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題名:活動性肺結核病人之共病與住院天數及健保費用之探討
書刊名:醫務管理期刊
作者:劉雅絃翁紹仁潘忠煜劉士嘉黃惠美陳俊朋
作者(外文):Liu, Ya-hsienWeng, Shao-jenPan, Chung-yuLiu, Shin-chiaHuang, Hui-meiChen, Jun-peng
出版日期:2020
卷期:21:2
頁次:頁93-110
主題關鍵詞:活動性肺結核共病住院天數健保費用Active tuberculosisComorbidityDays of hospitalizationHealth insurance costs
原始連結:連回原系統網址new window
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  • 共同引用共同引用:6
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目的:肺結核是臺灣最常見也是死亡率最高的法定傳染病,具傳染性的肺結核病人,必要時需接受長時間住院隔離治療,本文藉由統計分析探討肺結核與共病相關性。本研究主要為探討活動性肺結核病人合併共病、痰塗片結果,以及影響住院天數及健保費用的相關因素。方法:以某醫學中心臨床資料庫2014年6月1日至2017年6月30日的活動性肺結核病人為對象共221人,進行病歷資料的收集,應用SPSS軟體統計分析,連續資料以獨立樣本t檢定(Independent t-test),不同共病組間之比較類別資料以卡方檢定(Chi-square test),三組以上資料則以變異數分析(ANOVA)及事後檢定使用Bonferroni test,並以卜瓦松迴歸(Poisson regression)分析相關因素。結果:發現活動性肺結核病共病紅斑性狼瘡者,其住院天數、健保費用有顯著差異;合併三種以上共病含有糖尿病時,其住院天數有顯著差異。病人的年齡、性別、痰塗片結果及合併共病,為影響住院天數及健保費用的相關因素。結論:肺結核病人合併共病及痰塗片陽性較嚴重者,因為需要更長的時間控制疾病及感染症狀,故住院天數較長,健保費用較高,建議透過對肺結核相關知識及預防之宣導,提升民眾相關知能,尤其合併共病且免疫力弱的病人,應早期診斷早期治療,藉此提供預防保健、臨床照護及未來健保決策的參考。
Objectives: Tuberculosis is the most common statutory communicable disease in Taiwan and has the highest mortality rate. Patients with tuberculosis require long-term hospital isolation and treatment, which can cause physical and psychological discomfort and incur social and medical costs. The purpose of this study was to investigate the relationship of comorbidity with days of hospitalization and health insurance costs in patients with active tuberculosis, relationship of sputum smear findings and comorbidity with days of hospitalization in patients with pulmonary tuberculosis, and factors affecting days of hospitalization in patients with active tuberculosis. Methods: Medical records of 221 patients with active tuberculosis were collected from the clinical database of medical center for the period between June 1, 2014, and June 30, 2017. SPSS software was used for statistical analysis, and an independent -samples t-test was used for continuous data. Data of different groups of comorbidities were compared using a chi-square test. Data of three or more groups were analyzed using analysis of variance and post-mortem using the Bonferroni test; relevant factors were analyzed using Poisson regression. Results: Active tuberculosis comorbid with erythematosus lupus engendered significant increases in days of hospitalization and health insurance costs. Moreover, the presence of three or more comorbidities including diabetes resulted in a significant increase in days of hospitalization. Factors such as patient age, gender, sputum smear results, and comorbidities affected days of hospitalization and health insurance costs. Conclusions: When tuberculosis is comorbid with both lupus erythematosus and diabetes, controlling the disease is difficult because of immune diseases and infections. Patients with positive smear results for severe bacteria would require a longer time for the results to change to negative; therefore, their days of hospitalization would be longer. The results of this study can provide reference for making preventive health care, clinical care, and future health care decisions.
