| Summary: | 碩士 === 國立臺灣大學 === 預防醫學研究所 === 91 === Background Notwithstanding screening for cancer and chronic disease can lead to morbidity and mortality reduction it also induces considerable demand on both referral service and confirmatory diagnosis of positive screen-detected cases and clinical management of early neoplasm detected by specific screening tool. From the aspect of provider, this also enhances the burden of clinical management given limited health manpower.
Objectives The aim of this study was therefore to develop a framework for evaluation of supply and demand associated with cancer screening. A community-based colorectal cancer screening was illustrated.
Methods Three stochastic processes were proposed, including queueing process for waiting referral service and confirmatory diagnosis, eight-state Markov model for projecting demand on pre-cancerous lesion, asymptomatic and symptomatic cases, and renewal process for projecting number of supply on Board-Certified endoscopist and general surgeon. Full-Time Equivalent information was also obtained by interviewing 26 endoscopist.
Data Sources Community-based colorectal cancer screening derived from Keelung community-based integrated screening (KCIS) program was used to illustrate how demand and supply of framework underpinning three stochastic processes can be applied.
Results: Regarding demand for waiting colonoscopy, if the standard of average waiting time is mandated as 21 days 25 servers are required after adjusting for FTE. The demand for colonoscopist was 1509 in the year of 2005 and increased to 1749 in the year of 2025. If all registered endoscopists are involved in endoscopic examination there is a shortage before 2014. The equilibrium reaches at the year of 2015. If the participation rate is less than 80% there is always a shortage of endoscopist in the face of mass screening for colorectal cancer. Concerning the demand for clinical management of colorectal neoplasm, if only 10% B-C general surgeon get involved the average number of CRC neoplasm served by one GS is 45 in 2005 and decreased to 1.5 in 2025.
Conclusions A framework for evaluation of supply of health manpower and demand on health service associated with colorectal cancer screening was formulated and evaluated by three stochastic processes. Evaluation of supply and demand is very important in the initial period of mass screening. This framework can be applied to other cancer or chronic disease screening projects.
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