| 摘要: | 背景：失智症長者因疾病影響肢體動作與行為能力，口腔照護變得困難，若是未能妥善照護口腔，可能因而增加系統性疾病。為此我國相關單位皆提出專案及計畫，希望增加醫療院所對失智症病患牙科需求的服務，改善失智症病患牙科利用情形。因此，本研究探討國內失智症病患牙科利用情形，進而探討其牙科利用之影響因素及照護成果。
方法：利用衛生福利資料科學中心2000年至2016年門住診健保申報資料之200萬人抽樣檔，以ICD-9-CM定義2000至2007年底65歲以上之新發失智症病患健保申報資料，以邏輯式回歸與複迴歸探討在2010年牙醫試辦計畫實施後影響牙科服務利用與否及利用次數的因子；並以Cox比例風險模式探討有無利用牙科服務的失智症病人在2012年後之後續的照護結果，包括了疾病發生的風險及醫療利用之差異，本研究將使用SAS 9.4版統計套裝軟體進行資料整理及分析。
結果：2016年65歲以上國人牙醫就診率為38.25%，而65歲以上失智症患者之牙科利用率僅有27%，顯現出高齡失智症患者之低牙科利用率問題。研究發現高齡失智症患者為男性、年齡較輕、教育程度較高、已婚者及居住於都市化程度高之地區者較傾向使用牙科服務，且有使用牙科服務的失智症病人罹患肺炎的風險比沒有牙科利用的失智症病人低（crude HR：0.74, 95% CI：0.61-0.90，p = .002; adjust HR：0.79, 95% CI：0.96-0.98，p = .018）。此外，研究指出牙科護理的使用與未來急性醫療支出的風險較低有關。
結論：性別、年齡、婚姻狀況、教育程度、就醫健保分區可作為預測高齡失智患者是否使用健保牙醫之因子，未來應更加重視高齡失智患者之口腔衛生照護，透過特殊牙科治療，進而減少因口腔疾病導致的全身性併發症，使高齡失智患者的牙科利用情形得到更完善的照護，減少社會與醫療資源浪費。
Background：
The elderly dementia patients suffer from physical movements and behaviors due to illness, so oral care becomes difficult. If the oral cavity is not properly taken care of, it may increase systemic diseases. To this end, relevant units in Taiwan have proposed projects, hoping to increase the hospital's services and improve the use of dentists in dementia patients. Therefore, this study is aim to investigate the dental care utilization, its related factors and outcome among the dementia patients in Taiwan after dental demonstration program.
Method：
This is a cohort study using a nationwide database. The participants were recruited from the Taiwan National Health Insurance Research Database between 2000 and 2016 , aged 65years or older who were new cases of dementia.We used multiple regression analysis to investigate the dental care utilization and its related factors among dementia patients, and then used Cox proportional hazards model to investigate outcome of the dental care after dental demonstration program. All analyses were conducted using statistic software SAS version 9.4.
Results：
Only 27 % dempatients visited the dentist in 2016.The results indicated that individual factors such as being male, younger, married, having a higher educational level and living in urban were associated with higher odds of having utilized dental care. Subjects who received dental care presented a 26 % decrease in their risk of aspiration pneumonia (crude hazard ratio: 0.74, 95% CI: 0.61-0.90, p = .002; adjusted hazard ratio: 0.79, 95% CI: 0.96-0.98, p = 0.018), after controlling for potential confounding factors.Furthermore, this study revealed that dental care utilization is associated with a lower risk for future acute medical expenditures.
Conclusion：
The predictors for the dental care utilization of the elderly dementia patients are: gender, age, marital status, education level and regional divisions. Our study suggests that government should put more concern on dental health issues related to the elderly dementia patients. Besides, they could teach dementia patients and their caregivers about dental health education to let patients get better care. |
