某醫學中心門診持續性照顧之研究

Continuity of Care in a University-Based Outpatients Department

宋元宏(Yuan-Hung Sung) ； 賴美淑(Mei-Shu Lai) ； 張智仁(Chih-Jen Chang) ； 謝維銓(Wei-Chuan Hseih)

《中華民國公共衛生學會雜誌》 10卷1期 (1990/03) Pp. 11-18

https://doi.org/10.6288/JNPHARC1990-10-01-02

摘要

本研究以民國77年6月1日至6月7日，某醫學中心家庭醫學斜門診病人年滿15歲以上的391個門診次為樣本，採用以門診就診為基礎的測量方法（包括曾有相同醫師持續性指標、接連相同醫師持續性指標、修正後比例式持續性指標），評估其持續性照顧型態，並就各指標間的相互差異，探討其所代表的意義。
研究結果顯示，曾有相同醫師持續性指標值、接連相同醫師持續性指標值、修正後比例式持續性指標值分別為0.6803、0.5678、0.5127。在各年齡層間，中年年齡層的持續性照顧最佳；保險制才方式的不同、預約的有無、門診就診間隔日數的長短、及醫師資歷的深淺均會影響持續性照顧。
本研究的疾病診斷以國際疾病分類第九版加以編碼，其中，高血壓、糖尿病等慢性疾病的持續性照顧最好。而肌肉骨骼疾患組的曾有相同醫師持續性指標值與糖尿病組相近，但其另外二種指標值卻較糖尿病組及高血壓組為差。這些指標之間的相互差異，可據以推測病人的就醫狀態。
綜而言之，本研究採用的三種測量指標，得以方使他將持續性照顧的品質加以量化，以評估門診的持續性照顧型態。

並列摘要

This study was carried out between the 1st and 7th of June 1989. Selection criteria required patients to be 15 years old or over. The study included 391 cases from the Outpatient Department, Family Medicine Division, National Taiwan University Hospital.
The research methodology utilized visitbased measurements (including known-provider continuity, sequential continuity, and discounted fraction of care continuity) to evaluate the continuity of care situation. In addition, the implications and significance of the different values arising from the above measurements were investigated.
Our research produced the following values: 1) known-provider continuity, 0.6803; 2) sequential continuity, 0.5678; 3) discounted fraction of care continuity, 0.5127.
Reviewing all age groups, the middle-aged group received the best continuity of care. The following factors were key determinants of good continuity of care: 1. benefits provided by medical insurance; 2. prior appointment with consulting physician; 3. length of time between patient visits; and 4. experience of consulting physician.
We concluded from our research that, the continuity of care for diabetes, hypertension and other chronic diseases was superior to that for all other diseases. However, the values for known-provider continutiy for musculo-skeletal disorders were similar to-those for diabetes, but were lower than those for both diabetes and hypertension for the other two values. These variants may be used to predict patient attitudes with respect to outpatient care.
In conclusion, by using the above three mentioned measurements, we can quantify the quality of continuity of care and thereby evaluate the continuity of care in outpatient departments.

並列關鍵字

Continuity of Care ； Delivery of Health Care ； Family Practice