- 學位論文
台灣民眾對於遠距醫療態度及使用意願之研究
Attitudes toward Telemedicine and Willingness to Use in Taiwan: An Exploratory Analysis
摘要
隨著20世紀資通訊科技日益普及，「遠距醫療」的發展日益蓬勃，提供病患及醫療人員更為便利及準確的溝通渠道。台灣遠距醫療的發展可回溯自1995年，行政院衛生署開始試辦「遠距醫療計畫」，但多半是D2D2P 模式，即 Doctor（舉例來說眼科專科醫師）2 Doctor（家醫科醫師）2 Patient（糖尿病人）的模式，並非Doctor 2 Patient，即病人與醫師直接互動的模式。隨著2020年COVID-19的爆發，多數民眾減少去醫療院所就醫，衛福部提供居家隔離、居家檢疫、或自主健康管理的民眾，及慢性病病人可選擇視訊診療，遠距醫療走入更多病人的家中，形成遠距諮詢Doctor 2 Patient模式，照護服務內容包括複診、輕症諮詢甚至健康管理。然而在遠距醫療日益普及之下，台灣民眾對於遠距醫療的使用及認知仍有限，期待透過此研究，了解民眾對於遠距醫療態度及使用意願，提出遠距醫療永續發展之建議以符合民眾就醫需求。 本研究透過網路問卷方式，針對20歲以上的民眾進行「遠距醫療」態度及使用意願調查，透過七個不同就醫科別或情境（眼科、皮膚科、耳鼻喉科、急性病照護、慢性病初診、慢性病回診、精神疾病），探討「健康識能」、「資訊化健康識能」、「實體醫療可近性」、「遠距醫療感知有用性」是否影響民眾對遠距醫療接受態度，並且進一步探討遠距醫療的接受態度是否影響其對遠距醫療的使用意願。研究方法採用結構式問卷，以滾雪球抽樣，在2022年3月30日到4月12日共訪問341人，所收集之資料透過敘述性統計及推論性統計（卡方檢定、羅吉斯迴歸）進行分析。研究結果顯示，民眾願意使用遠距醫療的比例隨著科別有極大的差異性，包括有16.72% 受訪者願意接受眼科遠距醫療，51.32% 受訪者願意接受皮膚科遠距醫療，23.46% 受訪者願意接受耳鼻喉科遠距醫療，55.43% 受訪者願意接受慢性病初診遠距醫療，93.55% 受訪者願意接受慢性病回診遠距醫療，12.90%受訪者願意接受急性病照護遠距醫療，66.86%受訪者願意接受精神疾病遠距醫療。此外，推論性統計結果顯示，民眾健康識能高低、是否有實體醫療可近性問題、遠距醫療感知有用性高低，各自對特定科別遠距醫療的接受態度有顯著影響。未來政策若要推廣遠距醫療，建議可以納入民眾的使用習慣及想法，從民眾較容易接受及採用遠距醫療的科別著手，逐步推廣遠距醫療至民眾的生活之中。
並列摘要
With the increasing popularity of information and communication technology in the 20th century, the development of "telemedicine" has become increasingly vigorous, providing patients and health professional with more convenient and accurate communication channels. The development of telemedicine in Taiwan can be traced back to 1995, when the Department of Health, Executive Yuan started telemedicine trial program. In this program, however, most telemedicine visits were conducted as D2D2P, or Doctor（for example, a remote ophthalmologist）to Doctor（a local family physician）to Patient （a diabetic patient）mode. With the outbreak of COVID-19 in 2020, most people have reduced their visits to healthcare providers. Ministry of Health and Welfare expand telemedicine services program to people with chronic diseases as well as for whom quarantine was required, including home isolation, home quarantine, or self-health management. Therefore, a growing population began to use telemedicine services, and Doctor 2 Patient（doctor direct to patient）mode is formed. Telemedicine services include follow-up consultation, minor disease consultation, and health management. With the increasing popularity of telemedicine, people still have limited use and awareness of telemedicine. The present study investigated people's attitudes toward telemedicine and willingness to use telemedicine, hoping to provide some policy suggestions for the sustainable development of telemedicine. This study utilized an online survey among recruited participants ≥20 years old. The structured questionnaire included questions on people’s attitude towards to using telemedicine for each of the following seven different specialties or functions: ophthalmology, dermatology, ENT, acute care, chronic disease initial consultation, chronic disease follow-up, and mental illness. The present study also investigated whether "health literacy", "ehealth literacy", "physical medical accessibility", or "telemedicine perceived usefulness" affect people’s attitude toward telemedicine, and whether people’s attitude toward telemedicine affects their willingness to use. The study utilized snowball sampling, and 341 people were successfully recruited and completed the questionnaire from March 30 to April 12, 2022. Survey data was analyzed with descriptive statistics and inferential statistics（chi-square test, and logistic regression）. The results of the study showed that people’s attitude toward telemedicine varies greatly by specialties, with 16.72% of respondents willing to accept teleophthalmology, 51.32% of respondents willing to accept teledermatology, 23.46% of respondents willing to accept telemedicine in ENT, 55.43% of respondents willing to accept telemedicine for initial diagnosis of chronic diseases, 93.55% of respondents willing to accept telemedicine for return visits for chronic diseases, 12.90% of respondents willing to accept telemedicine for acute care, and 66.86% of the respondents willing to accept telemedicine for mental illness. In addition, the inferential statistics showed that people’s attitude toward telemedicine for selected specialties is significantly associated with health literacy, physical medical accessibility, and telemedicine perceived usefulness. Future policies aiming at promoting telemedicine should consider consumer attitude and acceptance towards telemedicine. Promoting telemedicine services for specialties which people are more likely to accept and adopt will likely to succeed, and to gradually make telemedicine services part of people’s lives.