花蓮區域基層醫療之評估

Evaluation of Primary Care in Hua-Lien Area

陳慶餘(Ching-Yu Chen) ； 沈友仁(Yu-Zen Shen)

《中華民國公共衛生學會雜誌》 9卷2期 (1989/06) Pp. 83-89

https://doi.org/10.6288/JNPHARC1989-09-02-03

摘要

配合台大醫院輔導花蓮區域醫療網計劃，本研究針對花蓮縣十三鄉鎮市137家基層醫療單位，以自行設計之評量表，進行診所診查。結果顯示：(1)在實際執業的129家負責醫師平均年鈴57歲，各鄉鎮人口診所比差異甚大；(2)醫師類別中，特考及格佔28.7%，醫學院校畢業佔48.8%和具有專科資格佔22.5%；(3)影響評量總分高低的項目包括：「有兩名醫師以上」、「無重複掛號的情形」、「靠完整身體檢查診斷」、「靠儀器診斷」、「靠檢驗診斷」、「相同作用的藥物無重複處方」、「無類固醇之濫用」、「打針的次數無明顯過多」、「服務時間一星期6天以上」、「有預防注射之服務」、「有消毒設備」和「有觀察床」。(4)評量總分為56分；特考及格醫師平均分數為28.6±5.6分，醫學院畢業醫師為34.4±6.3分，專科醫師為38.6±5.1分。(5)專科醫師在「有兩名醫師以上」、「靠儀器診斷」、「靠檢驗診斷」和「有消毒設備」等項目以及接受「繼續教育年次數」得分較高。最後本文根據上述評估結果，討論基層醫療服務品質的提昇策略。

並列摘要

Hua-Lien County, located on the east coast of Taiwan, occupies about of the Islands' area and has 10% of its population. In the County, there are 11 hospitals and 137 clinics, as well as four large hospitals; the latter are all within Hua-lien city. Shortage of primary care physicians and maldistribution of medical resources can be noted. The Department of Health initiated a Hua-Lien Regional Medical Care Network Plan in fiscal year 1989, and assigned the National Taiwan University Hospital as the responsible medical center. This study focused on evaluation of the current status of general practice, through assessment of clinics by visiting experts who used a modified primary care accreditation list with a full score of 56. Results are summarized as follows: (1) The mean age of physicians in the actual 129/137 practicing clinics is 57±12 years; (2) The ratio of population/clinic varies from 1,462:1 to 14,138:1; (3) Classiffication of physicians shows non-medical graduates, 28.7%; medical graduates, 48.8% and specialists, 22.5%. Their average total scores were 28.6±5.6, 34.4±6.3 and 38.6±5.1, respectively; (4) Clinics with the following practice pattern and services had higher scores: two or more physicians (group practice), no double registration, good medical record, instrument-assisted diagnosis, using laboratory data in diagnosis, no inappropriate use of drugs and injections, available service more than 6 days a week, providing vaccination service, using sterile equipment and providing observation beds; (5) The study of medical care provided by the three types of physicians described, revealed that the specialists, in addition to obtaining higher scores and attedning more continuing medical education courses, showed more favorably in such criteria as group practice, instrument-assisted diagnosis, using laboratory data in diagnosis and using sterile equipment.

並列關鍵字

Primary health care ； Accreditation ； Family physician