失智症與非失智症長者之照顧者醫療服務利用之比較

Comparison of healthcare utilization between caregivers of dementia and nondementia older adults

目標：比較台灣長期照顧十年計畫使用者中，失智症與非失智症照顧者醫療服務利用與費用。方法：本研究串聯照顧服務管理資訊平台與衛生福利資料科學中心資料庫，分析2008至2013年間，10,771位長照十年計畫使用者的照顧者，透過多變項羅吉斯迴歸與多變項線性迴歸，比較失智症與非失智症照顧者，在初次核定長照服務後一年內的門診、急診、住院利用與費用。結果：整體而言，失智症與非失智症照顧者在門診、急診、住院與整體醫療利用與費用皆未達統計顯著差異。然而，當被照顧者輕度失能時，失智症較非失智症照顧者每次急診費用高20.6%（p<0.01）、累積急診費用高31.9%（p<0.01）；被照顧者重度失能時，失智症較非失智症照顧者的住院使用次數多0.22次（p<0.05）。結論：失智症與非失智症照顧者的短期醫療利用無明顯差異，但失智症照顧者，特別是輕度失智症照顧者，可能更忽略自身健康、拖延就醫，最終尋求急性醫療資源協助。建議政策提供更多喘息服務，給予失智症照顧者時間滿足初級醫療服務需求。 Objectives: To compare the healthcare utilization and expenditures between the caregivers of elderly adults with or without dementia who were in Ten-year Long Term Care Project (TLTCP) in Taiwan. Methods: Data were extracted from the population-based datasets of the Long-Term Care Service Management System and the National Health Insurance in Taiwan. 10,771 individuals who were the caregivers of elderly adults aged ≥65 years in the TLTCP during 2008-2013 were included. Multiple logistic regression and multiple linear regression were used to compare the 1-year healthcare utilization and expenditures between the caregivers of elderly adults with or without dementia, including outpatients, emergency departments (EDs), and hospitalizations, after their care recipients being first time prescribed with LTC services. Results: In general, no significant differences were observed between the two groups. However, caregivers who cared for patients with dementia with mild disabilities had significantly 20.6% higher per ED fees (p < 0.01) and 31.9% higher ED fees (p < 0.01). Caregivers who cared for patients with dementia with severe disabilities had significantly 0.22 higher hospitalization visits (p < 0.05). Conclusions: In general, there is no difference in the use of healthcare services between the caregivers of elderly adults with or without dementia. Nevertheless, dementia caregivers, especially those caring for patients with mild dementia, are more likely to neglect their own health and hence tend to use more acute care healthcare resources. These results suggest policymakers to provide additional respite care services to allow caregivers time to seek for primary healthcare resources.