「醫院型家庭責任醫師試辦計畫」的發展與成果分析

Development and Outcome Analysis of Pilot Hospital-based Accountable Family Physicians System

張郁梓(Yu-Tzu Chang) ； 何清幼(Chin-Yu Ho) ； 陳怡如(Yi-Ju Chen) ； 璩大成(Da-Chen Chu) ； 黃勝堅(Sheng-Jean Huang)

《北市醫學雜誌》 13卷1期 (2016/03) Pp. 15-29

https://doi.org/10.6200/TCMJ.2016.13.1.02

摘要

目的：臺北市立聯合醫院為「落實家醫制度，讓每個市民多一個貼心的醫師朋友」，因此提出「醫院型家庭責任醫師制度試辦計畫」。過去並無針對家庭責任醫師制度收案對象的相關資料研究。方法：本研究為橫斷性研究，回溯性取得2015 年4 月13 日至10 月31 日間去連結之家庭責任醫師制度試辦計畫資料，以描述性統計分析收案對象之基本資料、收案來源、專業人員訪視次數等。中低、低收入戶與一般戶及獨居與否之後續照護計畫的比較是以SAS9.4 版進行卡方檢定。結果：本研究共22924 人納入統計，其中到宅訪視2958 人，非到宅訪視19966 人。到宅訪視獨居個案有1049 人（35.5%）。醫療專業團隊包括醫師、護理師、營養師、物理或職能治療師、社工師及志工，總計訪視9678 人次。比較到宅獨居和非獨居個案及中低、低收入戶和一般戶在照護需求上有無差異，發現兩組都是在門診追蹤和社工協助方面有顯著的差異。結論：此計畫雖有高滿意度，但收案人數僅占臺北市弱勢族群的少數，當務之急是找出有需要的人，使個案獲得完整的醫療照護，方能落實家庭責任醫師制度。

關鍵字

家庭醫師制度 ； 家庭訪視 ； 弱勢族群 ； 獨居

並列摘要

Objective: The Hospital-Based Accountable Family Physician System was proposed to promote the family physician system so that every citizen has a considerable physician friend. There was no study investigating the characteristics of the participants who joined the family physician system. Methods: This was a cross-sectional study focusing on citizens who joined the system between Apr. 13 and Oct. 31 2015. We retrospectively collected the anonymous data that described the characteristics of participants and the frequency of medical professional members visits. Chi-square test was performed by using the SAS 9.4 to analyze whether living alone and whether low income cause a difference in medical care need. The Institutional Review Board (TCHIRB- 10410108-E) had approved this study. Results: A total of 22924 participants were enrolled in the project. 2958 participants received home visits and 19966 participants didn’t. There were 1049 (35.5%) elderly who lived alone. All medical professionals, including doctors, nurses, dieticians, physical or occupational therapists, social workers and voluntary workers, had paid 9678 visits to all participants. Participants who were with low income and living alone had significantly more needs in outpatient follow-up and social worker assistance. Conclusions: Participants who were with low income and living alone were vulnerable people and needed more health care and social assistance. Although the enrolled participants had high satisfaction rate, they represents only a small portion of all vulnerable groups in Taipei city. The most imperative issue is to identify those who really need medical care.

並列關鍵字

family physician system ； home visit ； vulnerable groups ； living alone