有無習慣就醫地點／醫師與照護連續性及協調性的相關性

Abstract

背景：台灣正面臨片段式醫療的問題，甚至有重複用藥、重複檢查的現象，不僅影響患者的照護結果，也徒耗醫療資源，卻沒有完整的初級照護制度與轉診制度來提升照護連續性與協調性，因此台灣急需找到一項適合的替代方案。 目的：瞭解台灣民眾是否有其習慣就醫地點或醫師，以及這些民眾的特性，並探討有無習慣就醫地點、醫師，與照護連續性及協調性之間的關係，以瞭解在沒有完善初級照護制度及轉診制度的情況下，是否有可能透過習慣就醫地點或醫師改善照護連續性及協調性。 研究方法：本研究為橫斷性研究。所使用的次級資料為隨機抽樣全國60歲以上、具有本國國籍且設有戶籍的民眾，透過專業訪員進行結構式面訪，瞭解民眾對於照護連續性與協調性的自覺感受，共得有效問卷2143份。本研究再依研究目的進行分析。 研究結果：本研究發現，台灣60歲以上人口有高達88.24％的民眾有習慣就醫地點，76.57%的民眾有習慣就醫醫師；有43.76%的民眾同時擁有位於診所和醫院的習慣就醫地點。在經過檢定分析後，發現有無慢性疾病與有無習慣就醫地點、醫師都有顯著正相關，且多重慢性疾病患者與兩個以上的習慣就醫地點及兩位以上的習慣就醫醫師也有顯著正相關。有無習慣就醫地點和醫師，與照護連續性也都有顯著正相關，但與照護協調性並沒有顯著相關。 結論：在沒有完善初級照護制度與轉診制度的情況下，台灣也許可以從民眾的習慣就醫地點或醫師介入，以此改善醫療品質，但現階段僅靠單一醫師或地點可能無法產生效果，需要類似家醫群這樣的制度與組織，且必須加強不同場所之間的照護協調性。本研究建議，先從民眾的多個習慣就醫地點或醫師介入，將其統整、加強彼此的資訊互通與合作，或許是一個改善台灣醫療品質的可行策略。

Background: Taiwan is facing the problem of fragmented care, with repeated use of drugs and repeated examinations. This phenomenon not only affects care results but also consumes medical resources. However, we still do not have a universal primary care system and referral system to enhance continuity of care and care coordination. Therefore, we need a suitable alternative for Taiwan medical system. Objective: This study was to understand whether the Taiwanese have usual sources of care and the characteristics of these people. Then, we explore whether having usual sources of care is related to continuity of care and care coordination. This study aimed to investigate whether usual sources of care can be an alternative to improve continuity of care and care coordination in Taiwan. Methods: This study was cross-sectional and used secondary data. The data was randomly sampled across who were over 60 years old and had a nationality and registered households in Taiwan. With structured interviews conducted by professional interviewers, we understand the patient-perceived continuity of care and care coordination. After that, this research analyzed the 2143 valid samples to response the research purpose. Result: This study found that 88.24% of the population over 60 years old in Taiwan had usual places of care, 76.57% had usual providers of care, 43.76% had usual places of care cross clinics and hospitals. After the analysis, it was found that there was a significant positive correlation between the presence or absence of chronic diseases and the usual sources of care, and there were significant positive correlations between patients with multiple chronic diseases and two or more usual sources of care. There was a significant positive correlation between usual sources of care and the continuity of care, but there is no significant correlation with care coordination. Conclusion: The usual sources of care may be used to improve continuity of care and care coordination. However, it may not succeed to achieve the goal by a single physician or location. We should organize usual sources of care from different locations and providers, and strengthen the care coordination. This study suggests that integrating the usual sources of care may be a feasible strategy to improve our medical quality.