The Effect of Health Resources on Diagnostic Rate, Utilization Rate and Compliance Rate among Diabetes Patients

• Main Authors: Yun-Ying Chang, 張云孆
• Other Authors: Cheng-Hua Lee
• Format: Others
• Language: zh-TW
• Published: 2008
• Online Access: http://ndltd.ncl.edu.tw/handle/04509375216194265962

碩士 === 國立陽明大學 === 醫務管理研究所 === 96 === Background Diabetes is one of the increasingly prevalent chronic illnesses of domestic people. Long-term diabetes can easily lead to multiple complications. Early treatment of diabetes, including receiving medical attention, medical examination, and proper medication on a regular basis, can effectively reduce its harm on health conditions and burden on the entire medical system. In Taiwan, as revealed by many studies, most of the diabetic patients receive medical treatment in hospitals, because examinations are constantly required. However, in terms of the number of hospitals, there is still a wide gap between urban and rural areas. Therefore, whether the amount of health resources may affect the diagnosis of diabetes, utilization, and compliance of patients should be further investigated. Objectives The objectives of this research were to explore: (1) whether the odds that overweight or obese people running a high risk of diabetes are diagnosed as having diabetes will vary across regions with more and less health resources; (2) whether there is any difference in the frequency and cost of hospital admission among diabetic patients in regions with more and less health resources; (3) whether there is any difference in medication possession ratio, frequencies of blood glucose test and glycated hemoglobin test, and other prescription compliance ratios among diabetic patients in regions with more and less health resources. Subjects The research subjects included participants over age 20 in the “National Health Interview Survey” conducted by National Health Research Institutes during Apr 2005 ~ Jul 2005. Besides, detailed outpatient expenditures and therapeutic files applied for national insurance in 2005 and the medical resource profile of medical sub-regions in 2005 were also adopted. Patients with more than two records of applications for ICD-9CMcode and more than two records of diabetic prescriptions in 2005 were selected. In these files, a total of 12,242 people were aged above 20, and 673 of them were diagnosed with diabetes. Methods The collected data were analyzed for descriptive statistics, frequency distribution, mean, and deviation, using SAS 9.1. In inferential statistics, logistic regression was applied to analyze whether the amount of health resources will affect the diagnosis of diabetes on overweight or obese people. Further, multiple regression analysis was used to explore whether the amount of health resources will affect diabetic patients’ utilization of outpatient medical service, medication possessing ratio, and frequencies of blood glucose test and glycated hemoglobin test. Results 1.Among the research subjects, 43.81% were either overweight or obese, and 5.3% were diabetic. The prevalence rate of diabetes among overweight or obese people was 6.6%. Overweight or obese people, compared with those in an ideal weight, were more likely to be diagnosed as having diabetes (odds ratio=1.365, p<0.001). The odds ratio would also increase with the age, in a dose-response relationship. 2.With age, gender, education degree, marital status, ethnic group, and household income controlled, overweight or obese people were more likely to be diagnosed of having diabetes in sub-regions with more health resources than in sub-regions with less health resources (odds ratio=1.226) but not to the level of significance. 3.Diabetic patients in sub-regions with more health resources had an average of 1.8 (p<0.01) more outpatient visits and consumed $5,356.4 more outpatient expenditure (p<0.05) than those in sub-regions with less health resources. Both of the above statistics reached the level of significance. 4.In terms of compliance ratios, diabetic patients in sub-regions with more health resources exhibited a 3.6% higher medication possession ratio (p<0.05), 0.92 more blood glucose tests (p<0.05), and 0.36 more glycated hemoglobin tests (p<0.05) than those in sub-regions with less health resources. 5.65.2% of the diabetic patients said that hospitals were the main medical institutes where they would receive medical attention, while the rest 34.8% said basic-level hospitals were the main medical institutes where they would receive medical attention. Medication possession ratios were higher among patients of regional hospitals (90%) and patients of hospitals affiliated with non-profit organizations (89%). Frequency of blood glucose tests was higher among patients of regional hospitals (7.05 times) and patients of public medical institutes (7.39 times). The frequency of glycated hemoglobin tests was higher among patients of medical centers (2.3 times) and patients of public medical institutes (1.98 times). Conclusions and Suggestions Amount of health resources will affect diabetic patients’ utilization rate and compliance rates. For diagnosis of diabetes, utilization of health resources, and long-term compliance with prescription, the government needs to consider that amount of health resources in different regions may affect diabetic patients’ access to medical care. For regions with insufficient health resources, more health resources should be invested so as to improve the medical care for diabetic patients. For regions with sufficient health resources, the results of medical care provided to diabetic patients should be evaluated to understand the efficiency of health resources.