【摘要】：目的通過(guò)對(duì)青島市在機(jī)構(gòu)(養(yǎng)老院、護(hù)理院、精神衛(wèi)生中心)中接受護(hù)理的老年癡呆患者進(jìn)行調(diào)查,測(cè)算其直接經(jīng)濟(jì)負(fù)擔(dān)和間接經(jīng)濟(jì)負(fù)擔(dān),并分析老年癡呆患者疾病經(jīng)濟(jì)負(fù)擔(dān)的影響因素,為合理配置和利用醫(yī)療衛(wèi)生資源提供依據(jù),為減輕患者疾病經(jīng)濟(jì)負(fù)擔(dān)提供可行性建議。方法采用自行設(shè)計(jì)的調(diào)查問(wèn)卷,借助醫(yī)療機(jī)構(gòu)中的HIS系統(tǒng),收集患者的基本信息、疾病費(fèi)用等,運(yùn)用數(shù)據(jù)處理軟件EPIDATA3.0和統(tǒng)計(jì)分析軟件SPSS18.0,同時(shí)結(jié)合相關(guān)的衛(wèi)生經(jīng)濟(jì)學(xué)理論和衛(wèi)生統(tǒng)計(jì)學(xué)方法,對(duì)收集到的數(shù)據(jù)進(jìn)行描述性分析、非參數(shù)檢驗(yàn)和二項(xiàng)logistic回歸分析;采用現(xiàn)場(chǎng)訪談法,對(duì)家屬及機(jī)構(gòu)中的工作人員進(jìn)行訪談,了解老年癡呆患者的其他相關(guān)信息,以補(bǔ)充調(diào)查問(wèn)卷中的缺失信息,根據(jù)調(diào)查結(jié)果測(cè)算老年癡呆患者的疾病經(jīng)濟(jì)負(fù)擔(dān)并分析影響疾病經(jīng)濟(jì)負(fù)擔(dān)的主要因素。結(jié)果三個(gè)機(jī)構(gòu)(養(yǎng)老院、護(hù)理院、精神衛(wèi)生中心)中312例老年癡呆患者的月均直接經(jīng)濟(jì)負(fù)擔(dān)為834738.93元,月均間接經(jīng)濟(jì)負(fù)擔(dān)為308686.40元;平均每位患者的直接經(jīng)濟(jì)負(fù)擔(dān)為2675.45元,間接經(jīng)濟(jì)負(fù)擔(dān)為989.38元。影響因素方面,老年癡呆患者的單因素分析結(jié)果顯示,機(jī)構(gòu)類型、年齡、婚姻狀況、受教育程度、職業(yè)類型、家庭人均月收入、收入水平、日均社交活動(dòng)時(shí)間、日均鍛煉時(shí)間、自理程度、有無(wú)并發(fā)癥及有無(wú)醫(yī)療保險(xiǎn)等影響老年癡呆患者的直接經(jīng)濟(jì)負(fù)擔(dān),而婚姻狀況、家庭經(jīng)濟(jì)狀況、日均鍛煉時(shí)間、自理程度、護(hù)理服務(wù)等級(jí)以及家屬月均誤工時(shí)間等影響老年癡呆患者的間接經(jīng)濟(jì)負(fù)擔(dān);多因素分析結(jié)果顯示,機(jī)構(gòu)類型、家庭人均月收入、有無(wú)并發(fā)癥、婚姻狀況以及自理程度等對(duì)直接經(jīng)濟(jì)負(fù)擔(dān)的影響更為顯著,而家庭人均月收入、自理程度、所接受的護(hù)理服務(wù)等級(jí)對(duì)間接經(jīng)濟(jì)負(fù)擔(dān)影響更為顯著。結(jié)論與建議不同機(jī)構(gòu)老年癡呆患者疾病經(jīng)濟(jì)負(fù)擔(dān)存在差異,除了患者基本情況外,有無(wú)醫(yī)療保險(xiǎn),自理程度,護(hù)理服務(wù)等級(jí)等均是影響患者疾病經(jīng)濟(jì)負(fù)擔(dān)的因素,因此建議關(guān)愛(ài)、照護(hù)老年人群,降低老年癡呆發(fā)病率;堅(jiān)持公益性為導(dǎo)向,對(duì)不同機(jī)構(gòu)進(jìn)行分類管理;建立并完善老年癡呆患者護(hù)理保險(xiǎn)制度,減輕疾病經(jīng)濟(jì)負(fù)擔(dān);加強(qiáng)對(duì)老年癡呆患者的治療和護(hù)理,延緩病情惡化。
[Abstract]:Objective to investigate the direct and indirect economic burden of Alzheimer's disease patients in institutions (nursing home, mental health center) in Qingdao. The factors influencing the economic burden of disease in senile dementia patients were analyzed to provide basis for rational allocation and utilization of medical and health resources and feasible suggestions for alleviating the economic burden of disease in patients with Alzheimer's disease. Methods A self-designed questionnaire was used to collect patients' basic information, disease cost, data processing software (EPIDATA3.0) and statistical analysis software (SPSS18.0,) with the help of HIS system in medical institutions. At the same time, combined with relevant health economics theory and health statistics method, the collected data were analyzed by descriptive analysis, non-parametric test and binomial logistic regression analysis. In order to supplement the missing information in the questionnaire, we conducted interviews with family members and staff in institutions to find out other relevant information about Alzheimer's disease patients. According to the survey results, the disease economic burden of senile dementia patients was estimated and the main factors affecting the disease economic burden were analyzed. Results the direct economic burden and indirect economic burden were 834738.93 yuan per month and 308686.40 yuan respectively in three institutions (nursing home, mental health center). The average direct economic burden and indirect economic burden per patient were 2675.45 yuan and 989.38 yuan respectively. In terms of influencing factors, the results of univariate analysis of Alzheimer's disease patients showed that: type of institution, age, marital status, education level, occupation type, monthly income per family, income level, average daily social activity time, daily exercise time, The degree of self-care, complications and medical insurance influence the direct financial burden of senile dementia patients, but marital status, family economic status, daily exercise time, self-care degree, The level of nursing care and the delay time of family members affected the indirect economic burden of senile dementia patients. The results of multivariate analysis showed that the type of institution, the per capita monthly income of the family, the complications, the marital status and the degree of self-care had more significant effects on the direct financial burden, while the per capita monthly income of the family, the degree of self-care, etc. The level of nursing services received had a more significant impact on the indirect economic burden. Conclusion there are differences in the economic burden of senile dementia patients in different institutions. Besides the basic condition of the patients, medical insurance, self-care degree and nursing service grade are all the factors that affect the disease financial burden of the patients. Therefore, it is suggested to care and care for the elderly and reduce the incidence of dementia. Adhere to the guidance of public welfare, to different institutions for classified management; establish and improve the nursing insurance system for dementia patients, reduce the economic burden of disease; strengthen the treatment and nursing of senile dementia patients, delay the deterioration of the disease.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.74

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