| Abstract: | 台灣地區青少年保健門診
病例之分析及其健康問題改善之相關因素
中文摘要
緒言：青少年期是從依賴的兒童期進到獨立的成人期的重要過渡階段，會出現快速的身體及心理變化，青少年也經常出現身體、心理及社會層面的問題。青少年醫療與保健在國內逐漸受到重視，然而目前國內尚無針對台灣地區青少年保健門診的整體性評估研究。
研究目的：本研究的目的是：(一)對台灣地區青少年保健門診的青少年病患做分析，以探討就醫青少年的社會人口學、就醫行為、就醫健康問題及其對門診滿意度的評估。(二)探討以上就醫青少年自覺求診問題獲得改善之相關因素。
研究樣本與方法 ：研究對象收集自民國89年4月至89年12月由家庭醫學科負責(台中市中山醫學院附設醫院、高雄市市立小港醫院)、多專科負責(彰化市彰化基督教醫院；多專科指小兒科、家庭醫學科、精神科、與婦產科負責)及精神科負責(台北市市立和平醫院、花蓮市慈濟醫院)之青少年保健門診中11-21歲病患共402名。本研究的工具，包括自填式問卷調查及專家病歷查錄的方式。統計主要以卡方檢定(Chi-square test)為主要的統計檢定模式。台灣地區青少年保健門診就醫青少年病例之分析，除了對全部402名個案做整體描述性分析外，也依照個案之「看診醫師專科別」、「性別」及「青少年期年齡層」等進行分組分析。最後分析青少年患者自覺求診問題有否改善之顯著相關因素。
研究結果：本研究的結果如下：(一)台灣地區青少年保健門診就醫青少年之病例分析如下：(1).就全部402名個案做整體的分析，其中男性175人(43.5%)和女性227人(56.5%)，女性稍多於男性，平均年齡為16.4±4.7歲。依青少年期的分期而言，以青少年晚期(182人，45.2%)相較於青少年早期或中期為多。99.0%為未婚，87.8%為在學學生。就醫方式中，52.2%由父母陪同看診，自己來求診者只佔30.6%。到本門診的累積次數而言，屬初診者佔46.4%。患者對青少年保健門診之各項滿意度均達九成五左右，以對於醫師的服務滿意度感到很滿意和滿意共99.4%最高。患者對青少年保健門診認為最不滿意的四項依序為：對門診臨床心理師服務的不滿意度(9.5%)、對門診整體服務效率的不滿意度(5.3%)、對門診醫師看診時間長短的不滿意度(5.2%)、對於門診獲得隱密保障性的不滿意度(3.3%)。個案認為『青少年保健門診的看診醫師』與『其他科別的看診醫師』比較，前者的最主要缺點為不能獲得較多的隱密性保障(15.6%)。95.7%病患認為需要門診經費補助。就醫青少年主要求診的原因，依序為為身體不適(41.6%)、心理困擾(21.3%)和一般身體檢查(16.5%)。就醫青少年健康問題之最常見三大診斷類別分佈，包括精神疾患(31.6%)、呼吸系統疾患(17.9%)和補充性的分類(包括健康檢查、會談、諮詢、打疫苗與實驗室檢查，14.2%)，以上最常見的三類佔了所有診斷類別的63.7%。而就醫青少年健康問題之最常見三大個別診斷為上呼吸道感染(15.3%)、預防注射(7.3%)及憂鬱症(6.5%)。(2).病患之特性依照「看診醫師專科別」之不同而分為家醫科組、精神科組與多專科組等三組加以分析，顯示三組病患在青少年期的年齡層、宗教信仰、學歷、婚姻狀況、是否在學、就醫方式、求診原因、就診的累積次數、求診問題的改善情形、對門診環境舒適性的滿意度、對獲得隱密性保障的滿意度、對服務品質的滿意度、對醫師服務態度的滿意度、對醫師尊重患者的滿意度、對醫師看診時間的滿意度、為初診或複診、病患健康問題的診斷類別分佈、和病患健康問題的個別診斷分佈等均有統計學上顯著差異。三組不同專科別的就醫病患認為『青少年保健門診的看診醫師』與『其他科別的看診醫師』比較，前者的最主要缺點皆為不能獲得較多的隱密性保障。關於患者的最常見診斷類別，三組的分佈有統計學上的顯著差異，家醫科組常見的診斷類別依序是：呼吸系統疾病(27.2%)、補充性的分類(18.5%)、消化系統疾病(17.4%)，多專科組是：精神疾病(24.1%)、補充性的分類(18.1%)、呼吸系統疾病(15.5%)，精神科組則是：精神疾病(95.6%)、神經系統疾病(1.1%)、症狀病徵不明類別(1.1%)。(3).病患之特性依照「性別」分為男生組與女生組而加以分析，顯示兩組門診病患在門診硬體的滿意度、門診服務的滿意度及個案健康問題的診斷類別等均有統計學上顯著差異。關於個案常見的診斷類別，兩組的情形有顯著的差異，男生組(3.4%，2.3% )的肌肉骨骼疾病與循環系統疾病皆明顯多於女生組(0.0%，0.4%)，而女生組(6.6%)有特有的懷孕產檢及周產期照顧困擾，但男生組與女生組其最常見的診斷類別皆相同且依序為：精神疾病(33.7% ，30.0%)、呼吸系統疾病(21.1%，15.4%)、補充性的分類疾病(包括健康檢查、會談、諮詢、預防注射與身體檢查；14.3%，14.1%)。(4).病患之特性依照「青少年期年齡層」分為青少年早期、中期與晚期等三組而加以分析，對於個案常見的診斷類別，三組的情形沒有顯著的差異，但三組青少年期早期、中期與晚期皆以精神疾病(38.2%，40.0%，22.5%)為最常見的診斷類別。(二) 在問卷中就青少年自覺求診問題獲得改善與否項目而言，結果認為改善者共佔87.2%(316人)、認為無改善者共佔12.8%(47人)，以青少年自覺求診問題獲得改善與否項目為依變項，以卡方檢定分析各項因素對於青少年自覺求診問題獲得改善與否之間的相關性，發現對門診醫師服務能力的滿意度、對門診醫師看診時間長短的滿意度、對門診整體服務品質的滿意度、對門診環境舒適性的滿意度、對門診所獲得衛生教育的滿意度、對門診醫師服務態度的滿意度、對門診整體服務效率的滿意度、對平時門診護士的服務滿意度、以及個案的診斷類別等因素有顯著的相關性。
結論：(一)台灣地區青少年保健門診之青少年病患，以女性、青少年晚期及在學學生居多；就醫青少年對於隱私性有較高的需求，就醫方式中自行來看門診的只佔三成尚屬偏低；青少年保健門診的病患對此門診的滿意度高；所有就醫青少年健康問題之最常見三大診斷類別為精神疾患(31.6%)、呼吸系統疾患(17.9%)和補充性的分類(包括健康檢查、會談、諮詢、預防注射與實驗室檢查；14.2%)，而且不同的性別與不同的看診醫師專科別之病患，也有不同型態的健康問題與求醫需求。(二)從研究的結果來看，強化醫師的服務態度和服務能力、醫師增加為足夠的看診時間、提昇門診整體服務品質、增加門診環境舒適性、增加門診的衛生教育、改進門診整體服務效率、以及強化門診護士服務能力等的努力能促使青少年患者自覺求診問題更獲得改善。
Analysis of Adolescent Clinics Cases and
Relating Factors of Self-perceived Improvement
of their Health Problems in Taiwan
Abstract
Objective： In Taiwan, there has been an steadily increased number of adolescent health clinics in the past ten years, but still no comprehensive evaluation of the adolescent health clinics in Taiwan has been performed. The purpose of this study was to understand the characteristics of adolescent patients of adolescent health clinics in Taiwan and their sociodemography, the behavior of seeking health care, the health problems and satisfaction about clinical staff and services provided by the clinics. In addition, the study is also aimed at determining the relating factors of self-perceived improvement of their health problems of adolescent patients in adolescent health clinics .
