以質性研究探討基層醫師對家庭醫師整合性照護試辦計畫之看法及執行現況

Abstract

本研究主要是針對基層醫師對於家庭醫師試辦計畫的看法及執行現況作一質性訪談分析，目的在收集基層醫師們對該制度的看法、參與過程的經驗等相關資訊，期望能對現今實施的家庭醫師整合性照護試辦計畫有所建議，讓家庭醫師整合性照護試辦計畫能更完善且更貼近民眾的需求 本研究係針對台灣地區參與家庭醫師試辦計畫制度的31位基層醫師作質性的深入訪談，在研究的訪談資料分析上，則使用德國人研發、撰寫的質性研究資料分析電腦輔助軟體1998年版－WinMAX（WinMAX 98 Pro）作為分析的工具。 研究結果發現接受訪談的醫師多數都是由健保局得知家庭醫師試辦計畫的消息，而且多數是在認同家醫制度之下加入試辦計畫。 在籌備階段，醫療群夥伴的選擇大多是熟悉且交情不錯的，而在選擇合作醫院時則是以交情為主要的依據。 基層醫師在執行計畫的初期，通常會遇到資訊上、尋找家戶及行政作業上的困難，而家戶的找尋都多是以熟悉的老病人為主，再加上共同照護門診幾乎都只是自己的病人過去看，因此不會太擔心因轉診被合作醫院搶走。基層醫師會因為加入醫療群而建立一個獲得資訊平台，對於醫院提供的教育訓練，基層醫師希望在時間上及內容上有些改善。 多數的醫師都表示，在加入試辦計畫後，對醫療新知的獲得有進步，和衛生機關的交流、溝通也比較順暢，但是對於是否會對老人照護或以病人為中心的醫療更有幫助，醫師們多抱持著保留並心懷期待的態度。 最後基層醫師建議，組群時要找志同道合的醫師且發展各群的特色，並且與合作醫院建立互相配合、互助互贏的機制，此外健保局要多多向民眾宣傳家醫制度並提供民眾、醫療群和合作醫院三方面更多的利多和誘因，更能夠讓總額制度、卓越計畫和家醫制度能夠互相相輔相成，那麼在合理的評核制度下，家醫制度將能更上軌道。 根據研究結果，本研究建議：（1）衛生當局：應該主動向民眾推廣及介紹家庭醫師試辦計畫，並提供適當的誘因給予民眾與醫院。（2）基層醫師：應該拋開對經濟因素的考量，以病人為中心、以家戶為單位、以社區為背景來提供最適合的健康照護服務，那麼將會更海闊天空，並從新得到社區民眾的尊重與愛戴。（3）合作醫院：醫院應該著重垂直的整合，放開心胸與基層醫師真誠的合作、互助，讓家庭醫師制度更落實，轉診制度更確實。（4）未來研究者：利用更完整、更具代表性的抽樣方式來進行研究，並且以質、量並進且互補的方式進行，或是在本研究的基礎上繼續發展量性之研究。

This study is a qualitative analysis for primary physicians’ opinions and implementation of Family Physician System in Taiwan. The objectives of this study collect opinions of primary physicians and implementation of Family Physician System. This study interviewed 31 primary physicians that join in Taiwan Family Physician System. The study of tool is WinMAX (WinMAX 98 pro) that is used to qualitative analysis. The results of this study are as follow: 1)Plan: In my study, the major primary physicians got information of Family Physician System from Bureau of National Health Insurance（NHI）. They agreed to Family Physician System and joined it .The cause of primary physicians choose partners and hospitals is friendship. 2) Implement: The major primary physicians were beset by information system, seeking patient and administrative work. They established channels to get infortmention after joining Family Physician System. 3) Effect: The major primary physicians feel getting medical infortmention easier and communicate with NHI better after joining Family Physician.System. But they express conservative attitude which Family Physician System works for patient-centered and geriatric care. 4) Primary physicians’ suggestion: Primary physicians should seek more suitable partner and develop characteristic. Hospitals should cooperate with primary physicians sincerely. NHI should propagandize Family Physician System to patient frequently. The suggestions of this study are as follow: 1) NHI: NHI should propagandize Family Physician System to patient frequently and supply more suitable incentives to patients and primary physicians. 2) Primary physicians: Primary physicians should concern patient-centered care instand of financial incentives. 3) Hospitals: Hospitals should cooperate with primary physicians sincerely and implement Family Physician System. 4) Future research: Future researcher should use representative sampling method, and qualitative and quantity study at the same time.