醫病關係與醫師知識、態度在抗生素行為的潛在結構模式分析

The Structural Analyses of Attitudes about Antimicrobial Prescribing, Patient-Physician Relationships and Physician Knowledge

張妃妤(CHANG FEI YU)

指導教授 ： 藍守仁 蔡宜勳

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

廣泛且不適當地使用抗生素是目前公共衛生主要關切的問題，一般被認為是醫師持續開立不適當的抗生素處方造成的，研究結果證實醫師認定先前的抗生素濫用，會增加病患產生抗藥性的危險。而病人及其家屬之期待會影響醫師的抗生素處方行為。幸好藉由醫師的知識、態度信念可以改善抗生素使用情形。
本研究的目的是探討醫師與病人之間的關係是否和抗生素處方相關及醫師的知識、態度等中介變數的影響，再依醫師背景資料探討不同群組之差異性；研究方法是採用發放問卷方式，取樣地點包括兩個醫學中心及其他區域、地區醫院、診所，總共調查了420位各科醫師，問卷回收201份，回收率達47%，資料整理乃使用統計軟體SPSS而資料分析則採用結構方程模式( SEM )。
本論文的主要結論，除印證在文獻上所提，醫病關係被認為是影響醫師開立抗生素的重要因素外，醫師對於了解病人對抗生素的期待，與醫師擔心病人流失的壓力的影響，並發現若以醫師的特質做分群，尤其在醫病關係、知識、態度、行為相互間形成的結構模式裡醫師年齡、職別、執醫年數、醫院類別的不同確實有顯著的差異性，皆為論本文的主要結論。而醫師從事科別、服務的醫院是否聘感染科專科醫師或抗生素管制措施、是否曾接受抗生素專業課程訓練在整個結構模式裡雖然沒有差異性，但在醫病關係、知識、態度、行為中每一項的結構迴歸系數卻有不同，所以表示醫病關係、知識、態度、行為間之結構關係還是會各自受這些因素所左右。抗生素、抗藥性、醫病關係、結構方程模式

關鍵字

抗生素、抗藥性、醫病關係、結構方程模式 ； HASH(0x9a0ad34) ； HASH(0x9a0ad70) ； HASH(0x9a0b9f0) ； HASH(0x9a0ba44) ； 抗生素 ； 回收率 ； 抗藥性 ； 差異性 ； 變數

並列摘要

Abstract
One of the most important controversies in the field of public health has been the widespread and inappropriate use of antibiotics. The overuse of antibiotics has been attributed to overprescribing by physicians. Even with research proving that abuse of antibiotics leads to a higher resistance bacteria, over prescribing of antibiotics behavior continues. The influence of the patients and the patients’ family expectations has been linked to this continued over prescribing behavior. Fortunately, with proper education and training of the physician this condition can be improved.
This study explored the physician-patient relationship and its effect on the knowledge and attitude variables of the physician and whether these variables influenced physician prescription behavior. An analysis of patient group backgrounds was done and questionnaires were completed by 201 (47%) of 420 physicians from two university medical centers, several local area hospitals and clinics. Statistics Software SPSS and Structural Equation Modeling (SEM) methods were used for data analyses.
The results in this thesis research prove the patients and physicians are aware of the significant importance of buildup of antimicrobial resistance and believe better antimicrobial management will resolve this problem. Moreover, physicians were significantly more likely to perceive patience antibiotics prescription expectations if certain communication behaviors were used. The primary reasons for prescribing antibiotics in low pharmacological indications (non-pharmacological prescribing) situation were physicians were concerned that their patients might seek care elsewhere if antibiotics were not prescribed according to patient expectations and an overload of patients resulted in seeing as many patients in as short a period of time as possible resulting in the quick written prescription of antibiotics. Examination of the doctor's personal characteristics was also of significance. For example, age, official rank, number of experienced working years, and type of hospital category showed noticeable statistical differences in the structural SEM model. Although there were no such evident differences between departments, whether the department were infection department physician or there were antibiotics control measures, or whether there was antibiotics specialty training in a view of entire structural model, but we could find there were significant differences in the magnitude in the structural regression weights. Therefore, the effects of these factors could not be ignored in these models.relationship, Structural Equation Modeling (SEM)relationship,

並列關鍵字

antibiotics, drug resistance, patient-physician relationship, Structural Equation Modeling (SEM) ； knowledge ； AND

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