7卷1期

• Link 綜論 Review Article
• 亟待加強的藥物制工作亟待加強的藥物制工作
• 吳淑瓊
  吳淑瓊
• 無
  none
• 無
  none
• 1 - 7
• 10.6288/JNPHARC1987-07-01-01

• Link 綜論 Review Article
• 泛談美國多體制醫療機構(MUS)及其對我國醫院之示範作用The Multiple-Unit System in the U.S. and Its Impact on the Hospital System in Taiwan
• 吳肖琪
  Shiao-Chi Wu
• 無
  none
• MUS多體制醫療機構(Multiple-unit systems)是美國漸流行的一種趨勢，它指的是一群醫院組成一個系統，由單一管理制度來管理。這種聯合方式能滿足醫院及社區之需求，達到強有力的中央控制。 政府的介入醫療，民眾要求高品質低收費之醫療服務，保險公司的參與，醫院問的強烈競爭，醫院已不再單純是一種服務事業，而必須在爭取醫事人員、病人及財力支援上高度競爭。 可提供醫院包括經濟上，避免重覆投資、聯合採購、降低成本、分擔風險等，醫療品質的提升，民眾的可近性與留住人才、提高管理效率等利益。目前MUS採用的策略，可分?聯合分擔服務、合約服務、合併、聯盟、合約管理等。 近十幾年，台灣地區醫院不斷的擴建與新建，醫院間缺乏協調，預料醫院病床數將面臨過剩，且在地理上有分布不均，資源分布不均及重覆浪費之現象，?了醫院之生存以及民眾之需求，台灣未來的趨勢，將會更廣泛地運用MUS之策略。
  Multiple-unit Systems means that a variety of hospital systems operated by a single integrated management structure. All signs point to expansion and growth of hospital systems capable of balancing a need for strong central control with the needs and desires of local communities. The U.S. health care delivery system is part of a huge political arena. Congress, federal and state governments are demanding do more with less. Patients are saying they want more services at lower cost with quality and compassionate care. Hospitals today are not only service institutions, but also highly competitive organizations for physicians, patients and financial support. MUS offer contain advantages over autonomous hospitals. These primary advantages are (1) economy, (2) quality, (3) accessibility and (4) power. Hospital systems also offer specific advantages in terms of community accountability, responsiveness to consumers and comprehensive care programs. There are a variety of approaches being taken to regionalize and intergrate hospitals into systems. These new strategies are shared services, contract services, mergers, affiliations and contract management. In recent ten years, Autonomous hospital was built or expanded in Taiwan. The main problems, including hospital beds surplus, hospital beds maldistribute and a lack of coordination between providers, leading to overcapacity in some areas and duplication in others. As a result, hospitals in Taiwan will force for being systems in order to meet community needs and their survive. Now we can find some kind of hospital systems strategies in Taiwan. And we believe that the systems number will increase in a future.
