臺北市醫師對現行推動居家醫療照護計畫之意見調查
Authors: 陳澤元 陳澤元 , 施至遠 施至遠 , 曾家琳 曾家琳 , Chia-Lin Tseng 洪德仁 , 邱泰源 邱泰源 , Tai-Yuan Chiu 詹其峰 
Published: December 2024

<p>目的：高齡社會時代的來臨，居家醫療照護服務需求增加，然而目前醫師參與居家醫療照護比例仍偏低，因此本研究希望能透過問卷調查，協助瞭解台北市醫師對於推動居家照護相關計畫的實務運作與障礙。</p>
<p>方法：本研究為無記名結構式問卷調查，於2022年8月至2022年10月之間進行，針對執業登記會籍為臺北市醫師之意見調查，內容包括：基本資料、參加居家醫療照護整合計畫與居家失能個案家庭醫師照護方案現況與障礙誘因等，問卷經專家效度檢視修正後以電子式表單請醫師回答。針對醫師參與居家照護相關計畫（居家醫療照護整合計畫、居家失能個案家庭醫師照護方案）進行單變量分析與多元邏輯斯迴歸分析。</p>
<p>結果：本研究共計回收410份，發現到門診數較少的醫師，較願意參與居家醫療照護整合計畫，女性醫師較願意參與居家失能個案家庭醫師照護方案；而越瞭解計畫/方案內容的醫師，越願意參與居家醫療照護整合計畫、居家失能個案家庭醫師照護方案。醫師對於推動居家醫療照護整合計畫之障礙前三名依序為提供24小時電話諮詢服務有困難(76%)、往返案家交通耗時(75%)、給付不足(74%)；而居家失能個案家庭醫師照護方案前三名影響的因素為往返案家交通耗時(71%)、給付不足(69%)、個管師人力不易安排(69%)。</p>
<p>結論：對台北市醫師參與居家醫療照護整合計畫、居家失能個案家庭醫師照護方案之政策建議，包括給付需考量向上調整並納入交通成本與提供24小時緊急電話諮詢服務，以及建立更有效率之個案媒合溝通機制。</p>
<p>&nbsp;</p><p>Purpose: With the advent of an aging society, the demand for home medical care services in Taiwan has increased. However, the current participation rate of physicians in home medical care remains low. The study accordingly conducted a questionnaire survey to help understand the operational challenges and barriers facing physicians in Taipei regarding the promotion of home healthcare programs. </p>
<p> Methods: This study as an anonymous structured questionnaire survey was conducted between August 2022 and October 2022 to solicit the opinions of physicians registered for practice in Taipei City. The questionnaire covers basic information, participation in home medical care integration programs, the current status, and challenges and incentives of home care for disabled cases by family physicians. After expert validity review and revisions, the questionnaire was administered to physicians through in an electronic form. Univariate and linear regression analyses were performed on the results obtained from physicians participating in home healthcare programs (home medical care integration program, home care for disabled cases by family doctors). </p>
<p> Results: According to the 410 responses collected, physicians with less clinic sessions are more willing to participate in home medical care integration programs, and female physicians tend to be more willing to participate in home care for disabled cases by family physicians. Physicians equipped with a better understanding of the programs are also more willing to participate. The top three obstacles for physicians to promote home medical care integration programs were respectively difficulty in providing 24-hour telephone consultation services, time-consuming transportation, and insufficient reimbursement. For home care for disabled cases by family physicians, the top three challenges were time-consuming travel to patients at home, insufficient reimbursement, and difficulty in arranging case managers. </p>
<p>Conclusion: To promote the participation of Taipei physicians in home medical care integration program and home care for disabled cases by family physicians, the study recommends the following three measures: increasing the reimbursement considering transportation costs, providing 24-hour emergency telephone consultation services, and establishing a more efficient communication mechanism for case matching.</p>
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