Difference in Frequency and Outcome of Geriatric Emergency Department Utilization between Urban and Rural Areas

• Main Authors: CHEN, YU-LING, 陳妤昤
• Other Authors: Chen, Chu-Chieh
• Format: Others
• Language: zh-TW
• Published: 2017
• Online Access: http://ndltd.ncl.edu.tw/handle/4we664

碩士 === 國立臺北護理健康大學 === 健康事業管理研究所 === 105 === Background: In Taiwan, population is rapidly aging. The rate of population whose age is 65 or older is about 13.20% at the end of 2016. The elderly with poor physical fitness, complex disease which cause complications, and severe disease, so they often need to use emergency treatment of an emergency medical condition. There are about 80% of population live in urban area in Taiwan so far. According to previous studies, indicating the difference of medical care’s accessibility and outcome between urban and rural areas. Objectives: The study are going to explore the frequency and outcome of emergency medical use and correlative factors in urban and rural areas in 2013. Methods: The study uses longitudinal health insurance database (LHID) 2000 which released by National Health Insurance Research Database (NHIRD) was analyzed by SAS 9.4 package. First, to use descriptive statistics to explore frequency and outcome (disease urgent degree, hospitalized at fist visit ED, death at fist visit ED) of geriatric emergency department (ED) utilization in urban area and rural area in 2013. Second, to use complex logistic regression to explore the correlation factors of frequency and outcome (disease urgent degree, hospitalize at fist visit ED, death at fist visit ED) of geriatric ED utilization in urban area and rural area. Results: In 2013, there were 9,747 Taiwanese people in urban and rural areas, where 2,787 (28.59%) people had used emergency medcical care. In urban area, there were 6,695 elders that including 1,879 (28.07%) elders had used emergency medcical care. In rural area, there were 3,052 elders that including 908 (29.75%) elders have used emergency medcical care. There was no statistically significant difference between urban and rural areas. People who were older than 85, lower income had more than 30 outpatient visit and hospitalize in the previous year, and CCI classification of 3 or higher are associated with becoming frequent (4-12) emergency medical users. Hospital admission in the previous year is associated with becoming frequent (>12) emergency medical users. Urban area and medical center are associated with disease urgency at first visit ED. People who are older than 85, medical center, non-traumatic, and urgent are associated with hospitalizing at first visit ED. People who are older than 85, non-traumatic, and disease urgent are associated with death at first visit ED. Conclusions: There were no significant difference between the utilization rate of emergency medical care, average number of people for per person, hospitalize and death at first visit ED of urban area and rural area, but rural elders whose disease urgency are more higher than urban elders. The study recommends authority of health policy to strengthen universal primary health care, enhance medical advice’s accessibility of rural elders. If they could obtain good care, it would reduce the urgency of the disease when they went to ED. Key words: elder, emergency medical utilization, rural area