| 摘要: | 目的：嚴重精神病患者有較高的死亡率，且死亡的原因多與高血壓、糖尿病及心臟疾病等疾病有關。成人預防保健可以早期發現慢性疾病，減少疾病惡化所帶來的傷害。本研究主要分析全國精神障礙者成人預防保健使用情形，並與一般民眾比較使用之差異性，進一步探討影響精神障礙者使用成人預防保健服務之相關因素。
方法：本研究以2008年內政部登記領有身心障礙手冊之精神病患者(65,588人)及一般民眾(5,667,287人)為研究對象。利用內政部身心障礙者登記檔及國健局2006~2008年之「預防保健申報檔」，串連國家衛生研究院發行之「健保資料庫」進而分析。探討精神障礙者人口學特質，以及成人預防保健服務利用情形，並利用卡方、t-test、ANOVA及羅吉斯廻歸分析，探討影響精神障礙者使用成人預防保健服務之相關因素。
結果：精神障礙者的成人預防保健利用率為22.32%，一般民眾的利用率為29.96%；精神障礙者男性使用率22.68％略高於女性的21.99％；其年齡別以60-64歲利用率27.57%為最高；都市化程度以第六級利用率28.27%為最高；低收入身分者利用率31.29%高於非低收入者20.72%；極重度身心障礙者利用率37.07%為最高；除癌症外，罹患其他慢性疾病者的利用率都較高。以羅吉斯廻歸分析得知「年齡」、「都市化程度」、「投保金額」、「是否為低收入戶」、「罹患相關疾病」、「身心障礙嚴重級別」顯著影響使用成人預防保健。
結論：本研究發現40歲以上精神障礙者成人預防保健服務的利用率較一般民眾低。定期的健康檢查可以早期發現疾病，早期接受治療，並矯正不健康的行為，以達到預防疾病的目標。因此，增加成人預防保健服務的利用率，可提昇嚴重精神病患照護的品質。
Objectives: Many previous publications discover that serious mental illness patients have high rate mortality which are associated with high blood pressure, diabetes, heart disease, etc. Adult healthy examinations can diagnose chronic diseases at the early stages to reduce the damages and consequences from these diseases. This study is mainly focused on analyzing the utilization status of the Adult Health Examinations by the serious mental illness patients and the general population in the country wide between 2006 and 2008. We further investigated the influence factors of the Adult Health Examination used by mental disability patients.
Methods: A total of 65,888 people participated in this study of disabled of serious mental illness, who were registered in the “disabled person file” from the Ministry of Interior in 2008, and the files were merged with both the “preventive health care file” at the Bureaus of Health Promotions and the medical claim databases at the National Health Insurance between 2006 and 2008. This study analyzed the utilization of preventive health care for the mental disabled, and compared with non-disabled people. Besides descriptive statistics and bivariate analysis, this study was examined the factors affecting whether to use the preventive health care with logistic regression analysis.
Results: The utilization rate of adult health examination for the mental disabled was 22.32%, but the non-disabled group was 29.96％. In mental disabled, the utilization rate was 22.68% by men and 21.99% in women. The highest utilization rate was applied to people who are between 60 and 64 years old, which was 27.57%. The level six utilization rate of urbanization level was 28.27%. The utilization rate was 31.29% for the low income people and 20.72% for the non-low income people. The utilization rate ranked the highest as 37.07% by the sever degree of disabled patients. Besides cancer patients, patients who suffer from chronic illness had high utilization rate as well. Based on the logistic regression analysis results, the factors affecting whether to use the Adult Health Examinations were age, living area, demographics, economic status, health status, and degree of disability.
Conclusion: We concluded that 22.32% mental illness patients above 40 years old joined at the Adult Health Examinations, which was lower than the 29.96% of general populations who participated at the Adult Health Examinations. Regular health examinations can early diagnostic diseases, immediately provide treatment to correct the unhealthy behaviors, and prevent diseases. Therefore, increasing the utilization rates of Adult Health Examinations improves the quality care of the serious mental illness patients. |
