探討精神疾病患者急診醫療利用影響因素

Exploring Factors Affecting the Utilization of Emergency Medical Services by Psychiatric Patients

目的：近來精神疾病患者日漸增加，而精神疾病患者有可能是高度急診醫療利用族群，因此乃欲針對深入探討我國精神疾病患者急診醫療利用情形與相關影響因素。方法：以Aday and Andersen 之醫療服務利用行為模式為研究架構，使用全民健康保險資料庫2002 至2007 年精神疾病住院病患歸人檔，共得到95,435筆研究對象，並使用描述性統計、邏輯斯迴歸資料統計分析。結果：樣本急診醫療利用比率為16.114％，每人每年急診醫療次數為0.432 次。邏輯斯迴歸分析結果發現，在傾向因素與能用因素部分，女性（OR=1.314,95 ％ CI=1.266-1.363; OR=1.235, 95 ％ CI=1.133-1.346）、每萬人口精神科醫師數0.61 名以上（OR=1.761, 95％ CI=1.663-1.866; OR=1.264, 95％CI=1.095-1.457），其「利用急診醫療」與「高度利用急診機率」皆較高，此外，免部份負擔者高度利用急診醫療機率亦高於需部分負擔者（OR=1.529;95％ CI=1.263-1.851），而在需求因素方面，僅發現有慢性疾病（OR=1.571; 95％ CI=1.428-1.729），其高度利用急診醫療的機率較高。結論：精神疾病住院病患的急診醫療利用次數確實較一般民眾高，且性別、每萬人口精神科醫師數為主要影響利用急診與高度利用急診的因素，需求因素中的是否有慢性疾病對高度利用急診亦具有影響性。未來應針對女性精神病患者或精神科醫師資源豐富的地區，深入了解其造成較高急診利用的原因。

Purposes: In recent times, there has been a continuous increase in the number of psychiatric patients, while psychiatric patients are believed to be frequent users of the emergency medical services. Therefore, this study attempts to focus on an in-depth exploration of the utilization of emergency medical services by psychiatric patients in Taiwan and the relevant influential factors. Methods: This study adopted Aday and Andersen’s Healthcare Utilization Model as a research framework. A total of 95,435 research samples, from 2002 to 2007, were collected from the Psychiatric Inpatient Medical Claim Dataset of the National Health Insurance Research Database. Descriptive statistics and logistic regression analysis methods were applied for data analysis. Results: The result showed that 16.114% of all samples had utilized emergency medical services. The average number of visits to the emergency departments was 0.432 per year per person. Results of the logistic regression analysis indicated that, in terms of predisposing and enabling factors, females (OR=1.314, 95% CI=1.266-1.363; OR=1.235, 95% CI=1.133-1.346) and communities with over 0.61 psychiatrists per 10,000 people (OR=1.761, 95% CI=1.663- 1.866; OR=1.264, 95% CI=1.095-1.457) had a higher probability of both “utilization” and “frequent utilization” of emergency medical services. Moreover, samples with copayment exemptions were likely to visit the emergency departments more frequently than those with copayments (OR=1.529; 95% CI=1.263-1.851). In terms of need factors, only subjects with chronic diseases (OR=1.571; 95% CI=1.428-1.729) were found to be more probable to utilize emergency medical services more frequently than those without chronic diseases. Conclusions: Psychiatric inpatients do indeed use emergency medical services more frequently than average citizens. Gender and the number of psychiatrists per 10,000 people are also main factors that affect the likelihood and frequency of use of emergency services. In terms of need factors, a person having a chronic disease influences the probability of frequently using emergency services. Future focus should be on female psychiatric patients and regions with an abundance of psychiatrists, so as to explore in greater depth the potential reasons about the higher rates of frequent use of emergency medical services.