Epilepsy and Health Care Utilization among People with Intellectual Disability

智能障礙者合併癲癇及醫療利用之分析

10.30072/JDR.200307.0006

林金定(Jin-Ding Lin)；嚴嘉楓(Chia-Feng Yen)；李志偉(Chi-Wei Li)；吳佳玲(Jia-Ling Wu)；卓妙如(Miao-Ru Chwo)；羅慶徽(Ching-Hui Loh)；賴朝英(Chao-Yi Lai)

可近性 ； 智能障礙 ； 癲癇 ； 醫療照護利用 ； accessibility ； epilepsy ； health care utilization ； intellectual disability

身心障礙研究季刊

1卷1期（2003 / 07 / 01）

65 - 77

英文

儘管許多研究顯示智能障礙者合併癲癇患者的醫療照護體系存在許多問題，但極少有全國性的資料對此課題深入研究，本研究之主要目的乃在於調查台灣地區智障者之癲癇盛行率以及其主要的健康狀況與醫療利用情形。研究樣本以內政部民國89年12月底領有身心障礙手冊之智能障礙者為研究母群，經過分層系統抽樣，以郵寄問卷進行資料收集，共收回1071份結構式問卷為分析樣本。研究發現，智障者合併癲癇之盛行率為13.2%，智障者年齡與性別與癲癇盛行率有關，合併癲癇之智障者健康狀況較差，醫療利用率較高，定期服藥的比率也較沒有癲癇合併症之智障者高。癲癇是智障者常見的疾病之一，它造成不良的健康狀況與較高的醫療利用率，為了維持智障者良好的醫療照護品質，未來的研究必須著重於智障者抗癲癇藥物治療副作用之監測，醫療利用之可近性與可用性、預後及生活品質之改善分析等。

Background Although many studies have emphasized inadequacies in the provision of health care for people with intellectual disability (ID) accompanied by epilepsy, few studies have involved in a national survey of these people in order to determine levels of health care utilization in the ID population. This study was conducted to estimate the prevalence of people with ID accompanied by epilepsy and their health care utilization in the community, and in particular, their health status and use of primary health care services. Method A sample from the National Disability Registration Database, Taiwan, classified by administrative geographical area, was systemically selected for the study. Statistical analysis of 1071 respondents was made to determine the health status and health care utilization for people in Taiwan with ID accompanied by epilepsy. Results Findings showed a prevalence of 13.2% of individuals with ID who also have epilepsy. Age and disability level were associated with the prevalence of epilepsy. Those people with ID accompanied by epilepsy were reported to be unhealthier and to use health care services more frequently. They were also likely to take medicine more regularly (81.2% of cases) than those ID without epilepsy (25.9%). Conclusions Epilepsy is a prevalent morbidity among people with ID, and it causes these people ill health and high health care utilization. To maintain the quality of health care for people with ID, future research should examine the effects of anti-seizure drugs among people with ID plus epilepsy, along with their health care accessibility and availability, as well as health outcomes and changes in quality of life.

1. Department of Health (DOH)
2. (2001).World Health Organization The Global Campaign Against Epilepsy. eneva, WHO 2000 (Information Pack for the launch of the Global Campaign`s Second Phase,12-13.
3. Beange H.(1995).Medical disorders in adults with mental retardation: a population study.American Journal on Mental Retardation,99,595-604.
4. Bowley C.,Kerr M.(2000).Epilepsy and intellectual disability.Journal Intellectual Disability Research,44,529-543.
5. Brodie M.J.,French J.A.(2002).Management of epilepsy in adolescents and adults.Lancet,356,323-329.
6. Christianson A.L.,Zwane M.E.,Manga P.,Rosen E.,Venter A.,Downs D.,Kromberg J.G.R.(2002).Children with intellectual disability in rural South Africa: prevalence and associated disability.Journal Intellectual Disability Reaearch,46,179-186.
7. Deb S.(2000).Epidemiology and treatment of epilepsy in patients who are mentally retarded.CNS Drugs,13,117-128.
8. Department of Health (DOH)(1997).Public Health in Taiwan R.O.C., The Executive Yuan, Republic of China,48
9. French J.(1994).The long-term therapeutic management of epilepsy.Annals of Internal Medicine,120,411-422.
10. Goulden K.L.,Shinnar S.,Koller H.,Katz M.,Richardson S.A.(1991).Epilepsy in children with mental retardation: a cohort study.Epilepsia,32,690-697.
11. Hannah J.A.,Brodie M.J.(1998).Epilepsy and coming disabilities-a challenge for the next millennium.Seizure,7,3-13.
12. Heange H.(1996).Caring fore vulnerable population.Medical Journal Australia,164,159-160.
13. Lin J.D.,Wu J.L.,Li C.W.,Yen C.F.,Lai C.Y.(2001).Health care policy development for persons with intellectual disability in Taiwan.Research Report (DOH-90-TD-1153) of Department of Health, Taiwan, Republic of China,66
14. Lin, J.D.,Wu J.L.,Lee P.N.(2003).Health care needs of persons with intellectual disability to institutions in Taiwan: outpatient care utilization and implications.Journal Intellectual Disability Research,47,169-180.
15. McGrother C.W.(1996).Hauck A, Bhaumik S, Thorp C, Tomb N. Community care for adults with learning disability and their corers: nerds and outcomes from the Leicestershire register.Journal Intellectual Disability Research,40,183-190.
16. Minihan P.M.(1986).Planning for community physician services prior to deinstitutionalization of mentally retarded persons.American Journal Public Health,76,1202-1206.
17. Ministry of the Interior The Disabled Living Survey(2002).Health Care Services. Bureau of Statistics, Ministry of the Interior, Taiwan, Republic of China,11
18. Rubin I.L.(1987).Health care needs of adults with mental retardation.Mental Retardation,25,201-206.
19. Santosh P.J.,Baird G.(1999).Psychopharmacotherapy in children and adults with intellectual disability.Lancet,354,231-240.
20. Scott R.,Lhatoo S.D.,Sander J.W.(2001).The treatment of epilepsy in developing countries: where do we go from here.Bulletin of WHO,79,344-351.
21. Ziring P.R.,Kastner T.,Friedman D.L.(1988).Provision of health care for persons with developmental disabilities living in the community.The Journal of American Medical Association,260,1439-1444.

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2. 曾郁雯、徐尚為、江博煌(2011)。智能障礙者合併癲癇就醫之醫療資源耗用情形。身心障礙研究，9(2)，72-83。
3. 嚴嘉楓、林金定(2009)。智能障礙者女性月經來潮歷程探索：以智能障礙者女性與其主要照顧者之視觀分析。身心障礙研究，7(3)，156-181。
4. 嚴嘉楓、羅慶徽、徐尚為、唐紀絜、林金定、卓妙如、吳佳玲(2006)。機構內智能障礙者合併特殊疾病之健康管理制度分析。身心障礙研究，4(1)，1-17。
5. 嚴嘉楓、羅元婷、蔡艶清、張書菱、林金定、吳佳玲(2004)。健康促進：身心障礙福利機構健康管理新策略。身心障礙研究，2(1)，1-13。
6. (2009)。國小學童對智能障礙者之認知、態度與接觸經驗初探。身心障礙研究，7(1)，64-79。