類風濕性關節炎病患就醫行為調查－以某區域醫院為例

The Healthcare Utilization Behavior of Rheumatoid Arthritis Patients in a Regional Teaching Hospital

目的：為促成類風濕性關節炎病患早期診斷，早期治療之療效，進行類風濕性關節炎病患在就醫過程中，自覺疾病嚴重程度、病患延遲診斷與醫囑遵從性之就醫行為狀況調查。
方法：以參加某區域醫院類風濕性關節炎健康講座之民眾為調查對象，共發出150 份問卷，回收127 份，回收率為84.7%。問卷包含病患之人口學特性、個案對自我疾病的認知、就醫歷程等構面，由病患自行填選。資料分析以描述性統計、χ2卡方檢定、相關分析、獨立樣本t 檢定等探討變數間的相關性。
結果：本研究調查對象共127 名，女性占103 人。男性自症狀出現後平均19.48 週會至醫院求診就醫，女性則為27.11 週。就醫到確立診斷時間平均長達49.1週，男性平均54.1 週，女性平均47.8 週；研究結果發現自覺病情嚴重者其年齡、症狀出現到初次就醫週數、確立診斷週數與患病年數均顯著的高於自覺病情中度與輕度者。女性相對於男性較能遵從醫囑用藥，大專以下學歷的受試者較能遵從醫囑用藥，沒有使用民俗療法的受試者較能遵從醫囑用藥。
結論：類風濕性關節炎病患，從症狀出現到就醫及就醫到確立診斷時間均相當長，顯示有延遲診斷的情形，自覺病情嚴重者其延遲診斷情形也較嚴重。建議應從病患的就醫行為著手，提升病患對疾病的認知，才能改善類風濕性關節炎的延遲診斷的現象，進而強化治療成效。

Objective: The purpose of this study is to investigate and understand the healthcare utilization behavior of rheumatoid arthritis patients. A questionnaire was designed to examine the delay in diagnosis, compliance, and self- perceived illness severity of patients to help patients assess the early diagnosis and early treatment.
Methods: Data was collected in a health education lecture for rheumatoid arthritis. One hundred fifty questionnaires were distributed and a total of 127 valid questionnaires were returned, giving a valid response rate of 84.7%. Data was processed and analyzed by statistical software SPSS for Windows 14.
Results: A total of 127 persons (female 103) were enrolled in this study. The average delay in presentation to primary physician was 19.48 weeks in males and 27.11 weeks in female. The average weeks from the initial assessment in primary care to definite diagnosis was 49.1 weeks, 54.1weeks in male and 47.8 weeks in females. The age, presentation to primary physician, initial assessment to definite diagnosis was higher in the self-perceived disease being severe than that of medium and minimal. Compliance decreased with increasing education level, usage of alternative medicines, and in male respondents.
Conclusions: Our study indicates there are long lag times between disease onset to primary physician and the initial assessment to definite diagnosis in patients with rheumatoid arthritis. More efforts should be made to improve health education, to hasten the diagnosis and improve treatment.