摘要
目的：因應93年1月健保IC卡的全面施行，兒科醫師均認為兒童健康手冊不應內含於健保IC卡，有其紙本獨立存在之必要性。本研究著手規劃修訂健全的兒童健康手冊，希望除了可以提供兒童連續性、完整性的健康保健服務外，期望提昇父母親對正常生長發育的認知及具備預防醫學的概念。方法：本研究採取橫斷式的研究法，研究期間為2004年7月至同年12月底，研究對象包括兒科醫學會共123位醫師，研究工具以結構式問卷為主，並採用德爾菲法專家會議達成共識為目標，來修訂兒童健康手冊。結果：研究對象之資料以男性居多81.1%，平均年齡為46.35歲，平均執業年資為16.29年（表1），兒科醫師認為最需修正的項目為預防接種部分(52.1%)，其次為兒童生長曲線(41.2%)以及預防保健記錄欄(32.7%)（表2）；另專家會議意見整理如下；(1)增加兒童健康檢查給付為10次；(2)視力、聽力、牙齒之檢查應獨立訂出由其他專科醫師做進一步的檢查；(3)增列生理、認知、語言及生活自理機能等項目，以提升家長對兒童發育之自我評估；(4)健康手冊務必保留預防接種部分。結論：本研究建議政策制訂者考量：(1)製作各年齡層標準化的健康篩檢流程之視聽教材，並依其標準化服務臨床指引作教育訓練；(2)建議於預防接種表中加入各項自費疫苗，提供予兒科醫師或家庭醫師卓參；(3)建議兒童健康檢查給付為10次，並將滿6歲之兒童健康篩檢表，列為小學生入學前必繳之文件，以利健康檢查之落實與提高兒童預防保健之利用率。本研究大幅修訂之兒童健康手冊全仰賴兒科醫師精英專家許多寶貴的專業意見，方能使嶄新的兒童健康手冊受惠於兒童，國家未來的主人翁必需依賴第一線的兒科醫師幫忙協助早期發現疾病及早期預防，尤其在目前出生率降低、新移民女性生育比率漸增、少子化併發症、家暴問題等日趨嚴重的今日，兒童的預防保健更形重要。
並列摘要
Background and Purpose: With the corn pre-hensive implementation of the health insurance IC card in January 2004, the role of child healthcare handbook is not supposed to be substituted by the health insurance IC card by most pediatricians in Taiwan. The aim of the survey was to survey pediatricians' opinion and refine the original child healthcare handbook in order to improve the quality of preventive child healthcare, to increase parents’ attention on children’s physical and mental health development, as well as their acceptance and utilization of preventive child healthcare. Methods: From July to the end of December 2004, a cross-sectional method was used for the survey. The research included 123 members from the Taiwan Pediatric Association by questionnaires. The Delphi technique was used to achieve mutual recognition between the experts in order to revise the original child healthcare handbook. Results: Most of the surveyed doctors were male, with an average age of 46.35 years and practising duration of 16.29 years. Of these doctors, 52.1% advocated a need to revise the prophylactic inoculation section, 41.2% advocated a need to revise the child growth curve and 32.7% wanted to revise prevention health care recording. The experts' opinions on reorganization were as follows: (1) increase the number of child healthcare inspections from 6 to 10; (2) carry out eyesight, hearing and dental inspection by independent specialists; (3) increase awareness of physiology, cognition, language and ability of children to take care of themselves, to raise the parents' awareness of children's physical and mental health development; (4) keep prophylactic inoculation in the child healthcare handbook. Conclusion: This survey showed that policy makers should consider increasing the number of preventive child healthcare inspections from 6 to 10, and drawing up a standard list of health exam items and procedures, including prophylactic self-paid inoculation table and providing pediatrician or family doctor referrals. Based on the opinions of pediatric experts, a new health handbook has been issued. The purpose of this investigation was to ensure the child’s physical and mental health, in particular, the problem of the children raised by new immigrant females. In recent years, the birth rate has continued to drop and more babies are being born by foreign brides in Taiwan. Preventive child healthcare is very important in our country's future child-health quality.