結合可近性與空間自相關評估嘉義縣身心障礙者牙科醫療資源配置

Evaluating accessibility and spatial autocorrelation of dental resource allocation for people with disabilities in Chiayi County

目標：考量到身心障礙者牙科就醫不便性，如何讓醫療資源均勻分配及有效利用，並提升醫療量能為重要議題，本研究探討嘉義縣身心障礙者牙科醫療資源可近性與資源分布。方法：醫療需求只考慮嘉義縣2023年6月身心障礙統計人口數，但因嘉義縣人口會跨區移動至嘉義市就醫，醫療供給將同時考慮嘉義縣、市的醫療資源，包含醫療機構位址和牙醫師數。使用兩階段流動搜尋法（two-step floating catchment area），估計其就醫可近性，並用區域空間自相關指標（local indicators of spatial association）探討資源分配。結果：本研究納入嘉義縣5,593個最小統計區，總計34,346名身心障礙者。排除沒有身心障礙者區域，資源可近性為0有211個區域，佔最小統計區的3.8%，在這些區域內包含1,768位身心障礙者，資源可近性中位數為0.002（四分位距：0.003），可近性變異係數（coefficient of variation）為1.3，吉尼係數（Gini coefficient）為0.5，醫療資源集中在嘉義市周圍，資源可近性低的區域位於阿里山鄉、番路鄉、梅山鄉、竹崎鄉、大埔鄉、布袋鄉與東石鄉。空間自相關結果顯示醫療熱點集中在嘉義市周圍，醫療冷點多分布於嘉義縣西部沿海地區及東部山區。結論：嘉義縣醫療資源集中在都會區，資源稀缺處於嘉義縣西部沿海零星地區與東邊山區，目前有巡迴醫療、到宅醫療服務等，可藉由預防保健觀念的衛生教育推廣，提升口腔健康的認識及口腔疾病的早期發現。

Objectives: Considering the inconvenience of dental care for people with disabilities, it is essential to evenly distribute and effectively utilize dental resources to improve dental capacity. In this study, we explored the accessibility and equal distribution of dental resources among people with disabilities. Methods: We used open datasets of a population with disabilities in Chiayi County in June 2023. Due to the community, the dental supply, such as the locations of dental institutions and the number of dentists, was considered in both Chiayi City and Chiayi County. We used a two-step floating catchment area to estimate the accessibility and distribution equalities and applied local indicators of spatial association to examine the clusters of dental resources. Results: This study included 5,593 basic statistical areas in Chiayi County and with 34,346 people with disabilities. After excluding areas with no people with disabilities, 211 areas had a resource accessibility of 0, which accounted for 3.8% of the basic statistical areas. The median accessibility was 0.002 (interquartile range, 0.003), the coefficient of variation was 1.3, and the Gini coefficient was 0.5 across 1,768 people with disabilities. Dental resources are concentrated around Chiayi City and are less available in Alishan, Fanlu, Meishan, Jhuci, Dapu, Budai and Dongshih Townships. Spatial autocorrelation reported that dental hotspots were concentrated around Chiayi City, whereas dental cold spots were identified in the western coastal areas and eastern mountainous regions of Chiayi County. Conclusions: The dental resources in Chiayi County are concentrated in urban areas, with scarce resources in the western coastal region and eastern mountainous areas. Mobile and home healthcare systems are currently available. Through preventive health education, we can raise public awareness of oral health and promote the early detection of oral diseases.