居家慢性病患健康服務利用之探討---以新竹市高血壓及糖尿病病患
為例
Exploring health services utilization among chronically ill
outpatients-a study on patients with hypertension and diabetes in Hsin-Chu city.
中文摘要
本篇係應用Andersen-Newman 醫療利用行為模式，旨在暸解新竹市高血壓、糖 尿病等居家慢性病患利用健康服務之情形及其相關影響因素。研究工具採用結構 式問卷，內容包括基本資料、身體功能評估表、自覺健康狀況量表、社會支持量
表及憂鬱量表五部份。以新竹市1997 至 2003 年北、東、香山三區衛生所管案之
居家高血壓或糖尿病個案，其中包括有香山衛生所255 例、北區衛生所 546 例、
東區衛生所721 例，共 1522 人為研究母群體，依三區收案人數比例採 1:2:3 分層 隨機抽樣抽出樣本共253 例，接受面訪共 200 例(香山 33 人、北區 67 人、東區 100 人) 接受率達 79%，有效問卷 200 例達 100%，正式研究前特請產官學界代 表共5 位專家，針對問卷五大部份進行內容效度檢定，另抽 30 份做預測（Pilot Test）並進行問卷內部一致性分析各部份評量表所得之 Cronbach＇s α值達 0.84~0.96（自覺健康量表 Cronbach＇s α=0.84；社會支持量表 Cronbach＇s α
=0.94；身體功能評量表 Cronbach＇s α=0.96；憂鬱量表 Cronbach＇s α=0.91）。
問卷是透過8 位訪視員以家庭訪視面對面與個案訪談方式蒐集資料。研究資料以
描述性統計、皮爾森積差相關分析(Pearson＇s correlation coefficient)、多變項迴 歸(Multiple Regression analysis)、邏輯斯迴歸(Logistic multipal regression)等統計 方法分析之。研究結果顯示（1）慢性病患平均罹患 2 種慢性疾病；其選擇就醫 地點時主要考慮的因素依序為：┌治療成效好┘、┌離家近 ┘、┌醫院設備齊 全┘與┌醫護人員態度┘（2）慢性病患之「罹病時間」、「疾病總數」與門診就
診次數間具相關性；即「罹病時間愈長」、「疾病總數愈多」，則門診就診次數愈
多。且影響新竹市慢性病患門診就醫次數個人傾向、能力、需求三項因素中以需
求因素對門診就醫次數的解釋力最大，可解釋變異量達14﹪。（3）慢性病患需
求因素中「身體功能」、「自覺健康」、「憂鬱程度」、「疾病總數」、「罹病時間」、
能力因素中之「社會支持」、「就業狀況」、傾向因素中之「年齡」、「教育程度」
與住院次數間具相關性；且影響新竹市慢性病患住院量之因素中，也以需求因素
對住院次數的解釋力最大，可解釋變異量達21﹪。（4）約有 1/4 受訪慢性病患無
定期就醫，平日未定期就醫的主要原因依序為「無不適」、「自行購買成藥」、「自
行飲食控制」、「沒時間」等；影響受訪慢性病患定期就醫行為之主要因素為┌性
別」、「就業狀況」及「自覺健康」；以男性、無工作者、自覺健康差者較能定期
就醫。
英文摘要
This study was to explore the utilization patterns of health service and the influence factors among the community patients of chronic disease such as hypertension and diabetes mellitus in Hsin-Chu City.The study was based on Anderson-Newman
behavior model, and the study outcomes were measured by structured home-interview questionnaire. The content of the questionnaire was consisted of five sections that were personal information, the subscales of physical function assessment,
self-awareness of health status and social support, and the level of depression.The data was collected during 1997 to 2003 and the research population was consisted of 1522 clients, who have been listed under the control of three local health stations as North, East and Xiang-Shan health stations. A random sample of 253 patients from the population was selected for interview, and the response rate was 79% (200/253).
Before the study commenced, 5 experts of nursing research field were invited for revising the contents of questionnaire, which focused on the content efficacy of 5 sections. A pilot test of 30questionnaires were also distributed for the analysis of the content consistence, Cronbach’s α value for each section was between 0.84 to 0.96 (Cronbach’s α =0.84 for self-awareness of health status; Cronbach’s α = 0.94 for social support, Cronbach’s α = 0.96 for physical function; Cronbach’s α = 0.91 for the level of depression).A total of 200 questionnaires were returned and the response rate of interview questionnaire was 100% (200/200).The data was collected by 8
investigators with the methods of family visiting and face to face
interview.Descriptive statistics, Pearson’s correlation, multiple regression and logistic multiple regression were used for data analysis.The study outcomes presented:
1. Chronically ill outpatient had 2 different chronic diseases in average, and the factors that influenced the utilization of hospital included: A, the efficacy of medical treatment, B. the facilities of the hospital, C. the service attitude of medical staff.
2. There were correlations among the time of illness, the number of disease, and the rate of OPD follow up that resulting in increased rate of OPD follow up due to both increased illness time and disease number.
3. The demand factors of chronically ill outpatients included physical function, self-awareness of health status, the level of depression, the number of disease and the time of illness. The ability factors included the social support and the status of
employment. The trend factors included age, the level of education and the rates of hospitalization. The correlations among the factors as above were positive.
4. Approximately 25% interviewers did not follow OPD treatment regularly, the factors included nil uncomfortableness, self-purchase of medication, self-control of diet, and no time for OPD follow up. Furthermore, the influence factors for regular
OPD follow up included gender, the status of employment, and the self-awareness of health status.
