健保IC卡對醫師診療之助益及其相關因素

Helpfulness of Insurance IC card to Physicians' Diagnosis and the Associated Factors

蔡文正(Wen-Chen Tsai) ； 游秋華(Chiu-Hua Yu) ； 黃光華(Kuang-Hua Huang) ； 謝淑惠(Shwn-Huey Shieh) ； 陳慧珊(Hui-Shan Chen) ； 廖家慧(Chia-Hui Liao) ； 吳守寶(Shou-Bao Wu) ； 詹勳政(Hsun-Cheng Chan) ； 龔佩珍(Pei-Tseng Kung)

《台灣公共衛生雜誌》 28卷3期 (2009/06) Pp. 205-217

https://doi.org/10.6288/TJPH2009-28-03-05

摘要

目標：健保IC卡政策全面實施至今，少有全面性探討醫師對此政策之看法，因此本研究將全面探討醫師對於IC卡之整體評價。方法：以全國各醫療院所之中醫、西醫、牙醫為研究對象，以分層比例進行隨機抽樣，郵寄結構式問卷進行問卷調查，回收有效問卷分別為中醫227份，西醫712份，牙醫285份。同時以逐步迴歸分析探討影響醫師認為IC卡對診療助益性之因素。結果：醫師讀取健保IC卡頻率最高項目為「重大傷病」，登錄內容適切性則以「記載過敏藥物」最高，IC卡助益性認知主要為「記載過敏藥物等就醫安全更有保障」。醫師於看診後將病患資訊寫入IC卡意願平均為3.36分（1-5分），降低寫入及讀取主因皆為「延誤看診時間」（52.93%及58.11%），滿意度平均則為2.96分(1-5分)，認為IC卡對診療助益平均為62.34分（1-100分）。影響醫師自覺IC卡助益性之因素為：參考IC卡資料頻率、寫入IC卡之意願、對IC卡認知、是否參考IC卡資訊避免重複開藥、平均每週看診總人數及機構層級別。結論：整體而言除了基層西醫外，大多數醫師對目前IC卡實施表示中度滿意，對於寫入及讀取IC卡表示願意配合，但是認為花費時間，普遍認為IC卡對看診是有助益性。

關鍵字

健保IC卡 ； 助益性 ； 滿意度

並列摘要

Objectives: The National Health Insurance IC card has been used for more than 5 years, but there are no studies of physicians' viewpoints about it. This study explored the overall assessment of IC card implementation by physicians. Methods: The study subjects included western medicine physicians, Chinese medicine physicians, and dentists. A stratified random sampling method was used as we mailed questionnaires to physicians according to the ratio of levels of hospitals and the ratio of western medicine physicians, Chinese medicine physicians, and dentists in Taiwan. A total of 712, 227, and 285 useable questionnaires were received from western medicine physicians, Chinese medicine physicians, and dentists, respectively. Multiple regression analysis was conducted to explore the relative factors that influenced physicians' perceptions about IC cards with regard to patient care. Results: The IC card's content item with the highest frequency of being read by physicians is ”patient's catastrophic illness”. The item with most useful content is ”allergy medicine records”. This was the most helpful item from the physicians' point of view because ”the allergic medicines listed will enhance the safety of medical treatment”. The average score of ”willingness to upload patient's information into IC cards” is 3.36 (range 1-5). The major reason for unwillingness to upload and read IC card information is ”delaying the consultation time” (52.93% and 58.11%). The average satisfaction score with the IC card is 2.96 (range 1-5). The average score for the helpfulness of the IC card to a physician's care is 62.34 (range 1-100). The factors that influenced the physicians' perceptions of the helpfulness of IC cards in patient care are ”frequency of consulting the data on the IC card”, ”willingness to upload data into the IC card”, ”perception of the IC card”, ”consulting IC card data to avoid duplicate prescriptions”, ”number of patients' visits per week”, and ”level of the medical care organization”. Conclusions: Except for western medicine physicians practicing in clinics, most of the physicians had mid-level satisfaction with the implementation of the IC cards. Physicians were willing to upload and to read the data into/from IC cards but felt that it was time consuming. Generally, physicians thought that the IC card was helpful in patient care.

並列關鍵字

Insurance IC Card ； Helpfulness ； Satisfaction

參考文獻

Lindley RA,Pacheco F.(1995).Smart practice: smart card and design consideration in health care.Medinfo.1,349-353.

Neame R.(1997).Smart card-the key to trustworthy health information systems.Br Med J.314,573-577.

Naszlady A,Naszlady J.(1998).Patient health record on a smart card.Int J Med Inform.48,191-194.

蔡淑玲(1999)。IC卡在保險與醫療之應用－先進國家之經驗與分享。資訊與教育。69，23-29。

楊沛墩(2004)。台灣地區健保IC卡試辦作業對各級醫院資訊及作業流程管理影響因素探討(碩士論文)。台北醫學大學醫學資訊研究所。