[[alternative]]The relationship between health literacy and utilization of patients with type 2 diabetes

[[abstract]]背景：科技日新月異，環境發生變遷，時代的變化也讓人們的生活方式與飲食習慣悄無聲息發生改變，使得糖尿病的盛行率日漸增加。而過去有關糖尿病研究大多以血糖控制為主，也瞭解其中與併發症之關聯性，但為何醫療提供者給予病人許多有關糖尿病如何良好控制之相關健康資訊，為何我國罹患糖尿病人數不減反增，這很有可能與病人本身健康識能程度有關。目的：瞭解第二型糖尿病人健康識能的概況與評估第二型糖尿病病人健康識能與其整體醫療資源耗用之相關。方法：使用結構性問卷並透過專家會議與多位學界與業界專家進行修正，形成正式問卷。調查時間為2020年12月至2021年4月之每周二、三、四、五、六新陳代謝科門診時間執行問卷調查，並串聯西元2013年至西元2018年臺北市立聯合醫院忠孝院區門診、急診、住院之就診紀錄為主要醫療利用資料，最後以SPSS 22.0統計程式進行資料分析。結果：本研究以416位18歲(含)以上第二型糖尿病患者為研究對象，並串聯103至108年臺北市立聯合醫院忠孝院區內部六年醫療利用資料。教育程度國中者之發生急診機率是教育程度國小者的0.178倍[95%CI(0.034-0.950)]，且達統計顯著(p=0.043)，與國小相比，高中者之發生住院機率為0.293倍[95%CI(0.119-0.721)]，達統計顯著(p=0.007)；健康識能充足者之發生急診機率是健康識能有限者的0.433倍[95%CI(0.183-1.024)]，且達統計顯著(p=0.057)，健康識能充足者之發生住院機率是健康識能有限者的0.419倍[95%CI(0.207-0.847)]，且達統計顯著(p=0.015)。結論： 本研究結果發現，健康識能程度高低並沒有影響門診次數與費用，此結果與過去研究學者者說明健康識能會影響醫療成本之結果並不一致。而本研究之健康識能程度差異與急診、住院有無具有關聯性，此部分與其他研究結果一致，健康識能越高，與健康識能程度低者相比，使用醫療服務沒有那麼頻繁，但卻有其他研究結果發現，健康識能程度高者越有可能過度使用醫療服務。關鍵字：第二型糖尿病、健康識能、健康知識、醫療利用[[abstract]]AbstractBackground：With the rapid development of science and technology, changes in the environment, and changes in the times have also changed people's lifestyles and eating habits, making the prevalence of diabetes increasing day by day. In the past, most of the research on diabetes focused on blood sugar control, and the relationship between it and complications was also understood. However, why medical providers give patients information on blood sugar control, the number of people suffering from diabetes has not decreased but increased, which is likely to be related to the patient's own health literacy. related to ability.purposes：To understand the general situation of health literacy of type 2 diabetic patients and to evaluate the relationship between health literacy of type 2 diabetes patients and their overall medical resource consumption.Methods：A structured questionnaire was used and revised through expert meetings with a number of academic and industry experts to form a formal questionnaire. The survey time was from December 2020 to April 2021 to the outpatient time of the Department of Metabolism. The questionnaire was conducted, and the records of outpatient, emergency, and inpatient visits in Zhongxiao District, Taipei City United Hospital from 2013 to 2018 were connected in series. Finally, SPSS 22.0 Statistical program for data analysis.Result：This study took 416 patients with type 2 diabetes mellitus over 18 years old (inclusive) as the research object, and connected the medical utilization data for six years. The incidence of emergency department in the middle-school education is 0.178 times [95%CI(0.034-0.950)], and it is statistically significant (p=0.043). Compared with the elementary school, the high school has the hospitalization probability. It was 0.293 times [95%CI(0.119-0.721)], which was statistically significant (p=0.007); the probability of emergency in people with sufficient health knowledge was 0.433 times that of people with limited health knowledge [95%CI(0.183-1.024) ], and it was statistically significant (p=0.057), and the probability of hospitalization in those with sufficient health literacy was 0.419 times that of those with limited health literacy [95%CI (0.207-0.847)], and it was statistically significant (p=0.015) .Conclusions： The study found that the level of health literacy did not affect the number of outpatient visits and costs. This result is inconsistent with the results of previous research scholars who have demonstrated that health literacy affects medical costs. The differences in the health literacy level of this study are related to whether there is an emergency room or hospitalization. This part is consistent with other research results. The higher the health literacy level, the less frequent the use of utilization compared with the lower health literacy level, but the However, other studies have found that people with higher health literacy are more likely to overuse utilization.Keyword：type 2 diabetes、health literacy、health knowledge、utilizatio