| 摘要: | 目的：1995年政府實施免費孕婦產前檢查實施至今，尚未有研究探討孕婦產檢之成效，本研究欲瞭解孕婦產檢之異常率及異常個案之醫療保健措施，同時調查孕產婦產檢之滿意度，綜合評估產檢服務的執行成效。方法：本研究藉由回溯式病歷審查及滿意度問卷，依據2005年各層級醫療院所出生人數，依比例進行抽樣調查，共完成1282份病歷審查及1262份滿意度問卷。結果：本研究之異常個案共計733人(59.7%)。各層級醫療院所篩檢之異常率以醫學中心70.0%最高，其次為地區醫院65.3%。在十五次的例行性產檢中，檢測出異常的項目以水腫13.3%最多，其次為胎位異常11.3%。有6.9%超音波檢測出異常。大部分特殊產檢項目利用率皆高於九成，其中異常率最高的為「B型肝炎表面抗原」9.7%，其次「德國麻疹抗體反應」9.5%。自費項目利用率最高的是「母血唐氏症篩檢」72.0%、其次「乙型鏈球菌篩檢」41.1%。異常率以「妊娠糖尿病第一次篩檢」(14.6%)最高，其次為「妊娠糖尿病第二次篩檢」(14.5%)。針對異常情形醫師的建議或處置多為再追蹤或衛教或兩項併行。各層級醫療院所異常率之比較，醫學中心篩檢出例行性產檢異常率(58.9%)為最高，而自費產檢項目以地區醫院篩檢之異常率 (19.0%)最高。對於產檢滿意度方面，本研究受訪之產婦對於所有項目認為「非常滿意」或「滿意」皆大於60%，其中感到滿意比例最高的為「醫師的專業能力」(97.8%) 及「醫師的服務態度」(97.5%)。而滿意度最低的為：「等候看診時間」(62.1%)及「給付產前檢查的項目」(60.4%)。對於產檢的整體滿意度感到「滿意」或「非常滿意」者高達92.2%。「醫院層級」、「對產檢內容的瞭解程度」、「產檢項目是否足夠」、「是否曾更換醫療院所」、「是否依手冊時間檢查」、「胎兒健康」、「是否願意自費做產檢」及「自覺健康狀態」與產檢整體滿意度有顯著相關。結論與建議：結果顯示多數產婦對於所有產檢項目認為滿意，顯示孕婦產前檢查之成效良好。依據研究結果，建議可考慮將高利用率之自費項目納入政府給付；建議在媽媽手冊新增特殊檢查、自費產檢及其他重要檢查結果之紀錄欄位及輔助資訊。
Objective: Government has provided free gratis prenatal examination policy since1995. However, there was no relative research to examine the effectiveness of this program. This study would like to know the abnormal rate of prenatal examination and the following health care services for abnormal cases. In addition, this study would investigate the satisfaction of prenatal examinations for pregnant women and evaluate the whole effectiveness of this policy. Methods: This study was based on the number of birth in different level of health care facilities in 2005. Proportional sampling was conducted. There were total 1,282 medical records reviewed and 1,262 satisfaction questionnaires received in this study. Results: There were 733 (59.7%) abnormal cases in this study. Medical centers had the highest abnormal rate (70%) and the secondary was local hospitals (65.3%). In the 15 times routine prenatal examinations, the highest abnormal item was edema (13.3%) and the secondary was abnormal fatal presentation (11.3%). 6.9% abnormal cases were found by ultrasonic examination. The utilization rate was more than 90% for most of the special prenatal examinations. In these special examinations, the highest abnormal rate was HBsAg (9.7%), and the next one was rubella antibodies reaction (9.5%). The highest utilization rate for out-of-packet payment items was Down's syndrome screen (72%), and the second one was Group B streptococcus screen (41.1%). In which the highest abnormal rate was 50g glucose tolerance test (14.6%), and the next one was 100g oral glucose tolerance test (14.5%). Most of the suggestions from physicians were follow-up or health education or both for abnormal cases. Medical centers had the highest abnormal rate for routine prenatal examinations (58.9%) and local hospitals had the highest abnormal rate for out-of-packet payment items (19.0%). As for satisfaction with prenatal examination, more than 60% of childbirth women interviewed had satisfaction or high satisfaction for all items. Among them, both physician’s competence (97.8%) and service attitude (97.5%) had the highest satisfaction level. However, waiting time (62.1%) and examination items provided (60.4%) had the lowest satisfaction level. For all examination services, there was 92.2% satisfaction. The factors including health care facility level, the degree of understanding examination content, perception of sufficiency in examination items provided, experience in changing health care organizations for examination, examination based on schedule in brochure, fetal health, willingness to pay examinations by out-of-pocket, and perceived health status were significantly associated with global satisfaction for gratis prenatal examination policy. Conclusion and suggestions: The results showed most of childbirth women satisfied with prenatal examination, which means the policy had good effectiveness. Based on the study results, we provide the following suggestions: firstly, government should consider including out-of-pocket examination items with high use rate into free items; the second, the results of the special examinations, out-of-pocket examinations, and other important examinations as well as other supported information should be added in pregnant women’s brochure. |