Sample and methods: The study was carried out from April to December, 2000. A total of 402 adolescent patients aged 11-21 years who visited the adolescent health clinics of five selected hospitals in Taiwan operated by family physicians, physicians of multidisciplines, or psychiatrists, were investigated by a structured questionnaire . Health problems of adolescent patients were analyzed based on review of medical records.
Results： The results showed that the sociodemography of all 402 adolescent patients is as follows: 175 (43.5%) were male and 227 (56.5%) were female; the average age was 16.4±4.7 years; 99.0% of the adolescents were unmarried; and 87.8% were in school. About half of adolescent patients visited the clinics with the company with their parents; 46.4% of subjects were first-visit patients; the main reasons for adolescents’ visits included physical problems (41.6%), mental problems (21.3%), and general medical examinations (16.5%). Patients’ satisfaction on the staff and services provided by the clinics are quite high (95.0%), especially on the area of physicians’ attitude toward patients. On the other hand, patients were less satisfied on the services provided by clinical psychologists (9.5%), the efficiency of services provided by the clinic (5.3%), the treatment time offered by the visiting doctors (5.2%), and confidentiality kept by the physicians (3.3%). 95.7% of patients demanded a financial aids to access the clinic services. The leading categories of adolescent health problems were mental disorders (31.6%), respiratory system diseases (17.9%), and supplementary classifications (14.2%), while the leading diseases diagnosis were upper respiratory infection (15.3%), immunizations (7.3%), and depression (6.5%). Analysis of the characteristics of patients and their health problems by the specialty of responsible physicians showed that statistically significant differences existed in different stages of adolescence , religion, marital status, schooling, reason for consultation, satisfaction on the environment of clinic, confidentiality kept by the physicians, quality of services provided, and physicians’ respect toward the adolescents, the treatment time offered by their visiting doctors, whether the first-visit or repeated visit patient, the distribution of disease category, and the distribution of individual disease diagnosis. Satisfaction on physicians’ service ability and respect toward the adolescents, satisfaction on nurses’ service, satisfaction on the environment of clinic, the quality and efficiency of services provided, the treatment time offered by their visiting doctors, the information received from their clinic, and the distribution of disease category were the factors significantly related to adolescents’ self-perceived improvement of their health problems.
Conclusions: We concluded that adolescent patients were satisfied with the staff and services provided by the adolescent health clinics in general. Adolescent patients demanded of a series of high confidentiality. The characteristics of adolescent health problems were mainly determined by the speciality of physicians who run the clinic, and also determined by the gender of the adolescents. We suggest that efforts to promote physicians’ service ability and respect toward the adolescents, nurses’ service ability, the environment of clinic, the quality and efficiency of services provided, the treatment time offered by their visiting doctors, and the information received from their clinic could result in a better adolescent self-perceived improvement of their health problems. |
