Investigation for The Reasons of Positive Oral Cancer Screening Cases Accept Subsequent Diagnosis

• Main Authors: Chin-Sheng Huang, 黃金聲
• Other Authors: 黃茂栓
• Format: Others
• Language: zh-TW
• Published: 2015
• Online Access: http://ndltd.ncl.edu.tw/handle/97317501073652501147

碩士 === 臺北醫學大學 === 牙醫學系碩博士班 === 103 === Background and Purpose : Latest AD 2014, the Ministry of Health and Welfare reported Taiwan''s cancer registration showed that there are more than six thousand new cases of oral cancer (including oropharynx , hypopharynx ) occurred each year. The positive rate of oral cancer screening for high-risk group who smoke or chew betel nut was 8.5% , but the referral rate was 52.3% .To promote all level medical institutions to enhance the positive referrals rate, this study combined the data of positive cases in oral cancer screening, impact on the prognosis of cancer treatment and care patterns , impact on the diagnosis between the positive cases and various medical institutions , the positive cases and the treatment of resource distribution and so on.. Methods and procedures : In medical institutions of oral cancer screening have implemented, we extract the random cluster sampling clinic samples , issued questionnaire to North 615, Central 267 , Southern 370 , East 34 , a total of 1,286 medical institutions in Taiwan, began in August 2012. In this study, the main analysis.method was the multi -class model (Hierarchical Model). Results: In the northern of Taiwan, referral rates was higher in Medical Center and other level hospitals than the national average. In central and southern of Taiwan, other level hospitals and local health bureau had higher referral rate than the national average. In eastern of Taiwan, the medical center and local health bureau had higher referral rate than the national average. Oral cancer screening worker except of local health bureau, the dentist is a majority. Positive cases in other hospitals are up to a total of 12,740, followed by the Medical Center 9360. In oral cancer screening, other hospitals have the highest benefits are 1:24, then medical center are lower 1:18. For every positive case in every-singleday outpatient number, medical centers had the proportion of 1:18, then other hospital is about 1:68. That efficiency of positive cases screening in the medical center outpatient is highest. The average referral positive cases in the medical center are highest 234 positive cases. If the medical institutions implemented of adult health prevention and smoking cessation classes, there has higher referral rate. Difference between referrals successful and failed is the factor of family support. In the group of successful referrals, 83.2% of screening case family noticed the oral lesion and suggested received medical treatment as soon as possible, on the contrary, group of failed referral was only 28.3% supported by their families and 22.5% of the cases are deliberately concealed reluctant family to know that condition. Conclusion: This study found that levels of medical institutions influence on referral rates include oral cancer therapy equipment, community area screening, adult health care and consultation before referrals. Individual level factors that influence the rate of referral are family support, younger age, betel nut chewing habit and repeated screening. In addition, adult preventive care and smoking cessation classes related to the referral rate. Cases of unsuccessfully referred told that the most common reasons include disease-insight and the time factor (too busy, prolong waiting time) ; if the hospital to facilitate referral program or encourage to receive local clinics follow. Suggestion are setting referral reward, encourage medical institutions refer positive actively , providing practice management resources of cases, assisting other clinic referral resource, setting up referral service primary care centers to improve the current plight of low referral .