Chiang Chih-Lin, Chen Pei-Chun, Huang Ling-Ya, Kuo Po-Hsiu, Tung Yu-Chi, Liu Chen-Chung, Chen Wei J
Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan Department of Psychiatry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
BMJ Open. 2016 Mar 3;6(3):e010802. doi: 10.1136/bmjopen-2015-010802.
To examine the disparities in psychiatric service utilisation over a 10-year period for patients with first admission for psychosis in relation to urban-rural residence following the implementation of universal health coverage in Taiwan.
Population-based retrospective cohort study.
Taiwan's National Health Insurance Research Database, which has a population coverage rate of over 99% and contains all medical claim records of a nationwide cohort of patients with at least one psychiatric admission between 1996 and 2007.
69,690 patients aged 15-59 years with first admission between 1998 and 2007 for any psychotic disorder.
Patients' urban-rural residence at first admissions.
Absolute and relative inequality indexes of the following quality indicators after discharge from the first admission: all-cause psychiatric readmission at 2 and 4 years, dropout of psychiatric outpatient service at 30 days, and emergency department (ED) treat-and-release encounter at 30 days.
Between 1998 and 2007, the 4-year readmission rate decreased from 65% to 58%, the 30-day dropout rate decreased from 18% to 15%, and the 30-day ED encounter rate increased from 8% to 10%. Risk of readmission has significantly decreased in rural and urban patients, but at a slower speed for the rural patients (p=0.026). The adjusted HR of readmission in rural versus urban patients has increased from 1.00 (95% CI 0.96 to 1.04) in 1998-2000 to 1.08 (95% CI 1.03 to 1.12) in 2005-2007, indicating a mild widening of the urban-rural gap. Urban-rural differences in 30-day dropout and ED encounter rates have been stationary over time.
The universal health coverage in Taiwan did not narrow urban-rural inequity of psychiatric service utilisation in patients with psychosis. Therefore, other policy interventions on resource allocation, service delivery and quality of care are needed to improve the outcome of rural-dwelling patients with psychosis.
在台湾实施全民健康保险后,研究首次因精神病住院患者在10年期间精神科服务利用方面城乡居住差异。
基于人群的回顾性队列研究。
台湾全民健康保险研究数据库,人口覆盖率超过99%,包含1996年至2007年全国至少有一次精神科住院的患者队列的所有医疗理赔记录。
1998年至2007年期间首次因任何精神障碍住院的69690名15至59岁患者。
首次住院时患者的城乡居住地。
首次住院出院后以下质量指标的绝对和相对不平等指数:2年和4年全因精神科再入院率、30天精神科门诊服务中断率、30天急诊科治疗后出院就诊率。
1998年至2007年期间,4年再入院率从65%降至58%,30天中断率从18%降至15%,30天急诊科就诊率从8%升至10%。城乡患者再入院风险均显著降低,但农村患者降低速度较慢(p=0.026)。农村患者与城市患者再入院的校正风险比从1998 - 2000年的1.00(95%可信区间0.96至1.04)增至2005 - 2007年的1.08(95%可信区间1.03至1.12),表明城乡差距略有扩大。30天中断率和急诊科就诊率的城乡差异随时间保持稳定。
台湾的全民健康保险并未缩小精神病患者精神科服务利用的城乡不平等。因此,需要在资源分配、服务提供和护理质量方面采取其他政策干预措施,以改善农村精神病患者的治疗效果。