• 8 - 14
• 10.6288/JNPHARC1987-07-01-02

• Link 原著 Original Article
• 台北市立醫院處理高血壓病人之醫師有關病人衛生教育的態度與行爲研究Attitude and Behavior Related to Patient Education among Physicians Who Manage Hypertensives at Taipei City Hospitals
• 李蘭、劉慧俐、紀雪雲、黃琪璘
  Lee-Lan Yen, Hui-Li Liu, Shang-Yun Jii, Chi-Lin Hueng
• 無
  Hypertension ; Compliance ; Patient Education
• 「不遵醫囑治療」是高而壓控制得不理想的主要原因之一。許多研究者指出，病人順從醫囑的行?常受到醫師的行?，以及種種醫師和病人之間的關係所影響。因此本研究之目的在瞭解醫師處理高血壓病人的情形，並進一步探討醫師有關病人衛生教育的態度和實行之間的關係。 台北市四所市立醫院內科和心臟血管科的61位實際處理高血壓病人之醫師被選?調查對象。主要結果如下：(1)醫師們各以不同的方法處理高血壓病人；(2)醫師們在診治時，從事病人衛生教育的比率不高；(3)醫師對病人衛生教育的態度愈正向，其從事病人衛生教育的比率也愈高；(4)影響醫師實施病人衛生教育的變項包括工作年數、態度、年齡、職位、服務醫院別等，其中以年齡和醫院別因素最顯著；(5)醫師們對於高血壓在職教育的主題，偏好「藥物治療」和「併發症的處理」，至於「衛生教育教材」和「行?治療」則興趣極低。 如何提高醫師對病人衛生教育的重視，並建立正確的看法和做法，是衛生教育專業人員應努力的方向之一。
  Noncompliance with the therapeutic regimen is one of the major factors responsible for the relatively low levels of high blood pressure control. A number of investigators have shown that compliance can be affected by physicians' behavior and by various aspects of the physician-patient relationship. Thus, the purposes of this study are to understand physicians' management of hypertension and to investigate the relationship between physicians' attituate toward patient education and their use of educational strategies in the management of hypertension. A survey was conducted to the physicians of Taipei City Hospitals. 61 physicians who are practicing Internal Medicine/Cardiovasology and have managed hypertensives were selected. Major results are following: (l) physicians manage hypertensives in different ways; (2) the proportion of physicians who are performing patient education is low; (3) the more positive the physicians’ attitude toward patient education, the higher rate the physicians' practice in patient education; (4) among the variables which affect physician' practice in patient education such as the years of working, attitude, age, position, and hospital, the most salient ones are age and hospital; (5) regarding physicians' interests in continuing education, ”drug treatment of hypertension” and ”complication of hypertension” are perceived to be the most interesting topices while ”patient education material” and ”behavioral treatment of hypertension” are perceived to be the least interesting topics. It is suggested that health education professionals should do their best to increase physicians' attention in patient education and to help them to estabilish approproate attitude toward patient education. Then, there is a great likelihood of performing patient education among those physicians
• 15 - 27
• 10.6288/JNPHARC1987-07-01-03

• Link 原著 Original Article
• 臺北市水環境中汞污染之調查研究An Investigation and Study on the Water Environmental Mercury Pollution in Taipei City
• 高思懷、許整備
  Sue-Huai Gau, Chen-Pei Hsu
• 無
  none
• 汞是一種有害的重金屬，它所造成的危害事件以日本曾發生的「水?病」最著名。環境中汞污染來源除了大家所熟知的?氯工廠以外，仍有少數其他的來源可能造成局部地區之污染。 本調查研究主要目的在於瞭解台北市區內的汞污染來源，以及水環境中目前之污染狀況，以?進一步控制與改善之基礎。 調查內容包括河川水質調查與污染標調查兩方面，其中污染源方面又分?下水道水質與底泥之分析，以及工廠、機關、學校、醫院、垃圾場等可能來源之廢水調查。 調查結果顯示：?河川水中含汞量多次測出超過河川水質標準(2 ppb)，底泥則多在自然底泥含汞量(200 ppb)以下；?下水道排水口水質多超過2ppb，但均未超過放流水標準(50 ppb)，底泥則多在10~400ppb之間；?醫院廢水均合放流水標準，但少數底泥含汞量較高；?機關廢水多合格，僅得一所超過標準很多；?學校廢水亦均合格，少數底泥含汞量偏高；??氯工廠廢水水質不穩，附近底泥含汞量最高測得29 ppm；?垃圾場滲出水含汞量均非常低；?烷基汞多可測出，顯示仍有相當之危險性。 另建議?應針對工廠以外事業廢水予以管制，並針對其造成污染者勸導改善；?含汞廢棄物於未來分類收集垃圾時予以考慮分類收集處理；?義芳化工廠之遷廠清理計劃應謹慎以防繼續污染。
  Mercury is a very toxic heavy metal. There are notorious health hazard events happened in Japan called ”Minamata Disease”. In addition to the notorious pollution source of alkali-chloro industry, there are some other sources which may cause local mercury pollution. The purpose of this research is to find out the sources of mercury pollution, and its effects in water environment, in order to provide the basic information for pollution control and improvement. This research contains river pollution investigation, and the pollution sources investigation such as sewer water and sediments, wastewater from industry, institutions, schools, hospitals and landfill sites. The conclusions are: 1. Mercury concentration in river water always exceeds water quality standard (2ppb), but the concentration in sediments are usually bellow natural concentration (200ppb). 