Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan, ROC.
Curr Med Res Opin. 2020 Nov;36(11):1761-1767. doi: 10.1080/03007995.2020.1832057. Epub 2020 Oct 13.
We aimed to identify associated factors of highly frequent use of outpatient services and explore how they were impacted to provide policy references for government and medical institutes in their efforts to seek provision of reasonable medical services, continuous care and integrated outpatient services.
The Taiwanese national health insurance database was used and 661,125 patients were identified in 2009. The patients with ≥100 internal medicine outpatient (IMO) visits were defined as the highly frequent group and they were matched at a ratio of 1:4 with patients of 1-99 IMO visits based on demographic characteristics. Multivariate logistic regression was used to estimate adjusted odds ratios with 95% confidence intervals.
Among 1 million patients in the outpatient department, 0.05% had at least 100 visits. These patients with highly frequent IMO visits had significantly higher rates of emergency department (ED) visits, hospitalization, psychiatric disorders and possession of a catastrophic illness card as well as a significantly lower level of continuity of care index (COCI). Multivariate analysis showed that ED visits (adjusted OR [AOR] = 1.63), psychiatric disorders (AOR = 7.13), low COCI (AOR = 1.69), and several comorbidities including peripheral vascular diseases (AOR = 4.33), dementia (AOR = 0.04), chronic pulmonary disease (AOR = 3.02), peptic ulcer diseases (AOR = 3.70), diabetes mellitus (AOR = 3.45) and renal disease (AOR = 2.43) were significant associated factors.
To rationalize use and distribution of medical resources, we suggest proper regular care and health education to those with mental disabilities and multiple chronic conditions, which may not only improve the situation of highly frequent hospital visits but also effectively control incidence of acute conditions and reduce their ED visits. In addition, improving the continuity of care is vital, and the best way to do this is to promote family medicine as the primary form of healthcare.
本研究旨在识别频繁使用门诊服务的相关因素，并探讨其影响，为政府和医疗机构提供合理医疗服务、连续性护理和综合门诊服务提供政策参考。
利用台湾全民健康保险数据库，于 2009 年共纳入 661125 名患者。将≥100 次内科门诊就诊（IMO）的患者定义为高频组，并按照人口统计学特征，以 1:4 的比例与 1-99 次 IMO 就诊的患者相匹配。采用多变量 logistic 回归估计调整后的优势比及其 95%置信区间。
在 100 万门诊患者中，有 0.05%的患者至少就诊 100 次。这些高频 IMO 就诊患者急诊就诊、住院、精神障碍和持有重大疾病卡的比例明显较高，而连续性护理指数（COCI）明显较低。多变量分析显示，急诊就诊（调整后的比值比[OR] = 1.63）、精神障碍（OR = 7.13）、COCI 低（OR = 1.69），以及多种合并症，包括外周血管疾病（OR = 4.33）、痴呆（OR = 0.04）、慢性肺部疾病（OR = 3.02）、消化性溃疡病（OR = 3.70）、糖尿病（OR = 3.45）和肾脏疾病（OR = 2.43），是高频就诊的显著相关因素。
为了合理利用和分配医疗资源，我们建议对精神残疾和多种慢性疾病患者进行适当的常规护理和健康教育，这不仅可以改善高频就诊的状况，还可以有效控制急症的发生，减少急诊就诊。此外，提高连续性护理至关重要，最好的方法是推广家庭医学作为初级医疗形式。
