皮膚科醫師使用遠距醫療之現況、使用意圖與影響因素初探

Abstract

研究背景與目的：國內人口快速老化、醫療需求大量增加、醫療資源分布不均等問題是健康照護體系當務之急需要積極解決的困境，遠距醫療之優勢能克服時間及空間障礙，讓病人即時獲得醫療照護服務，增進服務的可近性。在遠距醫療應用中，皮膚科仰賴視覺診斷特性而在遠距醫療應用上具備優勢，專科醫師在許多地區服務量能不足之情況為遠距皮膚科醫療發展較成熟之原因。過去臺灣遠距醫療使用的相關研究多聚焦於民眾使用意願、使用經驗及滿意度等，在遠距醫療發展中扮演重要角色的服務提供者方面及臨床診療情境之相關研究較少。因此本研究以皮膚科臨床應用為研究情境，了解國內皮膚科醫師在遠距皮膚科醫療之使用情況，並以科技接受模型為基礎，探討個人、組織、行政管理因素與皮膚科醫師對遠距皮膚科醫療使用意圖之關聯性。 研究方法：本研究採用橫斷面研究（cross-sectional study），以結構式問卷調查法蒐集資料，並以便利抽樣方式招募受訪者，研究對象為國內的皮膚科專科醫師。本研究與國內專業醫師學會及診所、醫療院所臨床或行政部門合作，以紙本及網路問卷方式進行，邀請各專業單位協助招募受訪者。本研究利用雙變項分析及線性機率模型探討個人、組織及行政管理層面因素與遠距皮膚科醫療使用意圖之關係。 研究結果：本研究共蒐集88位皮膚科醫師之問卷資料，有60%受訪者曾使用過遠距皮膚科醫療，大多數醫師以使用硬體傳輸設備（例如：電腦、平板電腦、手機等）為主，遠距醫療資訊系統則以使用Line為最多；皮膚科醫師認為遠距皮膚科醫療模式之執行困難主要為診斷正確率（81%）、病人端使用障礙（78%）及病人隱私之疑慮（51%），且多數皮膚科醫師因為COVID-19疫情而增加使用遠距皮膚科醫療之意願。在控制皮膚科醫師人口學特質及執業特性後，皮膚科醫師認為使用遠距皮膚科醫療之相容性越高時，知覺有用性越高（p=0.015）；個人自我效能感越高時，知覺易用性越高（p=0.003）。組織促進條件支持程度越高時，遠距皮膚科醫療使用意圖越高（p=0.005）；對遠距醫療法規政策影響的認知程度越高時，遠距皮膚科醫療使用意圖越高（p<0.001）。 結論：組織層面促進條件因素的支持程度及行政管理層面法規政策影響的認知程度為皮膚科醫師對遠距皮膚科醫療使用意圖的正向影響因素。本研究建議政策制定者在訂定遠距醫療相關法規及政策上應與時俱進，除遠距皮膚科醫療健保給付方案外，應將基礎資訊設備、醫療儀器建置及相關教育訓練計畫加入政策制定考量的因素，並根據皮膚科之臨床特性給予合理且適當之誘因或獎勵機制，發揮遠距醫療服務之效益。

Introduction: The rapidly aging of population, the significant increase in medical demand, and the uneven distribution of medical resources are the most urgent dilemmas that must be actively solved in the health care system. Telemedicine can overcome the barriers of time and space, by allowing patients to obtain health care services in a timely manner, and by improving the accessibility of health care. Among all telemedicine applications, teledermatology relies more on visual diagnostic features than other specialties and thus has advantages in telemedicine applications. Additinoally, many areas are facing shortage of dermatologists and would benefit from teledermatology. Past research related to telemedicine use in Taiwan mostly focused on patients' intention to use, experience, and satisfaction with telemedicine. Physicians' intention to use, however, an essential factor affecting the development of telemedicine, is less invetigated. Therefore, focusing on the clinical application of dermatology, the purpose of this study is to understand the use of teledermatology among dermatologists in Taiwan. Methods: This study applied Technology Acceptance Model as the major theoretical framework to explore the relation between individual, organizational, and administrative factors and physicians' intention to use teledermatology. This study adopted a cross-sectional design, collected data by structured questionnaire (included paper and online questionnaires), and recruited respondents by convenience sampling. The research objects are dermatologists in Taiwan. This study collaborated with Taiwanese Dermatological Association, community dermatology clinics, and dermatology department of teaching hospitals to recruit study participants. The study used bivariate analysis and linear probability model to investigate the relationship between individual, organizational, and administrative factors and intention to use teledermatology among dermatologists in Taiwan. Results: There were 88 dermatologists who responded and answered the questionnaire. Of all the respondents, 60% had used teledermatology in the past, with majority experienced in using electronic devices (e.g., computers, tablets, cell phones, etc.). Meanwhile, LINE was the most used telemedicine information platform. The majority of dermatologists believed that the barriers to the implementation of the teledermatology were diagnostic accuracy (81%), patients’ limited access to technology (78%), and patients’ privacy concerns (51%). Most dermatologists have increased their intention to use teledermatology due to the COVID-19 pandemic. After controlling the dermatologists' demographics and practice characteristics, higher compatibility of dermatologists in the use of teledermatology was associated with higher perceived usefulness (p=0.015); higher personal self-efficacy was associated with higher perceived ease of use (p=0.003). Additionally, higher degree of organizational facilitating conditions support was associated with higher intention to use teledermatology (p=0.005); higher degree of awareness of the impact of teledermatology policy and regulations was also associated with higher intention to use teledermatology (p<0.001). Conclusions: The degree of support for organizational facilitating conditions, and the degree of awareness of the impact of administrative policy and regulations, were both positively associated with dermatologists’ intention to use teledermatology. This study suggested that policy makers should consider all aspects while formulating telemedicine regulations and policies. In addition to the telemedicine health insurance coverage, basic information technology equipments, infrustrature, and education training programs should be also taken into consideration in policy formulation. Reasonable and appropriate incentives or reward mechanisms should also be provided according to the clinical characteristics of dermatology to maximize the benefits of telemedicine services.