2. Sewer effluent water usually exceeds 2ppb, however within effluent standard. (50ppb). Sediments are usually between l0-400ppb. 3. Hospital wastewater are all bellow the concentration of effluent standard, but a few of their sediments are slightly heigher. 4. The concentration in institutional wastewater effluents are usually low, however only one sample exceeds effluent standard. 5. School wastewater are all low, but a few of their sediments have relatively high mercury concentration. 6. Alkali-chloro wastewaters are varied from time to time. Sediments of receiving sewer was found having 29ppm of mercury. 7. Generally speaking, mercury in landfill leachates is quite low. 8. Alkyl mercury is usually detectable. sherefore, it is a high potential of health hazard. We suggest that: 1. Hospital, school and institutional wastewater should be properly regulated and improved. 2. In the future, whene spnarately garbage collection system is being operated, mercury contained wastes should be separately collected. 3. The cleaning plan of closed alkali-chloro factory must be carefully excuted, in order to prevent continuous pollution.
• 28 - 34
• 10.6288/JNPHARC1987-07-01-04

• Link 原著 Original Article
• 用面訪問卷測定行職業分類及暴露之準確度The Accuracy of Occupational Exposure Histories by Questionnaire Interviewers
• 黃品宏、王榮德、張蓓眞、陳淑娟、李莉君、黃秀英、楊瑜薇
  Ping-Hung Hwang, Jung-Der Wang, Pei-Jen Chang, Su-Juan Chen, Li-Jun Lee, Show-Ying Huang, Yu-Wei Yang
• 無
  none
• 本研究之目的是測定經由問卷面訪者所獲得之職業史，包括行職業分類和各項職業暴露之準確度。7,000位孕婦於產前檢查時經由三位專業面訪者，使用制式問卷面訪並記錄其行職業，以及工作環境中之數種暴露。我們由其中系統性隨機抽樣143人，除產前及產後辭職26人，電話改換及無法聯繫等30人，和其它原因無法訪得者15人外，共有72人由職業衛生專家完成現場訪視，以此專家所記錄之結果作標準來評估問卷之準確度時，結果行業分類項目大類相符合者之比率有96%，中類93%，小類86%，細類75%；職業分類項目大類相符合者93%，中類81%，小類79%。至於鉛、有機溶劑、塑膠、銲錫及汞暴露所得訪視記錄與原問卷甚?符合。由本研究我們發現經由面訪問卷調查孕婦之職業暴露時，有特定製造過程如銲錫者較易準確，未有特定製造過程且定義不清者如有機溶劑和塑膠易低估；而危害性大者如鉛者則易高估。此外經由問卷面訪者所得之行職業分類大致可以接受。
  The object of the study is to determine the accuracy of occupational histories, including exposures at the workplace, taken by standardized questionaire interviewers. Seven thousand pregnancy women were taken their occupational histories by three mutually standardized interviewers using structred questionnaires. Each woman was asked about her job titles and several specific exposures at her workplaces, including lead, mercury, organic solvents, plastics, and soldering operation. To verify the accuracy of our measurements, we have randomly selected 143 subjects out of 4340 working women for site visits. Because the site visit was performed several months after delivery, we found that 26 subjects had already resigned before or after delivery, 30 subjects either moved to other pl aces or changed their phone numbers and could not be located, 5 subjects with their factories closed, 6 subjects with factories which refused to be inspected although the main reasons are unrelated to occupational exposures, and there were 4 subjects whom we were unable to reach their workplaces, We have successfully determined the occupational titles and exposures on 72 subjects (50%). Using the assessment of an experienced occupational physician as the golden standard, we have found that the accuracy of interviewers were 9.6%, 3%, 86% and 75% for major division, division group, and item of international slassification of occupations, respectively. And job titles ere as accurate as 93%, 81%, and 79% for major division, division, and group of iternational classifications. The sensitivities of exposures to lead, organic solvents, plastics, soldesing and mercury were 100%, 67%, 0%, 100% and 0% respectively, while the specificities were all 100% except lead exposure, which was 98.6%. We conclude that occupational histories with a specific operation (e.g. soldering taken by interviewers were relatively accurate. Occupational exposures to well-known toxic metals such as lead tended to be over-reported by working women, while those of organic solvents and poorly-defined terms such as plastics tended to be underreported.
