The Compliance and Determinants of Clinical Guidelines of Liver Disease in Taiwan

• Main Authors: Shaui-Shing Hung, 洪小幸
• Other Authors: Wui-Chiang Lee
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/99752455944679330126

碩士 === 國立陽明大學 === 醫務管理研究所 === 95 === Background：Taiwan is a hyperendemic area of liver disease. This lethal disease always influences the health of national. In the trilogy of hepatitis-liver cirrhosis-liver cancer, the close correlations among hepatitis B virus (HBV) inflection, hepatitis C virus (HCV) inflection, liver cirrhosis, and liver cancer are proved. Unfortunately, the general publics lack the knowledge of liver disease. Moreover, most infected people have no sense since the early days of liver disease has no any symptom. Although some people have been filtered out as abnormal, willing to do the periodical tracing. But low rate still obvious. Result in a tragedy since patient usually doesn't go to doctor until the terminal liver disease. If these patient accept the therapy after diagnosed, and accept the following periodical tracing. The liver cirrhosis, liver cancer happens can be reduced effectively, and recovered rate can be increased. Purpose： For above reason, lead the purpose of this research. In the scope of the patient of hepatitis, liver cirrhosis and liver cancer, both the compliance and determinants of clinical guidelines for the personal characteristic and predisposing characteristics are studied. Method：This study makes use of the sub-database of National Health Insurance Research Database (NHIRD) provided by the National Health Research Institutes (NHRI). The samples include insurant data, clinic prescription and treatment details, clinic prescription order details, and basic characteristics of physicians in 2004. There are 9996, 680, 317 patients whom are diagnosed with hepatitis, liver cirrhosis, liver cancer, respectively, to be treated as the research target. Based on theory construction of Aday & Andersen's Health Care Utilization Expanded Behavioral Model, the compliance and determinants of clinical guidelines are studied. The Chi-square test analysis and Multiple Logical Regression for multivariate analysis, are implemented by SAS version 9.1 package software. The research results indicate as following. Results： 1. The popular place for patient chosen as regular source of care (RSOC) is analysed. In hepatitis case, local clinic is the most popular place, and medical center is the least popular place. In liver cirrhosis case, regional hospital is the most, and community hospital is the least. In liver cancer case, medical center is the most, and community hospital is the least. 2. The continuous care rate of hepatitis, liver cirrhosis, and liver cancer is 37.55%, 41.32 %, and 58.99 % respectively. Three values increase as the seriousness of liver disease. 3. All of the hepatitis, liver cirrhosis, liver cancer cases in this study are lower than the clinical guidelines, which surveyed from the utilization pattern of the liver disease case of National Health Insurance. The scope of utilization pattern includes ultrasound, a-fetoprotein,alanine transaminase,aspartate transaminase. 4. The amount of liver disease among the predisposing characteristics is analysed. In hepatitis case, local clinic, private hospital, and Taipei Branch are the most. In liver cirrhosis case, regional hospital, private hospital, Taipei Branch is the most. In liver cancer case, medical center, profit private institution, Taipei Branch are the most. Conclusion：According to the results of this study, some suggestions are proposed below for policy and future research: For policy part, 1. Increase the periodical tracing rate for liver disease. 2. More advertising to the liver patient whom belongs to low utility rate of clinic guidelines. 3. Doctor should remind the liver patient of the liver function test and ultrasound examination immediately when the liver patient go to a doctor. 4. For more efficiency using of medical resource, the Bureau of National Health Insurance should put the liver disease as the first promote target of disease management, and encourage health care institutes to build the case management strategy. For future research part, both data of NHIRD and questionnaire should be carried out together in order to perfect the evaluation.