期刊論文
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2.Getahun, H.、Matteelli, A.、Abubakar, I.、Aziz, M. A.、Baddeley, A.、Barreira, D.、Raviglione, M.(2015)。Management of latent Mycobacterium tuberculosis infection: WHO guidelines for low tuberculosis burden countries。The European Respiratory Journal,46(6),1563-1576。  new window
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4.鄒長志、簡順添、簡榮彥、盧明志、吳盈勳(20140300)。肺結核病人服藥順從性與都治計畫實施的影響。醫學與健康期刊,3(1),25-36。new window  延伸查詢new window
5.江昇達、王勝廣、高東煒、方文輝、張耀文、高森永、周稚傑(20110500)。高齡患者長期住院醫療利用影響因子之探討。臺灣老年醫學暨老年學雜誌,6(2),86-104。  延伸查詢new window
6.王閃(2017)。肺結核感染合併慢性阻塞性肺疾病病人的臨床分析。中外醫療,16(18)。  延伸查詢new window
7.吳禮泓、李英(2017)。老年危重症病人心衰發病特徵及相關危險因素分析。中國實用醫藥,29,46-47。  延伸查詢new window
8.郭靜燕、潘人豪、陳麗資、陳厚全、詹前隆(20160900)。評估脊椎融合術納入全民健保診斷關聯群對醫療費用影響因子分析。醫學與健康期刊,5(2),57-71。new window  延伸查詢new window
9.黃炳生、陳秀敏(20160600)。開顱手術或血管內栓塞治療顱內動脈瘤破裂之醫療耗用比較。安泰醫護雜誌,22(1),1-12。  延伸查詢new window
10.賴金梅、羅蘭裕、劉錦華(2017)。老年肺結核合併肺源性心臟病的臨床分析。臨床合理用藥雜誌,22,167-169。  延伸查詢new window
11.竇俠玲(2015)。綜合護理干預對繼發型肺結核合併高血壓病人的效果觀察。中西醫結合心血管病電子雜誌,19,92-93。  延伸查詢new window
12.Almeida-Junior, J. L.、Gil-Santana, L.、Oliveira, C. A.、Castro, S.、Cafezeiro, A. S.、Daltro, C.、Andrade, B. B.(2016)。Glucose Metabolism Disorder I s Associated with Pulmonary Tuberculosis in Individuals with Respiratory Symptoms from Brazil。PLoS One,11(4)。  new window
13.Gil-Santana, L.、Almeida-Junior, J. L.、Oliveira, C. A.、Hickson, L. S.、Daltro, C.、Castro, S.、Andrade, B. B.(2016)。Diabetes Is Associated with Worse Clinical Presentation in Tuberculosis Patients from Brazil: A Retrospective Cohort Study。PLoS One,11(1)。  new window
14.Hermosilla, S.、You, P.、Aifah, A.、Abildayev, T.、Akilzhanova, A.、Kozhamkulov, U.、Schluger, N.(2017)。Identifying risk factors associated with smear positivity of pulmonary tuberculosis in Kazakhstan。PLoS One,12(3)。  new window
15.Leung, E. C.、Leung, C. C.、Chang, K. C.、Chan, C. K.、Mok, T. Y.、Chan, K. S.、Leung, W. M.(2018)。Delayed diagnosis of tuberculosis: Risk factors and effect on mortality among older adults in Hong Kong。Hong Kong medical journal,24(4),361-368。  new window
16.Li, J. C.、Fong, W.、Wijaya, L.、Leung, Y. Y.(2017)。Disseminated tuberculosis masqueradingas a presentation of systemic lupus erythematosus。International Journal of Rheumatic Diseases,21,352-355。  new window
17.Sarker, M.、Barua, M.、Guerra, F.、Saha, A.、Aftab, A.、Latif, A. H.、Islam, A.(2016)。Double Trouble: Prevalence and Factors Associated with Tuberculosis and Diabetes Comorbidity in Bangladesh。PLoS One,11(10)。  new window
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其他
1.衛生福利部疾病管制署(20180405)。肺結核疾病概述,http://www.cdc.gov.tw/professional/knowdisease.aspx?treeid=89b930c89c1c71cf&nowtreeid=89b930c89c1c71cf&id=fe81c4ade2a4a38f&did=652。  延伸查詢new window
 
 
 
 
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