精神科醫師遠距醫療之使用意圖：調查研究

Abstract

研究背景與目的：近年來醫療科技日新月異，各國逐漸發展遠距醫療，且因應嚴重特殊傳染性肺炎疫情，讓這種利用虛擬通訊的就診方式受到世界各國的重視。遠距心理健康（Tele-mental health）是利用遠距醫療，提供遠程心理健康評估和治療的方法；而精神科遠距醫療（Tele-psychiatry）則是在精神科的評估和治療中使用通訊模式進行。世界各地已有多國使用遠距方式來評估和治療精神疾病患者，以改善精神醫療照護的可近性；然而我國對於遠距醫療之相關研究著重在服務接收端，較少針對醫療服務提供者之研究，特別是在精神科方面更為缺乏。因此，本研究針對精神科醫療服務提供者探討其對於遠距醫療的使用意圖，以計畫行為理論模式結合整合科技接受模型為基礎，探討精神科醫師對於使用遠距醫療之態度、主觀規範、感知行為控制、績效期望、促進條件與使用意圖間的關係。 研究方法：本研究採橫斷性（Cross-Sectional Study）研究，以自填結構式問卷調查法蒐集資料，並以便利取樣方式招募受訪者，研究對象納入臺灣精神科專科醫師（含精神科住院醫師），並與臺灣精神醫學會及全國醫療院所合作收案，以紙本及網路問卷方式招募受訪者。本研究利用獨立樣本T檢定、單因子變異數分析及線性迴歸分析探討態度、主觀規範、感知行為控制、績效期望及促進條件與精神科遠距醫療使用意圖之關係。 研究結果：本研究共回收152份精神科醫師回覆之有效問卷，結果顯示65.79%的精神科醫師在COVID-19疫情期間有使用過精神科遠距醫療的經驗，其中61.76%有使用經驗的醫師願意在疫情結束後繼續使用精神科遠距醫療；疫情期間遠距醫療資訊平臺使用上以Line最多。鑑於精神醫療的獨特性，實施精神科遠距醫療的最大阻礙為急性有自殺風險的病人，遠距醫療需要搭配合適的輔助、緊急轉介機制（82.2%）。在控制精神科醫師人口學特質及執業特性後，發現精神科醫師對精神科遠距醫療的態度越好，使用意圖越高（p=0.002）；當精神科醫師的主觀規範支持者對精神科遠距醫療的支持程度越高時，其使用意圖越高（p<0.001）；對感知行為控制程度越高時，精神科遠距醫療使用意圖越高（p=0.029）；對績效期望程度越高，精神科遠距醫療使用意圖越高（p<0.001）。 結論：精神科醫師的態度、主觀規範支持程度、感知行為控制程度及績效期望的認知程度為精神科遠距醫療使用意圖的正向影響因素，本研究建議，政策制定者在訂定遠距醫療相關法規及健保給付政策時應不斷求新，並制定遠距醫療相關指引，將醫療系統建置、資訊技術設備以及完善的配套措施納入政策制定的考量因素，並依據精神科臨床服務之特性給予適當的誘因及績效獎勵機制，以提升遠距醫療服務之效益，建構完善的醫療照護體系。

Background & Purpose: In recent years, due to rapid advancements in medical technology, many countries have been developing and applying telemedicine in clinical fields. In response to COVID-19, use of virtual communication in medical consultation has attracted attention worldwide. Tele mental health is defined as to provide remote mental health assessment and treatment through telemedicine, whereas Telepsychiatry is defined as psychiatric evaluations and treatments via telecommunication. Many nations around the globe are already applying telemedicine to evaluate and treat people with mental illnesses and to improve health care accessibility. Prior research in Telemedicine or Tele-psychiatry use in Taiwan mainly focused on consumers or patients, with only few focused on healthcare providers. This study investigates intention to use telemedicine among psychiatrists based on combined theory of planned behavior and unified theory of acceptance and use of technology（UTAUT）, aming to understand the relationship between psychiatrists’ attitudes, subjective norm, perceived behavioral control, performance expectations, facilitating conditions, and their intention to use telemedicine. Methods: This study conducts a cross-sectional study among psychiatrists in Taiwan by collecting data with a structured questionnaire and recruiting respondents through convenience sampling. Study population are Psychiatrists（including resident physicians）in Taiwan. This research collaborates with the Taiwanese Society of Psychiatry, Taiwan Medical Association, and community psychiatric clinics in different geographical areas to recruit participants. Data is analyzed using independent sample t-test, one-way ANOVA as well as linear regression model to investigate the relationship between psychiatrists’ attitudes, subjective norm, perceived behavioral control, performance expectations, facilitating conditions and their intention to use telepsychiatry. Result: The study successfully recuited 152 psychiatrists as study participants. Results indicate that 65.79% of the respondents utilized Telepsychiatry during the COVID-19 pandemic; among them, 61.76% were willing to continue to do so after the pandemic. During the pandemic, LINE was the most frequently used platform in Telepsychiatry. Due to the unique nature of Psychiatry, psychiatrists believe that the greatest obstacle to implementing Telepsychiatry is that “Patients at acute suicide risk, appropriate assistance complementing Telepsychiatry required and existing emergency referral mechanism.”（82.2%） After controlling for demographic and practice characteristics, this study found that the more positive attitudes towards Telepsychiatry, stronger their intention to use（p=0.002）; greater psychiatrists’ subjective norm supports Telepsychiatry, stronger their intention to use （p<0.001）; greater psychiatrists’ perceived behavioral control, stronger their usage intention of Telepsychiatry（p=0.029）; higher the performance expectancy, stronger psychiatrists’ usage intention of Telepsychiatry（p<0.001）are all significantly associated with stronger intention to use telemedicine among psychiatrists. Conclusion: Psychiatrists’ attitudes, support of subjective norm, perceived behavioral control as well as perception of performance expectation are positive factors associated with intention to use telemedicine among psychiatrists. The study suggests that policy makers should constantly reinnovate on telemedicine as well as health insurance reimbursement policies. Factors for consideration such as establishing guidelines on telemedicine, constructing healthcare system, procuring information technology equipment and developing adequate contingencies should be included. In addition, appropriate incentives in reimbursement and value-based strageties（such as pay for performance plans）would encourage psychiatrists to adopt telemedicinehealth care model and therefore to improve effectiveness of health care delivery system.