知情消費者與機構所在地區對剖腹生產醫療利用之探討

The Relationship between Informed Consumers and the Geographic Area of the Providing Institutions with respect to Utilization of Caesarean Section

目的：護產人員為醫療機構中最主要的專業人員，受過專業訓練及較易掌握醫療知識，會與其選擇生產方式有關。本研究旨在探討護產人員身為知情消費者與地區差異對剖腹產利用的影響。方法： 研究資料為全民健康保險資料庫2001-2003年的住院生產案件，樣本選取條件以單胞胎、產婦年齡20-50歲為主，而檢視四種不同身份的單胞胎產婦與醫療機構所在地區分布對剖腹產利用差異，並以複邏輯式迴歸進行分析。結果：以國內一般產婦與台北分局當作參考組，在控制產婦、醫師及機構等特性後發現。1. 護產人員(OR= 1.10，95%CI: 1.02-1.20)的整體剖腹產利用明顯較多，而其他醫事人員(OR=0.87，95%CI: 0.76-0.99)和新移民女性(OR=0.63，95%CI: 0.60-0.66)則相對利用較少。2. 機構所在南區(O R= 1 . 3 2 ， 9 5%C I :1.27-1.37)和高屏分局(OR= 1.11，95%CI:1.07-1.15)的剖腹產利用明顯較多，但是機構所在北區(OR=0.65，95%CI:0.63-0.67)、中區(OR=0.77，95%CI:0.75-0.80)和東區分局(OR=0.48，95%CI:0.44-0.52)則相對利用較少。結論： 本研究認為護產人員可能對手術之效益比較和風險評估能力較佳，進而影響其剖腹產利用；而地區差異利用可能與醫療提供者之偏好、執業型態及機構所在地區對手術適當性認定不一致有關。

Objectives: Nursing staff represent the largest portion of health professionals in medical institutions. With their professional training and access to medical information, they are more aware than the general public of the various different types of childbirth delivery that are available. Variations in how people obtain medical information may exist among different groups of women and across the various regions of Taiwan. This study evaluates the relationships among various different groups of women who have given birth and the geographic area of providing institution with respect to the utilization of caesarean section in Taiwan. Methods: Population-based data were obtained from the Bureau of National Health Insurance’s inpatient delivery database that includes delivery cases between 2001 and 2003. Women with singleton pregnancies and a maternal age between 20-50 years were included in the analysis. Using logistic regression, we calculated the odds ratios (OR) that measured the association between the use of caesarean section delivery and various different groups of women, which consisted of nursing staff, health professionals, laywomen and immigrants in relation to the providing institution’s region within Taiwan. Results: After controlling for the characteristics of the pregnant women, the service providers and the institutions, nursing staff were significantly more likely (OR = 1.10; 95% CI: 1.02 - 1.20) to undergo caesarean sections compared with laywomen. In contrast, health professionals (odds OR = 0.87; 95% CI: 0.76 - 0.99) and immigrants (OR = 0.63; 95% CI: 0.60 - 0.66) were significantly less likely to choose a caesarean section. Compared with institutions in the Taipei region, women in the southern (OR = 1.32; 95% CI: 1.27 - 1.37) and Kao-Ping (OR = 1.11; 95% CI: 1.07 = 1.15) regions were significantly more likely to have a caesarean section. However, institutions in the northern (OR = 0.65; 95% CI: 0.63 - 0.67), central (OR = 0.77; 95% CI: 0.75 = 0.80) and eastern regions (OR = 0.48; 95% CI: 0.44 - 0.52) were significantly less likely to have a cesarean section. Conclusions: The findings suggest that nursing staff may be more informed and this able to evaluate the risks and benefits of a caesarean section; this may influence their caesarean section utilization rate. The utilization differences in caesarean section delivery among the different geographic regions may be attributable to physicians’ practice patterns and to variation in the standard of performing caesarean sections at the various institutions.