病患積極度與照護協調性之相關性探討：以門診的醫病互動為例

Abstract

研究背景：照護協調性被認為是照護結果的重要影響因素之一，台灣民眾普遍缺乏主責醫師，而且在就醫高度自由的情況下常有逛醫師的現象產生，面對席捲而來的慢性照護時代，提升病患的照護協調性已成為一個重要的議題，而民眾是否主動積極的為自己的健康負責，也是值得探討的重點之一。 研究目的：瞭解影響病患積極度的相關因素，並著重探討病患積極度與照護協調性之間是否呈現正相關的關係，倘若可與期望之結果（研究假說）一致，那麼台灣未來不只是仰賴於衛生主管機針對醫療服務供給者的管理作為，並可藉由病患積極度的提升做為照護協調性的改革方案之一。 研究方法：分析2018年台大公衛學院「病人就醫經驗調查」所完成的問卷資料， 該調查為一全國性的面訪問卷調查，研究對象為過去12個月內曾有過西醫就診經驗之60歲以上民眾(N=2144)。統計方法則透過多階層線性迴歸、多階層羅吉斯迴歸來檢視研究中各變項間之相關性，主要研究變項包括慢性病個數、習慣照護醫師、病患積極度、照護協調性及片段式醫療的經驗。 研究結果：經由多階層回歸模型分析後顯示，在病患積極度方面，顯著的影響因素為病患是否擁有習慣照護醫師(β=−0.3624, p=0.0186)，而慢性病個數與病患積極度則呈現無顯著的相關性。另外，研究發現病患積極度與照護協調性之間有顯著的正相關性(β=0.1899, p<0.0001)，而病患積極度與其接受到片段式醫療服務的經驗則未呈現顯著相關(OR=0.9690, p=0.3357)。 結論：本研究發現病患積極度與照護協調性有顯著的正相關，衛生主管單位除了可以針對照護提供流程提高協調性，也可以針對個別病患提升其自我照護的積極度，對於照護結果都能有所助益。

Background: Coordination of care has been reported to be associated with health outcomes. People in Taiwan generally lack a primary care physician and they are free to choose preferred physicians for each visit, and potential doctor-shopping often occurs. In a fast aging society with increasing prevalence of chronic conditions, improving care coordination has become an important issue. Meanwhile, patients’ activation in managing their own health is also worth discussing. Objectives: To examine the relevant factors that affect patient activation and to assess whether there is a positive correlation between patient activation and care coordination. If the association can be observed (research hypothesis), Taiwan can improve care coordination not only through the regulation programs of health authorities on health care providers but also by improving patients’ activation. Methods: An analysis of the survey data obtained from the “Patient Health Care Experience Survey” completed by the College of Public Health at National Taiwan University in 2018 which is a nationwide face-to-face interview survey. The research subjects are people 60-years old or older who have visited a doctor of western medicine in the past 12 months (N =2144). Multi-level linear regression and multi-level logistic regression were conducted to examine the effects of associated factors for patient activation and scores of care coordination. The major research variables are the number of chronic diseases, usual care provider, patient activation, care coordination and the occurrence of fragmented care. Results: The multi-level regression models show that having usual care provider is significantly associated with patient activation (β=−0.3624, p=0.0186), and the number of chronic diseases is not associated with patient activation. In addition, patient activation is significantly associated with care coordination (β =0.1899, p <0.0001), but it is not associated with the occurrence of fragmented care (OR=0.9690, p=0.3357). Conclusion: This study finds that there is a significant positive correlation between patient activation and care coordination. Health authorities can improve care coordination for better health outcome, it can also be achieved by enhancing patients’ activation in self-management for their health conditions.