| Abstract: | Background: The majority of elderly people with chronic disease has multiple chronic conditions coincidently (co-morbidity), and clinically, a patient generally seeks treatment for 3 to 7 different symptoms each year. About 50% of adults has one chronic condition, while many have more than one. This indicates that multi-morbidity is a clinical generality, and as the more symptoms there are, the more medical treatment is sought, multi-morbidity has a substantial effect on health insurance expenditure. Due to the gradually ageing population, there now is a whole array of geriatric care related problems. Rapidly increasing numbers of geriatric dementia patients place a high mental and financial burden on families and society. Alzheimer-type dementia and vascular dementia account for most cases of dementia, yet the medical world has still not found a cure. We want to find out if the use of medical services by dementia patients is influenced by disease and patient characteristics and treatment methods, so as to offer a reference for clinical practice and hospital management.
Material and Method: Subjects of this study consisted of dementia patients of a certain medical center in Central Taiwan. Those of all cases that were reported during the period from January 1, 2001 to December 31, 2004 who were entered into the database under the main diagnosis of ICD-9, reference numbers 290.1, 290.2, 290.3, 290.4 and 331, and who underwent intellectual assessment, were included in the study. A cross-sectional study was performed of 1208 patients who had been subjected to intellectual assessment more than once, while follow-up study was carried out with 202 dementia patients who underwent subsequent intellectual assessment after more than 6 months.
Results: The cross-sectional study showed that there is a significant correlation between subjects? basic characteristics and their health care index and medical resource utilization. A significant correlation was also found between arteriosclerosis-related complications and subjects? health care index and medical resource utilization. The follow-up study found that basic characteristics of subjects significantly affect the results of medical care, and that the more arteriosclerosis-related complications there are, the greater medical resource utilization is. Furthermore, providing different medical care to subjects did not positively influence the results of medical care.
Conclusion: This study clearly indicates that medical centers are yet unable to effectively treat and control dementia, and that the more arteriosclerosis-related complications there are, the greater medical resource utilization is. We suggest that attention is paid to arteriosclerosis-related complications in dementia patients, and overall disease management is applied so as to prevent and periodically follow-up arteriosclerosis-related complications. This study also indicates that the more additional medical specialisms there are involved, the greater medical resource utilization is, while no significant treatment results are achieved. Attention should therefore be paid to the importance of family medicine, and a comprehensive referral system should be established, so as to enhance basic medical care services. In Taiwan, dementia has not yet been ranked as a disease eligible for disease management care. The results of this study may be provided to the Bureau of National Health Insurance so that they may include dementia in their disease management program for better control. |
