花蓮縣偏遠與非偏遠地區民眾對於基層醫療保健服務的使用與需求之比較

目標：探討並比較花蓮縣偏遠與非偏遠地區民眾對基層醫療保健的使用情形及服務需求。方法：運用量性調查問卷詢問人口背景、基層醫療使用情形、醫療／預防保健／衛生教育服務之需求程度和原因，於花蓮縣偏遠地區選取六個鄉鎮，非偏遠地區選取三個鄉鎮民眾參與，共回收573份有效問卷（回收率97%）；另邀請10位偏遠／非偏遠村里代表參與訪談，收集質性資料。結果：偏遠民眾對醫療資源充足度有49.3%認為「不足」，非偏遠民眾僅佔16.6%。鄉鎮應強化之醫療科別，偏遠民眾首需「眼科」，非偏遠民眾則為「家庭醫學科」。鄉鎮應加強之醫療服務，偏遠民眾首需「巡迴醫療」，非偏遠民眾則為「降低醫療自付費用」。訪談另發現，村里長積極程度對村里醫療資源多寡影響極大。結論：本研究發現偏遠與非偏遠地區至基層醫療據點的可近性差異不大，但偏遠民眾的服務滿意度明顯較低，建議衛生主管機關對於偏遠地區醫療保健資源的規劃，在服務項目與服務品質方面需考量民眾需求來實質提升。

關鍵字

偏遠地區；基層醫療衛生保健；服務需求；需求評估

並列摘要

Objectives: This study compared the utilization of and requirements for primary healthcare services for residents living in remote and non-remote areas of Hualien County. Methods: We used quantitative questionnaires to survey 6 townships in remote areas and 3 townships in non-remote areas of Hualien County. The questionnaire gathered data about demographics, utilization of primary healthcare services, and the needs for medical care, preventive care, and health education services. A total of 573 valid questionnaires were retrieved for a response rate of 97%. In addition, 10 village heads of villages in remote/non-remote areas were invited to participate in qualitative interviews. Results: The results indicated that 49.3% of residents in remote areas thought that medical resources were inadequate, while only 16.6% of the residents in non-remote areas held the same opinion. Results also showed a need to strengthen various departments of healthcare services in villages and townships. Ophthalmology was the most needed medical service in remote areas, while family medicine was the most needed in non-remote areas. Mobile medical services were also needed for residents living in remote areas, while those living in non-remote areas emphasized a need for the reduction in payments for medical care. The qualitative in-depth interviews showed that the attitudes of village or neighborhood leaders were highly correlated with the availability of medical resources. Conclusions: Access to primary health care centers was similar in remote and non-remote areas; however, the residents in remote areas had a relatively lower level of satisfaction with health care services. We suggest that healthcare authorities consider specific service items and quality when determining the deployment of health care services in remote areas.

並列關鍵字

remote area ； primary health care ； service needs ； needs assessment

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