"醫院牙科部門人力,教學訓練,行政管理,醫療照護之探討-以2008年台灣地區(實地訪查)調查為例"

Abstract

在台灣，醫院牙科部門在牙醫生態扮演極為重要的角色。為了解目前台灣地區醫院 牙科部門在牙醫師人力、輔助人力、牙科行政管理、牙科臨床醫療及牙科教學訓練之現況，於2007-2008年進行全國醫院牙科部門之問卷調查及實地訪查研究，以期能對提昇醫院牙科部門有所助益，並帶動整體口腔醫療照護品質。 2007-2008年針對全國165家醫院設有牙科部門進行基本資料表及自評表調查及實 地訪查，共計134家醫院牙科寄回自評表，實地訪查102家，實地訪查之總執行率為62.0%。在基本資料調查表及自評表中，並研擬94項的訪查標準，涵蓋牙科行政管理30項、牙科臨床醫療36項、牙科教育訓練28項。問卷之評量機制是採用五項次評量(A-E代表達成度)，若不適用，則以NA(Not Applicable)表示。A：完全達成，B：一般水準以上，C：一般水準，D：一般水準以下，E：不適當。 2008年，在醫院牙科部門工作的牙醫師有1,421位，佔全國牙醫師總數(9,672位) 的13%。在此1,421位牙醫師中，牙科專任主治醫師共675位，專任住院醫師647位。。全國675位專任主治醫師具有專科醫師認定者為510位佔75.6%，具有部定教職者為272位佔(40.3%)。牙科實習醫師全部人數為382位，大部分集中在醫學中心342位(89.5%)。牙科助理人力總數為888位，有護理師/士執業執照者338位，以醫學中心聘用200位最多。但未具有護理師/士之執業執照而執行牙科門診助理550位。醫院牙科之牙醫師人力資源一半以上集中在北部地區。在牙科行政管理方面，大部份醫學中心為A(48%)、區域醫院為B(43%)、地區醫院為C(60%)，全部醫院平均為B(37%)。100%醫學中心，95%區域醫院，和88%地區醫院評分都在C(平均水準)以上。在牙科臨床醫療方面，大部份醫學中心為A(54%)、區域醫院為B(45%)、地區醫院為C(55%)，全部醫院平均為B(35%)。99%醫學中心，88%區域醫院，和76%地區醫院評分都在C(平均水準)以上。在教學訓練方面，大部份醫學中心為A(66%)、區域醫院為C(38%)、地區醫院為C(51%)。100%醫學中心，95%區域醫院，和88%地區醫院評分都在C(平均水準)以上。 醫院牙科部門各層級之人力資源以醫學中心最優，其次為區域醫院、地區醫院。與 2002年比較，2008年醫院牙科部門在醫師人力、輔助人力方面均略有成長。在整體牙科行政管理、臨床醫療、教學訓練方面，均為醫學中心優於區域醫院，區域醫院優於地區醫院。醫學中心提供了很好的牙科行政管理、臨床醫療、及教學訓練。雖然目前國內牙醫生態，13%在醫院牙科部門服務，但是基於醫院牙科有教學及服務功能，所以有必要挹注資源在以教學為本質的醫院牙科。醫院牙科部門應納入教學醫院評鑑，未來更應納入醫院評鑑，以提昇整體牙科醫療之醫療品質。本研究所研擬的訪查標準，反映出目前醫院牙科部門牙科行政管理、臨床醫療、及教學訓練的現況，可以作為未來擬定醫院牙科部門評鑑基準之參考。

In Taiwan, dental departments in hospitals plays an important role in dentistry. Questionnaires as well as filed survey were conducted to understand the situation of dental departments in hospitals in 2007 and 2008 in Taiwan. During the period from 2007 through 2008, questionnaires about dental administration, clinical dental practice, dental education, dental manpower and dental facilities were mailed to the dental departments of 165 hospitals located around Taiwan and 134 of which completed the questionnaire and mailed it back. The field survey was also carried out by visiting hospitals to collect and gather information at the local level. There were 102 hospitals within the 134 hospitals accepted the field survey and the rate of which was 62.0%. In 2008, the number of dentists working in the hospitals was 1421 and it was approximately 13% of the number of total dentists in Taiwan (9672). Within the 1421 dentists, 675 dentists were attending staffs and 745 dentists were training residents. Within the 675 attending dentists, 510 (75.6%) had dental specialist certificates and 272 (40.3%) had teaching positions in dental schools. Besides, there were 382 dental interns (the 6th year undergraduate students) taking the training programs in hospitals, most of them were trained in medical centers (342 of 382, 89.5%). Moreover, there were 888 dental assistants, 338 of which were nurses and the other 550 were hospital self-trained personnel. For overall dental administrative management, most(48%) medical centers received an A, most (43%) regional hospitals received a B, and most (60%) district hospitals received a C. The overall average was B (37%). The percentages above C were 100% of medical centers, 95% of regional hospitals, and 88% of district hospitals. For total clinical dental care, most (54%) medical centers received an A, most (45%) regional hospitals received a B, most (55%) district hospitals received a C. The overall average was B(35%). The percentage above C were 99% of medical centers, 88% of regional hospitals, and 76% of district hospitals. For overall dental teaching and training, most (66%) medical centers received an A, most (38%) regional hospitals received a C, and most (51%) district hospitals received a C. Percentages above C were 100% of medical centers, 95% of regional hospitals, and 88% of district hospitals. Comparing the dental manpower of different types of hospitals in Taiwan, medical center was the best, regional hospital was the next and district hospital was the last. While contrasting 2008 with 2002, the numbers of both dentists and auxiliary personnel in Taiwan’s hospitals increased with years. For overall dental administration management, clinical care, teaching and training, medical centers were superior to regional hospitals which were superior to district hospitals. Medical centers provide satisfactory quality dental teaching and training, clinical care, and administration management. Although there were still only 13% dentists working in the hospital, the hospital dentistry is still responsible for teaching and research which is vital for the cultivation and development of young dentists. The criteria we used reflected the current status of administration management, clicical care, teaching and training in hospital dental departments. In order to elevate their overall quality, we suggest that dental departments be included in teaching hospital accreditation, and hospital accreditation. The criteria we used can be taken as references for the dental department accreditation in hospitals of Taiwan.