities at Kaohsiung Area in Taiwan

本研究目的在於了解高雄地區長期照護機構住民醫療服務使用情形，以及探 討個人特質、健康功能狀態等因素與醫療服務使用的關係。採橫斷性研究設計，以高雄地區養護機構65歲以上老年住民為研究樣本，方便取樣方式，選取護理之家7家、安養護機構8家，共收案323位樣本進行分析，以結構式問卷為研究 工具，由機構護理人員負責住民資料之收集。依據Andersen行為模式提出假設：老年住民的醫療服務使用會受到個人特質與健康功能狀態因素的影響，以SPSS 18.0統計軟體，採用描述性統計與推論性統計（logistic迴歸分析），進行研究假說檢定工作。研究結果發現：個人特質與健康功能狀態因素會影響醫療服務使用。邏輯斯迴歸分析發現（一）「教育程度」、「婚姻狀況」、「疾病數」、「視力障礙」、「聽力障礙」、「語言障礙」以及「排尿障礙」會影響住民對藥物的使用；（二）「疾病數」、「見力障礙」、「語言障礙」、「排尿障礙」「排便障礙」、「皮膚完整性」、「認知功能得分」以及「身體活動功能」會影響管路使用的使用；（三）「年齡」、「皮膚完整性」及「身體活動功能」則會影響住民對於特殊照護的使用。此研究結果可讓機構管理者、臨床照顧者及政策制定者 擬定老年住民照顧計畫之參考依據，使長期照護機構老年住民可獲得完善照護。

The purpose of this study was to investigate utilization of medical services among residents in long-term care (LTC) facilities, and explored the relationships among personal characteristics, health functional status factors and utilization of medical services. This research adopts the cross-sectional study, using 323 senior residents (residents over the age of 65) living in 7 nursing homes and 8 care facilities in Kaohsiung area as the subjects. Next, this research uses Andersen's behavioral model (1995) to formulate a hypothesis: the utilization of medical services by senior residents in LTC facilities is influenced by personal characteristics and health functional status factors. This research adopts the descriptive statistics and inferential statistics of ＂Quantitative research method＂ (Logistic regression analysis) to conduct research hypothesis and accreditation. Results of the research indicate that among the 323 subjects, utilization of medical services indeed can be influenced by personal characteristics and health functional status factors. It can also be found through Logistic regression analysis, that ＂Education＂, ＂marital status＂, ＂number of diseases＂, ＂visual impairment＂, ＂hearing impaired＂, ＂language barriers＂, and ＂voiding＂ can significantly influence medication usage; ＂Number of diseases＂, ＂visual impairment＂, ＂language barriers＂, ＂dysuria＂, ＂defecation disorder＂, ＂skin integrity＂, ＂cognitive function score ＂, and ＂physical activity functions＂ can significantly influence pipeline usage; ＂Age＂, ＂skin integrity＂, and ＂physical activity functions＂ can significantly influence special care usage. The results of this research can serve as a reference for managers of LTC facilities, clinical caretakers and policy makers when formulating plans for the care of senior residents, allowing these residents to receive high-quality and comprehensive care.