通訊診療之使用者滿意度與偏好研究:以臺大醫院雲林分院「Ｅ定藥安全」為例

Abstract

研究背景 臺灣中央流行疫情指揮中心於2021年5月19日提升全國疫情警戒至第三級，同時指示配合醫療營運降載及廣泛運用遠距醫療於門診病人，並於同日宣布經各地區衛生主管機關指定之醫療機構，得免提報通訊診察治療實施計畫，以通訊方式診察門診病人。因此，臺大醫院雲林分院於2021年5月26日開始「E定藥安全」計畫，實施院外領藥窗口與針對連續處方箋病患的視訊門診，至2021年7月9日止。

研究目的 本研究的目的在於評估此計畫之使用者對於視訊門診的滿意度與偏好並同時分析滿意度與偏好之影響因子。期待研究結果將有助於未來通訊診療的建置與使用者族群鎖定，以持續嘉惠雲林縣民眾，更期望能成為全國典範。

研究方法 本研究利用電話進行問卷訪查，研究對象為2021年5月26日至2021年7月9日之間，曾經使用臺大醫院雲林分院通訊診療之病患。所蒐集之資料以卡方檢定與二項式羅吉斯迴歸進行分析。蒐集資料期間為2021年11月3日至2021年12月30日。

研究結果 本研究共完整訪問85人，總計258使用人次。受訪率為38%。其中多數的病患為女性，平均年齡為60.5 歲。60%的病患為高中以上學歷。65%的病患由醫院首頁得知本通訊診療門診之相關訊息。「整體通訊診療操作方便」獲得最低之「非常滿意」度（67%），「您覺得通訊診療醫師的態度良好」獲得最高之「非常滿意」度（95%）。全部受訪的病人中，有48.2%的使用者偏好視訊門診，其中比例最高（78%）的原因為節省時間，而偏好實體門診（51.8%）的使用者中，比例最高（68%）的原因為能擁有與醫師互動的機會。羅吉斯迴歸顯示男性病患相較於女性病患，對於系統方便性有較低的不滿意度(odds ratio, OR=0.323、95%信賴區間[0.114-0.917]、p=0.034)。居住地為虎尾或斗六以外的病患，亦即離院區較遠的病患，相較於居住地為虎尾或斗六者，對於聲音清楚有較低的不滿意度(OR=0.273、95%信賴區間[0.077-0.971]、p=0.045)。將年齡與教育程度交互分析，其中相較於小於75歲且教育程度較低之病患，小於75歲且教育程度較高之病患(OR=5.529、95%信賴區間[1.348-22.674]、p=0.018) 與75歲以上之病患(OR=5.614、95%信賴區間[1.208-26.100]、p=0.028)較偏好視訊門診。

研究結論 在COVID-19疫情下，藉由免費的網路視訊軟體，針對連續處方箋復藥病患，實施之視訊門診可達到高滿意度。男性病患針對系統便利性有較高的滿意度，而年輕且教育程度低之病患與高齡之病患偏好視訊門診。未來在通訊診療發展，應持續改善系統便利性，並持續鼓勵較無願意之族群增加使用，以促進醫囑之遵從性與照護之連續性。

Background The COVID-19 patient numbers sharply increased in May, 2021 in Taiwan. To enforce distancing and slower the pandemic, the Central Epidemic Command Center of Taiwan authorized providers of all levels to use telehealth for outpatient care without pre-approval from the central government but only from local public health authorities. National Taiwan University Hospital-Yunlin Branch therefore began outpatient telehealth service on May 26, 2021 through to July 9, 2021.

Aim The goal of the present study is to assess the user satisfaction and preference for telehealth outpatient care as well as to analyze factors associated with level of satisfaction and preference.

Material and Methods Telephone interviews were conducted among all the patients who utilized outpatient telehealth service during May 26, 2021 to July 9, 2021. Chi-square tests and logistic regression were used to analyze the factors associated with user satisfaction and user preference. All interviews were conducted during November 3, 2021 to December 30, 2021.

Results Among all 258 telehealth outpatient visits billed for National Health Insurance reimbursement, 85 patients responded to the request and completed the phone interview. The majority (60%) of the patients were female. The mean age was 60.5 years old. Most patients (60%) were with senior high school-level education or higher. Among all interviewees, 65% learned about availability of telehealth service offered by NTU Yunlin branch through hospital website. “The operating system of video-conferencing was convenient” got the lowest level of satisfaction (67%), and “The doctor had good attitude” got the highest level of satisfaction (95%.) Almost half (48.2%) of the users preferred video-conferencing than face-to-face visits, mostly due to time saving (78%.) On the other hand, users preferred face-to-face visits (51.8%) mostly because “they were able to interact with doctors”(68%.) Results from logistic regression showed that male gender was associated with lower odds of unsatisfaction with “system convenience” than female gender (OR=0.323, 95% confidence interval [0.114-0.917], p=0.034). Patients who live outside Huwei Township or Douliu City were associated with lower odds of unsatisfaction with “voice quality” than those who live in Huwei Township or Douliu City (OR=0.273, 95% confidence interval [0.077-0.971],p=0.045)。Patients <75 years old with higher educational level (senior high school or above) (OR=5.529, 95% confidence interval [1.348-22.674], p=0.018) and ≧75 years old (OR=5.614, 95% confidence interval [1.208-26.100], p=0.028) were both associated with a higher odds of preferring video-conferencing compared with patients <75 years old with lower education level (junior high or lower).

Conclusion Under COVID-19 pandemic, video-conferencing through a free online platform for outpatient services with refillable prescriptions led to high user satisfaction. Male gender had higher level of satisfaction than female in system convenience. Patients with younger age and higher education level and patients with elder age both preferred video-conferencing. Therefore, the convenience of outpatient telehealth service should be continuously improved, and those who had lower preference to video-conferencing should be encouraged to use such services.