智能障礙者健康照護品質之測量面向

Standards and Quality Measurements of Health Care Services for People with Intellectual Disabilities

嚴嘉楓(Chia-Feng Yen)

《身心障礙研究季刊》 5卷1期 (2007/03) Pp. 51-65

https://doi.org/10.30072/JDR.200703.0004

摘要

台灣從開辦全民健康保險以來，為因應逐年高漲的醫療支出及備受爭議的醫療服務品質，持續進行醫療相關各項改革，期望藉由整體制度面的改善，除了讓全民健保更符合公平正義之原則外，更重要的是使民眾獲得更高品質的醫療服務，但這些改革及思維還是以一般人口群為主，忽略弱勢群體的需求與享有高品質醫療的權益；本文以身心障礙者醫療服務品質為主軸回顧現存的文獻及理論，並以智能障礙者為主，討論英國如何在目前公醫制度下維護智障者的照護品質，最後探討「住宅政策」對智障者的醫療照護品質上帶來何種衝擊。本文文獻蒐集主要自MEDLINE 資料庫及其他搜尋引擎，以關鍵詞「照護品質」、「使用管道」、「基層醫療」以及「身心障礙者」、「智能障礙者」做連結挑選符合本議題之相關研究論述，並合併查詢英國政府網頁，瞭解目前英國醫療服務體制。從目前台灣的社會福利現況來看身心障礙者的各項服務及政策制度都還未臻成熟，進一步要求各項服務品質似乎是言之過早，但從本篇文獻回顧中可以了解提供身心障礙者暢行無阻的服務管道、提高服務使用機會即是高品質服務之必要條件，而英國政府在現行公醫制度下，亦致力於維護智障者享有高品質醫療之權益，這可以提供我國相關單位在政策擬定過程中的另一思維，期望在現行服務供給體制上與提升身心障礙者的服務品質之間尋求平衡點，考慮其特殊生理或心理特性，設計可近性更高的服務管道，提供他們和一般人口群一樣的服務品質。

關鍵字

照護品質 ； 醫療品質 ； 智能障礙者

並列摘要

In our society, the indicators of National Health Insurance performance, and services quality have become key targets in health care system. But, what are the specific quality measurements of health care services for people with intellectual disabilities are still discussed. Tensions exist among different sectors as the need to develop specific health targets for the population with intellectual disabilities when the philosophy of care is for real social inclusion in modern world. The objective of the present paper is to review the current literatures related to quality of health service for people with intellectual disabilities and to highlight the methodology of health care quality measurements. It also discusses the influences of residential policy context for people with intellectual disabilities within multi-dimensional model of quality of care for this group of people. The author collected data from the system - MEDLINE, used key words ”quality of care”, ”access”, and ”primary care” in conjunction with the words ”disability” or ”people with intellectual disability”. In addition, the author also analyzed many governmental published materials and related information to analyze the health care policies and quality measurements for people with intellectual disabilities. Conclusion: Taiwan's current policies and social welfare institutional care are still under construction for the quality care for people with disabilities. A high quality service for the people with disabilities should build on a sound system which includes not only institutional care, but also to consider the appropriate coordination of each service channel with the surrounding environments and the equal opportunities for them. Health care providers need to embrace a multi-disciplinary approach to service quality to meet the needs of people with intellectual disabilities.

並列關鍵字

People with intellectual disabilities ； primary care ； quality

參考文獻

Beange H.,McElduff A.,Baker W.(1995).Medical disorders of adults with mental retardation: A population study.AJMR.99,595-604.

UK: Center for Review and Dissemination

Creese A.,Floyed K.,Alban A.,Guinness L.(2002).Cost-effectiveness of WV/AIDS interventions in Africa: A systematic review of the evidence.Lancet.359,1635-1643.

Department of Health(2001).Valuing People: A New Strategy for Learning Disability in the 21st Century.London:HMSO.

Donabedian A.(1980).The Definition of Quality and Approaches to its Assessment.Ann Arbor, MI:Health Administration Press.