| 摘要: | 目的：台灣精神疾病盛行率逐年攀升，加上健保資源緊縮，即早正確診斷精神疾病顯得格外重要。心理測驗為精神醫療照護有效之臨床診斷工具，其使用呈增加趨勢，惟心理測驗使用之全國代表性探究闕如。本研究旨在分析心理測驗醫療利用現況及相關因素；及心理測驗使用後至精神疾病確診之時間間隔及風險差異，並檢視心理測驗使用種類與精神疾病種類之相關性。
方法：採2005-2010年全民健保資料庫百萬抽樣歸人檔進行分析。以使用心理測驗 (ICD-9CM處置碼：940.x與醫令代碼) 54,067位為研究架構一之樣本；並以使用心理測驗且確診精神疾病(ICD-9CM疾病碼：290.x~319.x)患者3,280位為架構二之研究對象。主要分析方法為以SAS 9.2進行複迴歸、多項式邏吉斯迴歸及Cox比例風險模型。
結果：心理測驗使用顯著相關因素為機構層級別等。測驗後確診精神疾病盛行率65.64%，平均時間間隔為0.34年，相關因素為心理測驗使用種類、機構層級別、機構權屬別、投保類別、投保金額、每萬人口醫療機構數、醫師年資、投保分局別、年齡及共病症等。生理心理功能檢查為最主要測驗使用項目。心理測驗使用與是否確診精神疾病及精神疾病種類呈顯著相關。
結論：心理測驗使用因素及精神疾患確診之相對風險可做為精神醫療照護資源合理分配參考。針對使用心理測驗可能確診為精神疾病之高風險族群之介入措施宜及早。
Objectives: The prevalence of mental disorders is escalating in Taiwan. Moreover, the constrained resources reimbursed by health insurance further boost the importance of early diagnosis of mental disorders. Psychological tests are effective diagnosis tools in clinical practices. Their usage shows an increasing tendency recently. However, there is a dearth of exploratory analyses on the utilization of psychological tests from nationally-representative data. This study aims to analyze the associated factors of psychological tests utilization, and the test-to-disorder time interval as well as relative hazards, with an emphasis on the link between the category of psychological tests and the category of mental disorders.
Methods: In the retrospective cohort design, the present research conducted secondary analyses by utilizing the data extracted from 1,000,000 randomly sampled beneficiaries recorded in the 2005-2010 Taiwan National Health Insurance Research Database. 54,067 psychological test users (ICD-9CM disease code: 940.x and order codes) are the sample for the first research model. 3,280 patients who experienced mental disorders (ICD-9CM disease code: 290.x~319.x) after the use of the tests were analyzed in the second framework. Major analytic methods include multiple regression, multinomial logistic regression, and Cox proportional hazards model conducted in SAS 9.2.
Results: Factors significantly associated with psychological tests utilization include the level of hospital. The prevalence of mental disorders among those who used psychological tests previously is 65.64%, with an average interval of 0.34 year. The associated factors of mental disorders include category of psychological tests used, level of hospital, ownership of hospital, beneficiary category, premium, number of hospitals and clinics per 10,000 population, seniority of physician, location of insurance bureau branch, age, and comorbidity. Psychophysiological function examination was found to be the major clinical test in psychiatric practices. The use of psychological tests was closely tied to whether a mental disorder was diagnized and also the types of mental disorders.
Conclusion: Theidentified factors of psychological tests utilization as well as the relative hazards of mental disorders may serve as a referential basis for formulating the policy measures of medical resources reallocation. The authorities and healthcare organizations should consider the different timing of mental disorders onset among patients using various categories of psychological tests and target the individuals of high risk, in the attempt to conduct timely medical interventions for preventing mental disorders. |
