影響台灣精神疾病患者未持續或中斷就醫之風險因素探討-以精神分裂症及情感性精神病為例

Abstract

目的：本研究乃探索性分析，藉以透過健保資料庫探討影響精神疾病患者未持續或中斷就醫的風險因素。方法：利用國家衛生研究院全民健康保險研究資料庫20萬人承保抽樣歸人檔中，2000年確診爲精神分裂症及情感性精神病之精神疾病患者，取其1997至2004年所有就醫資料，進行多重復發事件存活分析。結果：影響精神疾病患者之未持續或中斷就醫因素包括，女性風險明顯高於男性的1.185倍、17歲以下的風險高於其他年齡層、未在保的風險高於其他加保類別、每月健保費繳交金額超過605元的風險高於低於524元的1.058倍、每次就醫部分負擔金額高低影響並不顯著、未跨區就醫的風險高於跨區、精神分裂症的風險高於情感性精神病。CCI權重得分愈高者的風險是得分低者的1.258倍、有使用日間病房及社區復健的風險高於未使用者、未領取重大傷病證明卡的風險要高於有領重大傷病證明卡。結論：本研究所得影響精神疾病患者之未持續或中斷就醫的風險因素分析結果，提供未來精神醫療體系或全民健康保險之政策改革參考。

Purposes: Mental health treatment dropout is common; however, dropout patterns and predictors are poorly understood in Taiwan. This study explored patterns and predictors of mental health treatment dropout in a nationally representative sample. Methods: Claim data were from the Longitudinal Health insurance Database 2000 (LHID2000) of Bureau of National Health insurance. Subjects were diagnostic with schizophrenia and manic-depression psychosis in 2000. Their medical services utilization was analyzed for 1997-2004. Repeated recurrent event survival analyses were used to identify dropout predictors. Results: The main findings of this study are as follows: (1) the female sex, young age, underinsured status, and schizophrenia were associated with high dropout risk. (2) Psychiatric comorbidity was associated with a trend toward dropout. (3) Patients who use daycare services for the mentally ill and psychiatric community rehabilitation services were at higher dropout risk than those who did not use these services. (4) Patients who had a catastrophic illness card were at higher dropout risk than those without this card. Conclusions: Study findings underscore the importance of research to understand the clinical significance of dropout predicators, especially for populations at high dropout risk in Taiwan.