| Summary: | 碩士 === 中國醫藥學院 === 醫務管理研究所 === 90 === Abstract
Because of the implementation of National Health Insurance, the accessibility of health care services increases. The amount and expenditure of emergency services has risen quickly. The purpose of this study was to investigate the characteristics of frequent users for the emergency services and the factors associated with frequent use of emergency services.
This study used structural questionnaires based on Andersen’s behavior model of health care utilization. The samples of this study were the patients who were above 15 years old and used the emergency services between October 2000 and September 2001 in a medical center. In total, there were 30,986 samples. According to patients’ utilization of emergency services, this study separated the patients into frequent users (4+ times a year) and non-frequent users (1~3 times a year). The computer assisted telephone interview system was used to collect the data. The logistic regression analysis was applied to determine the relationship between frequent uses and the related factors.
The major findings of this study were that predisposing variables were not factors associated with frequent uses for emergency services while the most important factors were the need variables. The patients who had alcohol abuse, stable resource of primary care, more chronic diseases, worse self-report health and worse discharged health condition were more likely to frequently use emergency services. To compare with patients who suffered from trauma or fracture, the patients who had gastrointestinal disease, faintness, cancer, cardiovascular disease, psychical disease, genitourinary disease and hematic disease had higher probability to frequently use emergency services. Furthermore, eighty percent of patients chose emergency service because they felt their health problem so serious that they needed immediate care. However, there were ten percent of patients choosing emergency services because of convenience and less waiting time.
Finally, in order to have an appropriate utilization of emergency services, this study recommends that hospitals or public health offices continuously educate patients to use emergency services appropriately and transfer non-urgency patients to clinic primary care. Besides, for the health policy makers, this study suggests to establish integrated health care systems to satisfy the needs of continuous care for elder patients or patients with cancer or chronic diseases.
Key Words: Emergency services, Frequent users
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