病人(或照護者)和醫師對醫師到宅看診的接受度 －以臺北市某社區醫療群為例

Abstract

目的: 隨著人口老化，有越來越多的行動不便的老人無法出外就醫而需要醫師到宅提供看診服務。因此本篇研究的目的主要是想瞭解病人（或照護者）和醫師對於醫師到宅看診的接受度。 方法: 透過一醫師到宅看診的先驅性服務模式，針對其模式內使用過3次以上的民眾，利用結構式與開放式的問題，透過面對面的訪談，進行滿意度調查。在醫師方面，由於醫師人數較少，因此對醫師進行個別的深入訪談，以瞭解醫師們對於整個過程的看法、期待及對於這種服務模式的接受度。 結果: 病人及其照護者反應良好，普遍認為對病人的健康狀況有所幫助，至少可以減輕家屬的心理負擔，不必擔心是否有未知疾病是他們沒有發現的。此外，也由於醫師到宅服務的可近性與彈性，為病人及其家屬節省了許多的時間與人力成本。而醫師方面多認為進入病人的家中，可以獲得更多病人的資訊，是醫師在診所看診時難以發現的，有了這些資訊，更能為病人提供全方位的照護。在診療過程中，也建立了更好的醫病關係。相對的，醫師們認為對於急迫性需求的醫療照護，應有相關的配套措施。社區醫師背後應有醫院的支援，以增加照護的連續性，與完整性。 結論: 隨著需求的增加，政府應建立一完整的醫師到宅看診模式，以符合民眾的需求與期待。而醫師方面，建議應該要加強老人醫學與慢性病照護方面的知識，增加醫師全人照護的能力，增強醫師的溝通技巧與信心。建議社區醫療群醫師和合作醫院之間要建立良好的合作關係，形成一個醫療工作團隊，合作醫院要協助醫師處理行政工作，提供醫師合理的報酬。支付的費用在初期應以政府公務預算支付，待在模式成熟後，再討論如何與健保接軌。

Purpose: As the population ages, more and more elderly with functional disabilities are requiring physician house call visit. The purpose of this research is to evaluate the acceptance of the patients (or caregivers) and physicians toward physician house call service. Methods: Data were collected from patients and physicians who participated in a pilot house call program in Taipei. Face-to-face interviews were conducted with patients who had used the service at least 3 times. Both structural and open-ended questions were used in the survey. In-depth interviews were conducted with participating physicians regarding their views, expectations, and acceptance towards the physician house call program. Results: Both physicians and patients reported high level of acceptance toward the program. Patients and caregivers felt that house calls have positive effects in improving the physical health of patients and in relieving caregiver stress. They also felt that house call can help identify health problems before it becomes a serious concern. Other positive feedbacks including saving in time and traveling, high accessibility to services, and flexibility in scheduling were also reported by caregivers. Physicians felt that seeing the patients in their own homes can provide additional information that is useful in treating the patients. It also has positive effects in building physician-patient relationship. However, supporting mechanisms need to be established between physicians and local hospitals to deal with emergency situations and to provide an integrative and comprehensive care. Conclusion: As the demand for physician house call increases, the government should take initiatives in developing an appropriate delivery model that meets the need and expectation of the patients. Physicians should increase their training in geriatric medicine, chronic care, and communication skills. The research suggests that the community physicians should collaborate with local hospitals to ensure the continuity of care. The local hospitals should coordinate the care, pay the physicians, and conduct related administrative tasks. It is recommended that physicians can be paid through a government funding allocated specifically for such purpose until it can be integrated into the reimbursement of scheme of the National Health Insurance.