• 35 - 42
• 10.6288/JNPHARC1987-07-01-05

• Link 實務 Public Health Practice
• 衛生所群醫中心門診業務電腦化可行性之探討－以新屋群醫中心爲例The Effect of Computerization on Clinical Practice of Health Center-Evaluation and Verification
• 傳振宗、謝舜婉
  Chen-Chlng Fu, Swan Hsieh
• 無
  none
• 自民國75年6月，桃園縣新屋鄉衛生所的群醫中心開始推動門診業務電腦化，電腦軟體?配合群醫中心門診業務而設計，資料輸入主要?處方單主檔、藥品主檔、疾病名稱主檔和病人資料主檔，經由處方單主檔，電腦即可自動批價及列印公、勞、農保月報表，再經由疾病名稱主檔即可列印疾病分類統計表，醫護人員可立即掌握社區病人的疾病型態；若經由藥品主檔即可列印藥品庫存表，此表顯示進貨、出貨和庫存量是否短缺，提醒藥局人員及時進藥，使藥庫管理充分電腦化；此外，病人掛號證忘記帶或遺失時，可以根據姓名、身分證號碼、出生日期、家中電話號碼中的任何一項，經由病人資料主檔查詢，由於電腦處理許多費時費事的工作，所以電腦化前三個月花在門診業務時間，平均每天?10人時，電腦化以後兩個月，平均每天?6人時，故平均每天可以節省4人時，一年下來可節省1,200人時（以每月25個工作天計算）。 由於每個群醫中心業務多寡不一，並非每個群醫中心皆適合電腦化，最佳的方式是在門診人數每日超過80人的時候，由群醫中心約聘一人，專門負責將資料輸入電腦。
  In order to find whether the computerization of clinical practice of the health center will save us time, we'd chosen the Shin-Woo health center as our experimental clinic. The data entry included four parts: prescription, pharmacy, disease category and registration files. Through prescription' file, we could deal with the patient billing system including insurance claim processing. With the help of pharmacy file, we could manage the drugstore. Using the disease category file, we could analyse the distribution of patients by age, sex, race, or any other combination of variable. Comparisons were made, between the average manhours per day for a period of three months before computerization and the average manhours per day for a period of two months after computerization. The conclusions are follows: 1) The staffs of health center spent average 10 manhours per day before computerization, and spent average 6 manhours per day after computerization. This means 4 manhours was saved each day after computerization and the total went to 1200 manhours in one year. 2) Computer is helpful in managing drugstore, billing system, providing easy and quick information, Also it works very well in analysing the disease distribution. Furthermore, it contributes much in the follow up treatment of chronic disease patients. Whether the health center is fit for computerization depends on the patient loading. The best time is that the numbers of the patients exceed 80 per day.
• 43 - 55
• 10.6288/JNPHARC1987-07-01-06