| Abstract: | 中文摘要
分析牙科急診對於評估牙科醫療體系之健全有其重要性及特殊性。然而台灣少有全國性且長期的資料評估牙科急診的利用情形。本研究分析1997-2013年台灣地區牙醫院所急診的利用趨勢，並分析使用者的特性。使用全民健保資料庫的牙科總檔(National Health Insurance Data, NHIRD)中的牙科全檔 (Dental dataset) 1997-2013，辨識牙科急診的案件，計算歷年人口學特徵分層的牙科急診利用盛行率，並以次級資料運用及處理分析急診利用者的特性。結果發現，本研究以1997-2013年全民健保資料牙科總檔分析我國牙科急診利用情形(包含案件、盛行率及傾向特徵)，案件數的分析結果發現牙科急診申報案件自1997年的8615件上升至2002年的14864為高峰，最後趨勢微幅下降至2013年的13101件。牙科急診案件以性別分析多數為男性(約60%)，以年齡層分析多數為20-34歲(約佔30 %)，以醫院等級分析多數為區域醫院以上等級所申報(90 %以上)，以季節分析多數於春季(含農曆春節，約2 7%)就診、以投保地都市化程度分析多數為都市區域投保者(約65 %)，以投保地分局別分析多數為台北區(約45 %)。多數急診的原因為牙髓疾病(約佔總案件數的35 %)，接續為牙周疾病。本研究成果將可提供牙科急診的趨勢及需求特性，可以此作為相關牙醫醫療政策上的參考。Use of the hospital emergency department (ED) for dental conditions is a large and growing phenomenon in Taiwan. Dental emergency utilization is meaningful, important, and significant in representing the national oral health status; however, there is a lack of long term national wide analysis/study in Taiwan. The aim of this study was to determine 1998-2013 dental ED utilization for oral conditions in Taiwan, focusing on recent trends, total volume, repeat utilization, and patient characteristics. In our study, the Dental dataset of National Health Insurance Data, 1998-2013 was used. A dental ED visit was defined using International Classification of Diseases, Ninth Edition, Clinical Modification Diagnostic Codes (ICD-9). The study design includes both Panel cross-sectional study and case crossover. The primary independent variable was patient’s characteristics including: area of residence, gender, age, admission timing, causes for ED, classification of hospital. In Panel cross-sectional study, Chi-square test was used to evaluate the characteristics; Poisson regression was used to check whether the results are significant. In case crossover study, Chi-square test was used to evaluate the significant difference between dental ED and normal dental case. Odds ratio was calculated by generalized estimating equation. Multivariate logistic regression models were also estimated. The total dental cases increased from 21,499,200 to 31,922,582 since 1997-2013, the increase rate was 48.48%. The dental ED cases number increased from 8,615 to highest 14,864 in 2002, then oscillating down to 13,101 in 2013. We also found patients with the following characteristics tend to have higher dental ED usage, according to odds ratio: Male, age between 20-34 years group. ED mostly obtained in the medical center in city; the most peak occurring season is in spring. The most common causes for ED is dental pulp related followed by periodontal related diseases. Although dental-related ED visits account for a relatively small percentage of total ED visits, both the number and the percentage of such visits grew from 1997 to 2013. These demographic results serve baseline data that will be useful, helpful in making future oral health policy and hopefully to improve the national oral health status. |
