探討新冠肺炎流行期間轉診病人就醫利用──以某區域醫院為例

目的：本研究目的探討新冠肺炎期間個案醫院轉出病人接受轉診狀況，藉以了解個案醫院轉診(出)病人在新冠肺炎期間轉診情形和原個案醫院就醫利用的關係性。方法：分析2019年1月到2020年12月區間，由個案醫院經由健保署電子轉診平台，實際轉出至醫學中心個案資料共6,474筆，以卡方分析有無重大疾病、慢性病史、癌症、有無住院之轉診病人，在疫情前後，就醫行為是否有差異性，且對於轉診醫療院所層級、科別有無明顯差異，再以二元羅吉斯回歸預測門診就醫影響因子。結果：整體以2020年轉診人數多於2019年，2019年65歲以上、女性、內科、骨、復健科、五官科轉診地區醫院與診所人次較多，且呈現顯著(p<.001)；分析轉診原因，2020年接受轉診病人中，無重大疾病、無癌症、但有慢性處方箋之病人明顯增加，且呈現顯著(p<.001)；另外，研究發現2020年轉診病人回到原轉出個案醫院看診次數較2019年明顯下降，且呈現顯著(p<.001)。結論：由此推論，雖然2020年，新冠肺炎確診數持續增高，但長期用藥或是需要就醫之病人，無法因疫情不就醫，故輾轉到疫情較輕的診所看診，從轉診制度、分級醫療的角度來說，在此次新冠肺炎疫情期間，也確實看見政府在推行轉診制度有不同以往的成效。

Objectives: To examine outpatient service utilization by patients referred from hospitals before and after the COVID-19 outbreak in Taiwan between 2019 and 2020.
Method: From 2019 to 2020, approximately 6,474 cases of COVID-19 were referred from case hospitals through Taiwan’s National Health Insurance Administration’s referral system. Chisquare tests were used to analyze the incidence rates of major diseases, chronic diseases, cancer, and hospitalization. Additionally, behavior of referred patients in seeking medical care before and after the COVID-19 outbreak was analyzed. Binary logistic regression was employed to predict factors influencing medical utilization.
Results: Overall, the number of referred patients in 2020 exceeded that of 2019. Referrals to regional hospitals and clinics significantly increased for patients aged older than 65 years, women, and patients requiring internal medicine, orthopedics, rehabilitation, and otolaryngology (p < .001). Analysis of 2020 referrals revealed a significant increase in the number of patients without major diseases or cancer but with prescriptions for chronic diseases (p < .001). Moreover, the number of referred patients returning to the referring hospital in 2020 was significantly lower than in 2019 (p < .001).
Conclusions: The outbreak of COVID-19 in Taiwan did not affect the need of patients with chronic diseases to seek medical care. Nevertheless, patients with stable medication regimens tended to visit local clinics to avoid contracting COVID-19.