| Summary: | 碩士 === 國立陽明大學 === 醫務管理研究所 === 102 === Background
According to the World Health Organization (WHO), chronic obstructive pulmonary disease (COPD) will become the third leading cause of death worldwide in 2030. Therefore, the prevention and treatment of COPD is of substantial significance. In this study, a Group-based Trajectory formula was used to investigate the continuity of care in COPD patients to establish correlations between factors and good continuity of care.
Method
Patients with a first time diagnosis of COPD from 2003-2005 were selected from the National Health Insurance Research Database (NHIRD). Their continuity of care indicators (COCI) in the five year period after the diagnosis were calculated and used in Group-based Trajectory modeling, with gender, age, insurance salary, and Elixhauser Comorbidities as control variables. Multinomial logistic regression was used to identify the specific factors that were significantly correlated with the trajectory grouping of continuity of care.
Results
Gender, insurance salary and 20 types of Elixhauser Comorbidities exhibited significant correlations in Chi-square tests. Age and the clinic visit rate from years 1-5 exhibited significant (P <0.001) correlations in a one-way analysis of variance (ANOVA) and multiple logistic regression analysis. These factors in years 1 and 2 demonstrated significant correlations in a multinomial logistic regression analysis. The health status factor demonstrated significant (P <0.001) correlations in a one-way ANOVA in years 1-5 and significant correlations in multinomial logistic regression analysis in years 1-3.。
Discussion and Conclusion
The continuity of care of COPD patients fell into various trajectory groups. In view of the Comorbidities, the continuity of care of COPD patients was affected by chronic diseases, such as diabetes, presumably through prescription refills or a shared care network and other case management plans. It is recommended that government agencies should also establish a care network and case management plans for COPD patients. This approach would enhance the continuity of patient care and encourage the patients to visit a fixed location and physicians for medical treatment to maintain a fixed relationship between doctors and patients; an established relationship would promote medical services with high continuity of patient care.
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