埔里鎮基層醫療診所組成「糖尿病健康促進機構」專業團隊之探究

面對糖尿病的高發生率以及疾病控制不良時所產生的全民醫療負擔費用相當可觀，若能即早發現、積極治療對病患而言是一大福音。在糖尿病健康促進機構採多重專業別結合團隊方式照護著糖尿病患，讓病患能獲得更優質的醫療服務，因此也突顯糖尿病健康促進機構以及專業團隊運作功能的重要性。本研究旨在了解埔里鎮基層醫療診所組成糖尿病健康促進機構專業團隊之歷程並深入探究糖尿病健康促進機構的專業關係及夥伴關係、以及執行現況與困境。研究根據研究目的採用質性訪談的方式共邀請了九位受訪者參與。研究發現可歸納為三項：一、糖尿病健康促進機構在人才培訓時面臨教育訓練必需投入金錢與時間，然而人才也需要熟悉糖尿病患的現況後再建立起和諧的醫病關係，另外在人員的留任時會遭遇到理念難以契合、非當地人無法久任等困難；二、在基層醫療院所組成糖尿病健康促進團隊時，硬體部分則會需要額外添購相關的儀器設備以及檢驗資源自行連結，另外因應慢性病照護使用的是紙本單張，所以軟體部分也需建置專屬的資訊輔助系統以利作業更順暢進行，然而在健保抽審制度下所造成人力與成本的負擔以及抽審行政作業上的困擾，且同時還要面臨開立糖尿病藥物處方的壓力等實務上的挑戰；三、糖尿病健康促進的團隊運作上會有明確的業務分工以及多重專業別結合的照護，透過醫師、護理師、營養師、藥師等發揮團隊照護的優勢，同時也進入社區內深耕讓民眾有正確的防治觀念，然而在非都會區內的困境就是要如何吸引民眾參加活動，以及醫療領域中會面臨到權威認同時該如何解決的問題，最後因團隊積極照護下成為糖尿病照護的基層典範院所，同時也提升基層醫療的照護品質。最後，建議政府相關部門於基層醫療院所組成糖尿病健康促進機構時，應提供相關糖尿病衛教師人力資源整合，並協助建置相關軟體設備，以健全基層醫療診所所需之資源並可提供病患更多的協助。

關鍵字

糖尿病健康促進機構；專業團隊；基層醫療院所

並列摘要

With the high incidence rate of diabetes and the considerable medical care costs generated from poor disease control, it would be a blessing for patients if the disease can be diagnosed and aggressive treatment can be applied as soon as possible. The Diabetes Health Promotion Center cares for diabetic patients by employing a multi-disciplinary team to provide patients quality medical care service, thus highlighting the importance of the Center and its professional team. This study aims to understand the journey of the Diabetes Health Promotion Center formed by primary care clinics in Puli Township, and conduct an in-depth investigation on the professional relationships and partnerships of the Center as well as its current execution status and difficulties. Based on the research purpose, qualitative interview was adopted and a total of nine interviewees were invited to participate. The research results can be generalized as follows: A.The Diabetes Health Promotion Center must invest money and time in personnel education and training, but the personnel also have to be familiar with the current status of diabetic patients before building harmonious doctor-patient relationships; regarding personnel retention, the Center has faced difficulties, such as being hard to agree on certain concepts, non-locals are unable to hold their positions for long, etc. B.When primary medical institutions were forming Diabetes Health Promotion Team, for hardware, relevant apparatus must be purchased additionally and inspection resources must be self-connected; because chronic illness care used hard copies, the software had to be equipped with an exclusive information aiding system for smoother operations; however, in addition to the manpower and cost burdens generated under the NHI Review System and the troubling administrative works of the reviews, the Center also has to face practical challenges such as pressure from prescribing diabetic medications. C.The operation of the Diabetes Health Promotion Team will have specific functions and divisions as well as multi-disciplinary care; by fully utilizing the advantages of team care through doctors, nurses, dieticians and pharmacists, the Team will enter the community, immerse in the community to let people gain correct prevention and control concepts; however, the dilemma they face in non-metropolitan areas is how to attract people to participate in activities. Another issue they must face while in the medical field is dealing with whether or not they will be acknowledged by authority figures. Finally, under the active care of the Team, the primary medical institutions will become model institutions in diabetes care, and the quality of primary care will also be elevated. In the end, researcher suggests that governmental departments should provide relevant human resource integration of diabetes health educators when the primary medical institutions are forming the Diabetes Health Promotion Center, as well as to help them establish relevant software and equipment to perfect the resources these primary care require for them to offer patients more assistance.