探討影響醫師接受不同資訊溝通因子之相關因素

Abstract

在資訊不對稱的醫療產業中，控制醫療供給者的行為遠比控制醫療消費者就醫行為來得重要(郭信智 & 楊志良, 1994b)。學者指出要改變醫師行為必須透過資訊溝通的方式(Greco & Eisenberg, 1993; Lunberg, 1998)，因此本研究以「說服性溝通」為理論基礎，欲瞭解醫師對於不同形式之醫療資訊溝通的接受度，以作為後續改變醫師行為之參考。 故本研究之自變項為醫師所任職之醫院的權屬別、醫師是否擔任主管職、醫師的專業發展程度和醫師以病人為中心之自主性；依變項為醫師對不同資訊溝通形式接受的程度；控制變項為醫師之個人特性。 本研究之研究對象為全國地區級以上教學醫院之所有科別之醫師，研究工具為本研究者自行設計的結構式問卷，採用郵寄自填式問卷進行研究，總計發出7849份問卷，回收1304份有效問卷，有效問卷回收率為16.6%。 本研究以單因子變異數分析以及皮爾森相關性分析檢定自變項與依變項之相關性，並對檢定結果顯著之變項以Scheffe法進行事後比較；而在對於醫師對於不同資訊溝通因子的傾向程度則以卡方檢定分析其正、負傾向是否有達到顯著性差異。最後再以複迴歸分析，在控制醫師個人特性之後，對於假說進行驗證。 本研究主要發現有四： 一、國內醫師所接受的資訊溝通可分為五種不同形式：「自我提升因子」、「專業同儕因子」、「機構正式化因子」、「外部專業因子」和「病人相關因子」； 二、影響醫師接受資訊溝通因子的因素可分為「環境因子」和「接收者因子」； 三、「環境因子」包含「醫師所任職機構的權屬別」以及「所屬單位提供醫療資訊的頻率」； 四、「接收者因子」除了「醫師的個人特質（性別、年齡、科別、臨床年資）」外，還包含醫師「是否有擔任主管職」、「以病人為中心的自主性」以及「醫師專業發展程度」（醫師自行查閱醫學期刊論文的頻率、是否參加繼續教育課程、參加文獻討論會的頻率、是否於醫學期刊發表論文）。

Because of the information asymmetry, it is more important to control the behaviors of health care providers than receivers. In order to change physicians’ behaviors, using information communication is efficient(Greco & Eisenberg, 1993; Lunberg, 1998)The objection of this study is measuring physicians’ acceptance of different forms of medical communication based on Persuasive Communication. In this study, the researcher designed the questionnaire and mailed to all physicians who works in teaching hospitals in Taiwan. The total amounts of mailed questionnaires were 7849, out of which, 1304 were efficient, therefore the efficient rate is 16.6%. One way ANOVA and Pearson’s Correlation have been used to examine the correlation between dependent and independent variables. Chi-Square test has been used to exam the difference of intensions of physicians’ that are about different medical communication forms. In the end of this study, the researcher used Multiple Regression to exam the hypotheses.

The main findings of this study are: 1. The medical information that physicians can accept could be divided into five sources: Self-promotion, Professional peer, Formal orders of organization, External professional and Patient-related; 2. The factors associated with physicians’ acceptance of medical information are the environment and the receivers; 3. The environmental factor includes the types of hospitals which physicians work and the information of their apartment gave them;. 4. Except for physicians’ sex, age, speciality and clinical-working year, the factors of the receivers also include if the physician is also a manager, patient-centered autonomy and physicians’ professional promotion which including the rate of physicians read medical journals, attending to CME programs or journal meetings and publications on medical journals.