探討失能者居家醫療利用影響因素之社區性研究

Community-based Study on Related Factors of Home Medical Care Utilization Among Disabled People

目的：探討接受長期照顧服務之社區失能者其社會人口學、健康狀況及長期照護使用服務項目與居家醫療利用間之關係，以評估資源利用情形，有利整合性照護模式建立及提供未來施政參考。方法：以回溯性研究，蒐集2018 年1 月1 日至2018 年12 月31 日接受長照個案管理之個案，研究對象共2370 位。以皮爾森卡方檢定及邏輯斯迴歸分析其居家醫療利用的特性差異及探討社區失能者居家醫療利用之影響因子。結果：社區失能者其社會人口學（年齡、福利身份、獨居與否、住處是否爬樓梯、居住地之都市化程度）、健康功能狀況（合併罹病症指數、日常生活活動、長期照護案例組合系統核定等級）、長照服務使用項目（照顧服務- 日間照顧、居家復健）與居家醫療利用有顯著關係。經校正相關因子後，發現社區失能者年齡每增加一歲居家醫療利用增加1.020 倍，合併罹病症指數每增加一分居家醫療利用增加1.334 倍，每增加一項長照服務其居家醫療利用增加3.065 倍；在低收戶、居住於二樓無電梯者、日常生活活動完全依賴者、長期照護案例組合系統核定（LTC-CMS）為第四級、第五級、第七級、照顧服務- 日間照顧、居家復健，其居家醫療利用有顯著較高利用率。結論： 年齡越高、合併罹病症指數及使用長照服務項目增加時，其居家醫療需求亦相對增加， 建議在照顧社區失能者，其為低收入戶、居住於二樓無電梯、日常生活完全依賴、長期照護案例組合系統核定等級及使用居家復健者，應評估其居家醫療之需求，讓社區失能者能獲得更多且效益高的長期照護資源來照顧其生活及醫療品質，以實現社區失能者在地老化的願望。

 

Objective: This study was to discuss the disabled community dwellers’ social demogra¬phy, physical conditions, the utilization of long term caring service items, and the use of home medical care. By studying the cases, we can learn the factors that influence the utilization of home medical care resources, evaluate the situation of the use of resources, both of which could help to build an integrated care system and provided as a reference source for the government’s policy. Method: The research was a retrospective study. The persons who were subsidized through a long-term care management at the certain hospital from January 1 to December 31 in 2018 were selected to be the study subjects. A total of 2370 people were included. The study wants to realize the characteristics and differences between disabled community dwellers’ social demography, physical conditions, the utilization of long-term caring service items and the use of Home Medical Care, the statistical software, including, chi-square test,and logistic regres¬sion. Results: Disabled community dwellers’ social demography which is concerns age, welfare identity, living alone or not, climbing stairs in the residence or not and the degree of urbaniza¬tion in the place of residence is significantly associated with the utilization of home medical care services. Disabled community dwellers’ health condition which includes CCI-Q, function in daily life, on the LTC-CMS scale is significantly associated with the utilization of home med¬ical care services. The long-term caring service items including day care services and residential rehabilitation are significantly associated with the utilization of home medical care services. After correcting the relevant factors, the data shows that odds ratio of the utilization of home medical care services will increase 1.020 times when disabled community dwellers increase their age every year. The data also shows that odds ratio of the utilization of home medical care will increase 1.334 times when CCI-Q increases one score. In addition, odds ratio of the utili¬zation of home medical care services will increase 3.065 times when disabled persons increase each of the long-term care services. Further analysis reveals that the utilization of home medical care services has significantly of higher low-income households, of people living on the sec¬ond floor or more without elevators, of people complete dependence in daily life, of people are verified as the 4th 5th 7 th on the LTC-CMS scale,of using care services of day care,of residential rehabilitation.