建立台灣身心障礙者牙科專科醫師制度之研究

一、背景身心障礙者的口腔健康照護需求尚未從相關的立法保障中獲得應有的醫療、預防、保健權益，且由於台灣目前尚缺乏專業身心障礙者牙科醫療資源，造成身心障礙者普遍口腔健康狀況、整體健康情形、生活品質不佳之現狀。身心障礙者就醫權益不容忽視，推動身心障礙者牙科專科醫師制度、落實身心障礙者牙科醫療保健權益，已成為現代國家社會責無旁貸、實現平權之重要議題。二、研究目的（一）探討國內身心障礙者牙科醫療服務之現況。（二）探討產官學專家對建立身心障礙者牙科專科醫師制度之看法。（三）預期研究結果凸顯對此一制度之需求及必要性，或可提供衛生主管機關參考建立完整身心障礙者牙科專科醫師制度及配套措施。三、研究方法（一）文獻分析法：蒐集國內外身心障礙牙科專科醫師制度相關期刊論文、研究報告等文獻，進行整理比較與分析。（二）德菲問卷調查法：應用德菲法一系列系統性的問卷調查，徵詢與研究主題有關的專家學者所組成的研究小組，透過數回合的問卷調查與意見交流，最後凝聚共識。四、結果（一）身心障礙者口腔健康狀況「差」、照護者對於身心障礙者口腔健康重要性的認知程度為「低」、醫療資源利用率極低。（二）牙科醫療院所缺乏足夠人力提供適當服務專家小組成員普遍認為牙醫師缺乏身心障礙者牙科相關教育訓練。（三）取得身心障礙者牙科專科醫師資格，審查項目需要筆試、案例審查及口試；展延身心障礙者牙科專科醫師資格，審查項目認為需要繼續教育學分認證及案例審查。（四）身心障礙者牙科專科醫師最需加強訓練課程需要身心障礙者牙科實際操作、行為處理及身心障礙者全身系統性疾病認識。五、結論（一）牙醫師須接受更為完整與完善規劃之身心障礙者牙科教育訓練，以提高身心障礙者牙科醫療品質及牙科醫療資源可近性。（二）藉由德菲問卷調查法向與研究問題有關的專家學者徵詢意見，最後獲得一致且可靠的預測結果，包括獲得建立身心障礙者牙科專科醫師制度必要性之共識。（三）須規劃完善之『身心障礙者牙科專科醫師』制度與配套措施，擴大對於身心障礙者的口腔醫療照護，提高醫療品質。

關鍵字

身心障礙者；身心障礙者牙科；專科醫師；德菲法

並列摘要

Background People with disabilities have poor oral hygiene and have been suffering from decayed tooth and severe periodontal disease since their childhoods. Based on the international research related to the prevalence of dental caries, DMFT, the developed countries, such as the United Kingdom, United States, Canada and Japan, etc., have successfully take proper oral health care for people with disabilities in this day and age; on the other hand, the Special Care Dentistry in Taiwan is just getting start. Study objective Appealing for the Specialty of Dentistry for people with special needs to be accredited by the authority, this paper aims at analyzing foreign countries’ research about the system of Special Care Dentistry as a reference for Taiwan government to develop the specialty, and presenting the strong need for dental specialist with adequate training and skills to have people with special needs’ oral health care met. Methods Through a series of interactive questionnaires, designed with Likert-type scales and open questions to collect the judgments and feedback towards the development of specialty of dentistry for special needs from 45 professional dentists, the research was carried out by means of purposeful sampling and Delphi Method. Cronbach’s alpha analysis of 0.811 was applied in advance to test internal consistency and reliability by several professional examinees. The process continues until the feedback has been exchanged and the experts reach a consensus view regarding the tremendous dental treatment needs of people with special needs in Taiwan and the demand for more dental specialists who are willing and able to treat people with special needs. Results A total of 41 respondents (91.1%) said that the oral health of the disabled is severe, and almost three-quarters (73.3%) reported that in their hospitals, the dentists and staff specialized in oral care for people with special needs are insufficient. 35 respondents (77.7%) indicated they had received inadequate course related to oral care for people with special needs. Nearly 76 percent of the respondents stated that it is necessary to develop the Specialty of Dentistry for people with special needs. Discussion The respondents provided viewpoints that Taiwan needs more well-trained dental specialists for people with special needs to meet the urgent oral health needs. With appropriate dental specialists, people with special needs can have their right to a standard of living adequate for the health. Moreover, dentists are positively encouraged to advance their academic knowledge and improve their clinic skills. At the same time, both the health and well-being of people with special needs and the better quality of dental care are the ultimate goal to the Department of Health. As a result, the development of Specialty of Dentistry is beneficial to people with special needs, the dentists as well as the government. Conclusion By making use of Delphi Method, the 45 professional dentists have a consensus view towards the severe oral health of people with special needs, the necessity to establish the Specialty of Dentistry for people with special needs, and the required training programs for dental specialists. In conclusion, with the development of Specialty of Dentistry, those with special oral care needs could find more encouraged and accredited specialists who are willing and capable of special dental treatment.